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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Demographic and clinical characteristics of a population submited to chronic total occlusion angioplasty
Session:
Posters 2 - Écran 8 - Doença Coronária
Speaker:
Sara Couto Pereira
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.2 Coronary Artery Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Sara Couto Pereira; Pedro Pinto Cardoso; Miguel Nobre Menezes; Diogo Torres; P. Carrilho Ferreira; José Marques da Costa; E. Infante de Oliveira; Claudia Jorge; J. Almeida Duarte; Inês Aguiar Ricardo; Joana Rigueira; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p><strong>Introduction:</strong> Chronic total occlusion (CTO) angioplasty is one of the most complex techniques performed in the catheterisation laboratory. Thus, experience of the dedicated teams plays a central role in the success of the procedure. </p> <p><strong>Objective:</strong> We aimed to evaluate the results of CTO angioplasties performed at a high-volume center by multiple operators in the last years, and to emphasize the impact of establishing a CTO angioplasty protocol.</p> <p><strong>Methods:</strong> We examined demographic and clinical characteristics of the population, technical aspects of the procedure and outcome variables (namely success and complication rates). Data obtained were analysed using Chi-square and T-student tests.</p> <p><strong>Results:</strong> CTO angioplasty was performed in 334 patients (mean age 68±11 years, 75% men), with a prevalence of risk factors/comorbidities as follows: diabetes mellitus 64%, hypertension 81%, dyslipidemia 70%, smoking 76%, chronic kidney disease (creatinine clearance 60 mL/m2) 28% and peripheral arterial disease 9.2%; 36% of the patients had history of previous acute myocardial infarction with 9.5% submited to coronary artery bypass grafting. A total of 377 procedures were performed, with an average 1.1 procedures per patient. Fourty-three patients were submitted to more than 1 procedure, among which 2 patients were submitted to 3 and 1 patient to 4 CTO angioplasties. Femoral artery was the most preferred access site (61,5%). Large-caliber catheters (≥ 7 Fr) were necessary in 33% of the cases and contralateral injection in 29%. Thirteen percent of the procedures were performed via a retrograde approach. The success rate per patient was 65% and significantly differed depending on whether the procedure was performed in the scope of the CTO protocol or not (74% vs 56%, p = 0.001). No differences were observed between the baseline clinical characteristics between patients successfully revascularised and the remainder. The mean category of difficulty of the procedures, as assessed by the J-CTO score, was high (1,9 ± 1,1). One half of the lesions were deemed difficult or very difficult (J-CTO ≥ 2) and only 13% were reported as easy. We observed a strong association between the category of difficulty and the success rate, particularly in difficult or very difficult cases J-CTO≥2 (X 2 = 72,3 p&lt;0,001). Major complications occurred in 1,9% of the cases/procedures, resulting in 2 deaths peri-procedure (0,5% of the total).</p> <p><strong>Conclusion</strong>: Success and complications rate in CTO angioplasty in our center was similar to the described in literature, in spite of the significant number of difficult and very difficult lesions. The establishment of a CTO protocol resulted in a significant improvement in the success rate of these interventions.</p>
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