TY - JOUR
T1 - Distal Target Vessel Quality and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention
AU - Allana, Salman S.
AU - Kostantinis, Spyridon
AU - Simsek, Bahadir
AU - Karacsonyi, Judit
AU - Rempakos, Athanasois
AU - Alaswad, Khaldoon
AU - Krestyaninov, Oleg
AU - Khelimskiid, Dmitrii
AU - Karmpaliotis, Dimitrios
AU - Jaffer, Farouc A.
AU - Khatri, Jaikirshan J.
AU - Poommipanit, Paul
AU - Patel, Mitul P.
AU - Mahmud, Ehtisham
AU - Koutouzis, Michael
AU - Tsiafoutis, Ioannis
AU - Gorgulu, Sevket
AU - Elbarouni, Basem
AU - Nicholson, William
AU - Jaber, Wissam
AU - Rinfret, Stephane
AU - Rafeh, Nidal Abi
AU - Goktekin, Omer
AU - ElGuindy, Ahmed M.
AU - Sandoval, Yader
AU - Burke, M. Nicholas
AU - Rangan, Bavana V.
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/6/26
Y1 - 2023/6/26
N2 - Background: Distal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm. Objectives: The study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention. Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as <2 mm diameter or with significant diffuse atherosclerotic disease. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. Results: A total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01). Conclusions: A poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose.
AB - Background: Distal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm. Objectives: The study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention. Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as <2 mm diameter or with significant diffuse atherosclerotic disease. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. Results: A total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01). Conclusions: A poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose.
KW - chronic total occlusion
KW - coronary artery disease
KW - distal target vessel
KW - percutaneous coronary intervention
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U2 - 10.1016/j.jcin.2023.03.007
DO - 10.1016/j.jcin.2023.03.007
M3 - Article
C2 - 37380231
AN - SCOPUS:85162104584
SN - 1936-8798
VL - 16
SP - 1490
EP - 1500
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 12
ER -