TY - JOUR
T1 - Technical and procedural outcomes of the retrograde approach to chronic total occlusion interventions
AU - Tajti, Peter
AU - Xenogiannis, Iosif
AU - Gargoulas, Fotis
AU - Karmpaliotis, Dimitri
AU - Alaswad, Khaldoon
AU - Jaffer, Farouc A.
AU - Patel, Mitul
AU - Nicholas Burke, M.
AU - Garcia, Santiago
AU - Krestyaninov, Oleg
AU - Koutouzis, Michalis
AU - Jaber, Wissam
AU - Brilakis, Emmanouil S.
AU - Yeh, Robert W.
AU - Tamez, Hector
AU - Mahmud, Ehtisham
AU - Choi, James W.
AU - Khelimskii, Dmitrii
AU - Khatri, Jaikirshan J.
AU - Tsiafoutis, Ioannis
AU - Doing, Anthony H.
AU - Dattilo, Phil
AU - Toma, Catalin
AU - Uretsky, Barry F.
AU - Samady, Habib
AU - Jefferson, Brian
AU - Patel, Taral
AU - Potluri, Srinivasa
AU - Kandzari, David
AU - Michael Wyman, R.
AU - Abdullah, Shuaib
AU - Banerjee, Subhash
AU - Moses, Jeffrey
AU - Lembo, Nicholas
AU - Parikh, Manish
AU - Kirtane, Ajay
AU - Ali, Ziad A.
AU - Russo, Juan J.
AU - Hakemi, Emad
AU - Rangan, Bavana Venkata
AU - Ungi, Imre
N1 - Funding Information:
D. Karmpaliotis reports speaker honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. K. Alaswad reports consulting fees from Terumo, and Boston Scientific, and being a consultant (non-financial) for Abbott Laboratories. F.A. Jaffer reports being a consultant for Abbott Vascular, Boston Scientific, Siemens, and Philips, and research grants from Canon, Siemens, and National Institutes of Health. R.W. Yeh reports receiving a Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute. M. Patel reports being on the speakers’ bureau of AstraZeneca. E. Mahmud reports consulting fees from Medtronic and Corindus, speaker’s fees from Medtronic, Corindus, and Abbott Vascular, educational programme fees from Abbott Vascular and clinical events committee fees from St. Jude. M.N. Burke reports consulting/speaking honoraria from Abbott Vascular and Boston Scientific. R.M. Wyman reports honoraria/consulting/speaking fees from Boston Scientific, Abbott Vascular, and Asahi. D. Kandzari reports research grant/consulting honoraria from Boston Scientific, and Medtronic Cardiovascular, and a research grant from Abbott. S. Garcia reports consulting fees from Medtronic. J. Khatri reports a research grant from Asahi Intecc, and consultant/speaker honoraria from Abbott Vascular, Philips, and Abiomed. J. Moses reports being a consultant for Boston Scientific and Abiomed. N. Lembo reports being on the speaker bureau of Medtronic and the advisory board of Abbott Vascular and Medtronic. M. Parikh reports being on the speaker bureau of Abbott Vascular, Medtronic, CSI, BSC, and Trireme, and on the advisory boards of Medtronic, Abbott Vascular, and Philips. A. Kirtane reports receiving institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, Glaxo SmithKline, and Eli Lilly. Z. Ali reports consultant fees/honoraria from St. Jude Medical, and AstraZeneca Pharmaceuticals, ownership interest/partnership/principal in Shockwave Medical, and VitaBx Inc, and research grants from Medtronic and St. Jude Medical. B. Rangan reports research grants from Infraredx, Inc., and The Spectranetics Corporation. S. Banerjee reports research grants from Gilead, and The Medicines Company, consultant/speaker honoraria from Covidien, and Medtronic, ownership of MDCARE Global (spouse), and intellectual property in HygeiaTel. E.S. Brilakis reports consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, Infraredx, and Medtronic, research support from Regeneron, and Siemens, and being a shareholder in MHI Ventures. The other authors/study collaborators have no conflicts of interest to declare.
Funding Information:
The PROGRESS-CTO registry has received support from the Abbott Northwestern Hospital Foundation, Minneapolis, MN, USA and a gift from the Joseph F. and Mary M. Fleischhacker Foundation.
Publisher Copyright:
© Europa Digital & Publishing 2020. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Aims: The retrograde approach is critical for achieving high success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but has been associated with higher risk of complications. We examined the contemporary outcomes of the retrograde approach to CTO PCI aiming to identify areas in need of improvement. Methods and results: We compared the technical and procedural outcomes of retrograde (n=1,515) and antegrade-only CTO PCIs (n=2,686) in a contemporary multicentre CTO registry. The mean age of patients undergoing retrograde PCI was 65±10 years and 86% were men, with high prevalence of prior myocardial infarction (51%), prior PCI (71%), and coronary artery bypass graft surgery (45%). The mean J-CTO score (3±1 vs 2±1, p<0.001) was higher in retrograde PCIs. The most commonly used collateral channels were septals (65%), epicardials (32%), saphenous venous grafts (14%) and left internal mammary artery grafts (2%). Overall technical (79% vs 91%, p<0.001) and procedural (75% vs 90%, p<0.001) success rates were lower with the retrograde approach, and these patients had a higher rate of in-hospital major complications than antegrade-only PCI patients (5.1% vs 0.8%, p<0.001), due to higher mortality (1.1% vs 0.1%, p<0.001), acute myocardial infarction (1.9% vs 0.2%, p<0.001), repeat PCI (0.7% vs 0.1%, p=0.001), and pericardiocentesis (1.7% vs 0.3%, p<0.001). Conclusions: In summary, the retrograde approach to CTO PCI is performed in higher complexity lesions and is associated with lower success rates and a higher rate of major complications. Clinical Trial Registration: NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO).
AB - Aims: The retrograde approach is critical for achieving high success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but has been associated with higher risk of complications. We examined the contemporary outcomes of the retrograde approach to CTO PCI aiming to identify areas in need of improvement. Methods and results: We compared the technical and procedural outcomes of retrograde (n=1,515) and antegrade-only CTO PCIs (n=2,686) in a contemporary multicentre CTO registry. The mean age of patients undergoing retrograde PCI was 65±10 years and 86% were men, with high prevalence of prior myocardial infarction (51%), prior PCI (71%), and coronary artery bypass graft surgery (45%). The mean J-CTO score (3±1 vs 2±1, p<0.001) was higher in retrograde PCIs. The most commonly used collateral channels were septals (65%), epicardials (32%), saphenous venous grafts (14%) and left internal mammary artery grafts (2%). Overall technical (79% vs 91%, p<0.001) and procedural (75% vs 90%, p<0.001) success rates were lower with the retrograde approach, and these patients had a higher rate of in-hospital major complications than antegrade-only PCI patients (5.1% vs 0.8%, p<0.001), due to higher mortality (1.1% vs 0.1%, p<0.001), acute myocardial infarction (1.9% vs 0.2%, p<0.001), repeat PCI (0.7% vs 0.1%, p=0.001), and pericardiocentesis (1.7% vs 0.3%, p<0.001). Conclusions: In summary, the retrograde approach to CTO PCI is performed in higher complexity lesions and is associated with lower success rates and a higher rate of major complications. Clinical Trial Registration: NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO).
KW - Chronic coronary total occlusion
KW - Other techniques
KW - Stable angina
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U2 - 10.4244/EIJ-D-19-00441
DO - 10.4244/EIJ-D-19-00441
M3 - Article
C2 - 31638578
AN - SCOPUS:85097124036
SN - 1774-024X
VL - 16
SP - E891-E899
JO - EuroIntervention
JF - EuroIntervention
IS - 11
ER -