Very high perforation rate in patients undergoing unsuccessful percutaneous coronary interventions of chronic total occlusions could explain worse outcome in these patients and not chronically occluded artery

摘要

In the paper by Mehran et al. (1), the authors concluded that failure to open chronic total occlusion (CTO) lesions leads to a higher rate of cardiac death, total death, and coronary artery bypass surgery (CABG). The authors explain their findings on the basis of the possible deleterious effects of a persistently closed artery leading to more adverse events. However, the authors did not comment on the procedural complications, such as perforations, that could have occurred during a long, complicated CTO procedure, such as renal failure, bleeding, or peripheral vascular injury. In this registry, patients with unsuccessful CTO percutaneous coronary intervention had a high rate of procedural-related coronary perforation (7.4% vs. 1.7% in the successfully treated arm). The authors did not mention the rate of death or urgent CABG occurring among those with coronary perforation and whether this might explain the higher frequency of CABG, mortality, and myocardial infarction occurring in the unsuccessful CTO intervention cohort.