TY - JOUR
T1 - Impact of proximal cap ambiguity on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention
T2 - Insights from the PROGRESS-CTO Registry
AU - Kostantinis, Spyridon
AU - Simsek, Bahadir
AU - Karacsonyi, Judit
AU - Rempakos, Athanasios
AU - Alaswad, Khaldoon
AU - Megaly, Michael
AU - Krestyaninov, Oleg
AU - Khelimskii, 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 - Abi Rafeh, Nidal
AU - Goktekin, Omer
AU - ElGuindy, Ahmed M.
AU - Allana, Salman S.
AU - Rangan, Bavana Venkata
AU - Sandoval, Yader
AU - Burke, M. Nicholas
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Study data were collected and managed using Research Electronic Data Capture (REDCap) electronic data capture tools hosted at the Minneapolis Heart Institute Foundation (MHIF), Minneapolis, Minnesota.4,5 REDCap is a secure, web-based application designed to support data capture for research studies, providing: (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources. The authors are grateful for the philanthropic support of our generous anonymous donors, and the philanthropic support of Drs. Mary Ann and Donald A Sens, Mrs. Diane and Dr. Cline Hickok, Mrs. Wilma and Mr. Dale Johnson, Mrs. Charlotte and Mr. Jerry Golinvaux Family Fund, the Roehl Family Foundation and the Joseph Durda Foundation. The generous gifts of these donors to the Minneapolis Heart Institute Foundation's Science Center for Coronary Artery Disease (CCAD) helped support this research project.
Publisher Copyright:
© 2023 Wiley Periodicals LLC.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Background: Proximal cap ambiguity is a key parameter in the global chronic total occlusion (CTO) percutaneous coronary intervention (PCI) crossing algorithm. Methods: We examined the baseline characteristics and procedural outcomes of 9718 CTO PCIs performed in 9498 patients at 41 US and non-US centers between 2012 and 2022. Results: Proximal cap ambiguity was present in 35% of CTO lesions. Patients whose lesions had proximal cap ambiguity were more likely to have had prior coronary artery bypass graft surgery (37% vs. 24%; p < 0.001). Lesions with proximal cap ambiguity were more complex with higher J-CTO score (3.1 ± 1.0 vs. 2.0 ± 1.2; p < 0.001) and lower technical (79% vs. 90%; p < 0.001) and procedural (77% vs. 89%; p < 0.001) success rates compared with nonambiguous CTO lesions. The incidence of major adverse cardiovascular events (MACE) was higher in cases with proximal cap ambiguity (2.5% vs. 1.7%; p < 0.001). The retrograde approach was more commonly used among cases with ambiguous proximal cap (50% vs. 21%; p < 0.001) and was more likely to be the final successful crossing strategy (29% vs. 13%; p < 0.001). The antegrade dissection and re-entry (ADR) “move-the-cap” techniques were also more common among cases with proximal cap ambiguity. Conclusions: Proximal cap ambiguity in CTO lesions is associated with higher utilization of the retrograde approach and ADR, lower technical and procedural success rates, and higher incidence of in-hospital MACE.
AB - Background: Proximal cap ambiguity is a key parameter in the global chronic total occlusion (CTO) percutaneous coronary intervention (PCI) crossing algorithm. Methods: We examined the baseline characteristics and procedural outcomes of 9718 CTO PCIs performed in 9498 patients at 41 US and non-US centers between 2012 and 2022. Results: Proximal cap ambiguity was present in 35% of CTO lesions. Patients whose lesions had proximal cap ambiguity were more likely to have had prior coronary artery bypass graft surgery (37% vs. 24%; p < 0.001). Lesions with proximal cap ambiguity were more complex with higher J-CTO score (3.1 ± 1.0 vs. 2.0 ± 1.2; p < 0.001) and lower technical (79% vs. 90%; p < 0.001) and procedural (77% vs. 89%; p < 0.001) success rates compared with nonambiguous CTO lesions. The incidence of major adverse cardiovascular events (MACE) was higher in cases with proximal cap ambiguity (2.5% vs. 1.7%; p < 0.001). The retrograde approach was more commonly used among cases with ambiguous proximal cap (50% vs. 21%; p < 0.001) and was more likely to be the final successful crossing strategy (29% vs. 13%; p < 0.001). The antegrade dissection and re-entry (ADR) “move-the-cap” techniques were also more common among cases with proximal cap ambiguity. Conclusions: Proximal cap ambiguity in CTO lesions is associated with higher utilization of the retrograde approach and ADR, lower technical and procedural success rates, and higher incidence of in-hospital MACE.
KW - chronic total occlusion
KW - percutaneous coronary intervention
KW - proximal cap ambiguity
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U2 - 10.1002/ccd.30580
DO - 10.1002/ccd.30580
M3 - Article
C2 - 36740235
AN - SCOPUS:85147502037
SN - 1522-1946
VL - 101
SP - 737
EP - 746
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 4
ER -