In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery Insights From an International Multicenter Chronic Total Occlusion Registry

被引:29
作者
Tajti, Peter [1 ,2 ,3 ,4 ]
Karmpaliotis, Dimitri [5 ]
Alaswad, Khaldoon [6 ]
Jaffer, Farouc A. [7 ]
Yeh, Robert W. [8 ]
Patel, Mitul [9 ,10 ]
Mahmud, Ehtisham [9 ,10 ]
Choi, James W. [11 ]
Burke, M. Nicholas [1 ,2 ]
Doing, Anthony H. [12 ]
Dattilo, Phil [12 ]
Toma, Catalin [13 ]
Smith, A. J. Conrad [13 ]
Uretsky, Barry [14 ]
Holper, Elizabeth [15 ]
Potluri, Srinivas [15 ]
Wyman, R. Michael [16 ]
Kandzari, David E. [17 ]
Garcia, Santiago [18 ,19 ]
Krestyaninov, Oleg [20 ]
Khelimskii, Dmitrii [20 ]
Koutouzis, Michalis [21 ]
Tsiafoutis, Ioannis [21 ]
Jaber, Wissam [22 ]
Samady, Habib [22 ]
Moses, Jeffrey W. [5 ]
Lembo, Nicholas J. [5 ]
Parikh, Manish [5 ]
Kirtane, Ajay J. [5 ]
Ali, Ziad A. [5 ]
Doshi, Darshan [5 ]
Xenogiannis, Iosif [1 ,2 ]
Stanberry, Larissa I. [1 ,2 ]
Rangan, Bavana V. [1 ,2 ]
Ungi, Imre [3 ,4 ]
Banerjee, Subhash [23 ,24 ]
Brilakis, Emmanouil S. [1 ,2 ,23 ,24 ]
机构
[1] Abbott NW Hosp, Minneapolis Heart Inst, Minneapolis, MN USA
[2] Abbott NW Hosp, Minneapolis Heart Inst Fdn, Minneapolis, MN USA
[3] Univ Szeged, Dept Internal Med 2, Div Invas Cardiol, Szeged, Hungary
[4] Univ Szeged, Ctr Cardiol, Szeged, Hungary
[5] Columbia Univ, New York, NY USA
[6] Henry Ford Hosp, Detroit, MI 48202 USA
[7] Massachusetts Gen Hosp, Boston, MA 02114 USA
[8] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
[9] VA San Diego Healthcare Syst, La Jolla, CA USA
[10] Univ Calif San Diego, La Jolla, CA 92093 USA
[11] Baylor Heart & Vasc Hosp, Dallas, TX USA
[12] Med Ctr Rockies, Loveland, CO USA
[13] Univ Pittsburgh, Med Ctr, Pittsburgh, PA 15260 USA
[14] VA Cent Arkansas Healthcare Syst, Little Rock, AR USA
[15] Heart Hosp Baylor Plano, Plano, TX USA
[16] Torrance Mem Med Ctr, Torrance, CA USA
[17] Piedmont Heart Inst, Atlanta, GA USA
[18] VA Minneapolis Healthcare Syst, Minneapolis, MN USA
[19] Univ Minnesota, Minneapolis, MN 55455 USA
[20] Minist Hlth Russian Federat, Meshalkin Siberian Fed Biomed Res Ctr, Novosibirsk, Russia
[21] Korgialeneio Benakeio Hellen Red Cross Gen Hosp A, Athens, Greece
[22] Emory Univ, Atlanta, GA 30322 USA
[23] VA North Texas Hlth Care Syst, Dallas, TX USA
[24] Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA
关键词
chronic total occlusion; coronary bypass graft surgery; percutaneous coronary intervention; outcomes; perforation; LONG-TERM OUTCOMES; RETROGRADE RECANALIZATION; HYBRID APPROACH; HEMATOMA; SUCCESS; PERFORATION; LESIONS; EUROPE;
D O I
10.1161/CIRCINTERVENTIONS.118.007338
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG). METHODS AND RESULTS: We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32% of total cohort) were older (67 +/- 9 versus 63 +/- 10 years; P<0.001) and had more comorbidities and lower left ventricular ejection fraction (50% [40-58] versus 55% [45-60]; P<0.001). The CTO target vessel in prior CABG patients was the right coronary artery (56%), circumflex (26%), and left anterior descending artery (17%). The mean J-CTO (2.9 +/- 1.2 versus 2.2 +/- 1.3; P<0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; 1.5 +/- 1.1 versus 1.2 +/- 1.0; P<0.001) score was higher in prior CABG patients. Retrograde (53% versus 30%, P<0.001) and antegrade dissection reentry (35% versus 28%; P<0.001) techniques were used more frequently in prior CABG patients. Prior CABG patients had lower technical (84% versus 89%; P<0.001) and procedural (82% versus 87%, P<0.001) success, but similar incidence of in-hospital major complications (3.1% versus 2.5%; P=0.287). In-hospital mortality (1% versus 0.4%; P=0.016) and coronary perforation (7.1% versus 3.1%; P<0.001) occurred more frequently in prior CABG patients, however, CABG patients had a lower incidence of pericardial tamponade (0.1% versus 1.0%; P=0.002) and pericardiocentesis (0% versus 1.3%; P<0.001). CONCLUSIONS: In a large multicenter CTO percutaneous coronary interventions registry, prior CABG patients had lower success rate but similar overall risk for complications, although mortality was higher and the incidence of tamponade was lower.
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