Effect of Prior Failure on Subsequent Procedural Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention (From a Contemporary Multicenter Registry)

摘要

We sought to examine the impact of prior failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic characteristics and procedural outcomes of 1,213 consecutive patients who underwent 1,232 CTO PCIs between 2012 and 2015 at 12 US centers. Mean age was 65 ± 10 years and 84.8% of patients were men. A prior failed attempt had been performed in 215 (17.5%) patients. As compared with patients without prior CTO PCI failure, patients with prior failure had higher Japanese Chronic Total Occlusion (J-CTO) score (2.40 ± 1.13 vs. 3.28 ± 1.29, p<0.0001), and were more likely to have in-stent restenosis (10.5% vs. 28.4%, p<0.0001) and to undergo recanalization attempts using the retrograde approach (41% vs. 50%, p=0.011). Technical (90% vs. 88%, p=0.390) and procedural (89% vs. 86%, p=0.184) success were similar in the two study groups, however, median procedure time (125 vs. 142 min, p=0.026) and fluoroscopy time (45 vs. 55 min, p=0.015) were longer in the prior failure group. In conclusion, the main finding of our study is that a prior failed CTO PCI attempt is associated with higher angiographic complexity, longer procedural duration and fluoroscopy time, but not with the success and complication rates of subsequent CTO PCI attempts.