TY - JOUR
T1 - Impact of calcium on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention
AU - Kostantinis, Spyridon
AU - Rempakos, Athanasios
AU - Simsek, Bahadir
AU - Karacsonyi, Judit
AU - Allana, Salman S.
AU - Alexandrou, Michaella
AU - Gorgulu, Sevket
AU - Alaswad, Khaldoon
AU - Basir, Mir Babar
AU - Davies, Rhian E.
AU - Benton, Stewart M.
AU - Krestyaninov, Oleg
AU - Khelimskii, Dmitrii
AU - Frizzell, Jarrod
AU - Ybarra, Luiz F.
AU - Bagur, Rodrigo
AU - Reddy, Niranjan
AU - Kerrigan, Jimmy L.
AU - Haddad, Elias V.
AU - Love, Michael
AU - Elbarouni, Basem
AU - Soylu, Korhan
AU - Yildirim, Ufuk
AU - Dattilo, Philip
AU - Azzalini, Lorenzo
AU - Kearney, Kathleen
AU - Sadek, Yasser
AU - ElGuindy, Ahmed M.
AU - Abi Rafeh, Nidal
AU - Goktekin, Omer
AU - Mastrodemos, Olga C.
AU - Rangan, Bavana V.
AU - Sandoval, Yader
AU - Burke, M. Nicholas
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Background: Coronary calcification is common and increases the difficulty of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We examined the impact of calcium on procedural outcomes of 13,079 CTO PCIs performed in 12,799 patients at 46 US and non-US centers between 2012 and 2023. Results: Moderate or severe calcification was present in 46.6% of CTO lesions. Patients whose lesions were calcified were older and more likely to have had prior coronary artery bypass graft surgery. Calcified lesions were more complex with higher J-CTO score (3.0 ± 1.1 vs. 1.9 ± 1.2; p < 0.001) and lower technical (83.0% vs. 89.9%; p < 0.001) and procedural (81.0% vs. 89.1%; p < 0.001) success rates compared with mildly calcified or non-calcified CTO lesions. The retrograde approach was more commonly used among cases with moderate/severe calcification (40.3% vs. 23.5%; p < 0.001). Balloon angioplasty (76.6%) was the most common lesion preparation technique for calcified lesions, followed by rotational atherectomy (7.3%), laser atherectomy (3.4%) and, intravascular lithotripsy (3.4%). The incidence of major adverse cardiovascular events (MACE) was higher in cases with moderate or severe calcification (3.0% vs. 1.2%; p < 0.001), as was the incidence of perforation (6.5% vs. 3.4%; p < 0.001). On multivariable analysis, the presence of moderate/severe calcification was independently associated with lower technical success (odds ratio, OR = 0.73, 95% CI: 0.63–0.84) and higher MACE (OR = 2.33, 95% CI: 1.66–3.27). Conclusions: Moderate/severe calcification was present in nearly half of CTO lesions, and was associated with higher utilization of the retrograde approach, lower technical and procedural success rates, and higher incidence of in-hospital MACE.
AB - Background: Coronary calcification is common and increases the difficulty of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We examined the impact of calcium on procedural outcomes of 13,079 CTO PCIs performed in 12,799 patients at 46 US and non-US centers between 2012 and 2023. Results: Moderate or severe calcification was present in 46.6% of CTO lesions. Patients whose lesions were calcified were older and more likely to have had prior coronary artery bypass graft surgery. Calcified lesions were more complex with higher J-CTO score (3.0 ± 1.1 vs. 1.9 ± 1.2; p < 0.001) and lower technical (83.0% vs. 89.9%; p < 0.001) and procedural (81.0% vs. 89.1%; p < 0.001) success rates compared with mildly calcified or non-calcified CTO lesions. The retrograde approach was more commonly used among cases with moderate/severe calcification (40.3% vs. 23.5%; p < 0.001). Balloon angioplasty (76.6%) was the most common lesion preparation technique for calcified lesions, followed by rotational atherectomy (7.3%), laser atherectomy (3.4%) and, intravascular lithotripsy (3.4%). The incidence of major adverse cardiovascular events (MACE) was higher in cases with moderate or severe calcification (3.0% vs. 1.2%; p < 0.001), as was the incidence of perforation (6.5% vs. 3.4%; p < 0.001). On multivariable analysis, the presence of moderate/severe calcification was independently associated with lower technical success (odds ratio, OR = 0.73, 95% CI: 0.63–0.84) and higher MACE (OR = 2.33, 95% CI: 1.66–3.27). Conclusions: Moderate/severe calcification was present in nearly half of CTO lesions, and was associated with higher utilization of the retrograde approach, lower technical and procedural success rates, and higher incidence of in-hospital MACE.
KW - Calcification
KW - Chronic total occlusion
KW - Outcomes
KW - Percutaneous coronary intervention
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U2 - 10.1016/j.ijcard.2023.131254
DO - 10.1016/j.ijcard.2023.131254
M3 - Article
C2 - 37562751
AN - SCOPUS:85168388553
SN - 0167-5273
VL - 390
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 131254
ER -