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Coronary chronic total occlusions: 8-year experience from a dedicated single-center program
Session:
Sessão de Comunicações Orais - Cardiologia de Intervenção
Speaker:
Catarina Brízido
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Catarina Brízido; Henrique Gabriel; Mariana Gonçalves; Sérgio Madeira; Sílvio Leal; Rita Carvalheira Santos; João Brito; Luís Raposo ; Pedro de Araújo Gonçalves; Rui Campante Teles; Manuel Almeida; Miguel Mendes
Abstract
<p><strong>Introduction:</strong></p> <p>Coronary chronic total occlusion (CTOs) percutaneous coronary intervention (PCI) is a complex procedure that has shown to be safe and effective in symptom relief when performed by CTO-PCI experienced operators. Our aim was to evaluate procedural and clinical outcomes of CTO-PCI in a high-volume center.</p> <p><strong>Methods: </strong></p> <p>Single-center retrospective analysis of all patients included in a CTO-PCI dedicated program from January/2011 to November/2019. Baseline characteristics, procedural related features and clinical outcomes were analyzed. Predictors of procedural success were assessed with uni- and multivariate analysis using binary logistic regression.</p> <p><strong>Results:</strong></p> <p>A total of 183 patients were referred to our CTO-PCI dedicated program (mean age 65 ± 9 years, 79% males). There were 169 patients with single vessel CTO and 14 patients with double occlusion (8 treated within the same procedure). Target vessel was RCA in 51%, LAD in 25% and circumflex artery in 24%. The median J-CTO score was 2 (IQR 1-3) and 70% of lesions had J-CTO score ≥2.</p> <p>CTO-PCI attempt was made for 196 lesions throughout 210 procedures, with a success of 83% (n=163) per CTO and 81% (n=149) per patient. Most procedures where uneventful (96%), with 6 severe complications and 3 deaths. Higher J-CTO scores predicted procedural failure (HR 2.1, 95%CI 1.2-3.7; p=0.006), as did using the retrograde approach (95% CI 1.01-6.26; p=0.046). PCI success was independent of the target coronary artery, number of previous attempts and arterial access. Baseline characteristics and clinical cardiovascular background did not influence each patient outcome.</p> <p>During a median follow-up of 41 months (IQR 20-68), all-cause mortality was 12% (n=22). Most patients who were alive at follow-up remained asymptomatic (69%) or in CCS class 1 (11.5%). 6.5% of patients (n=12) underwent at least one target lesion revascularization since CTO-PCI.</p> <p><strong>Conclusion:</strong></p> <p>We report good success rates without significant safety concerns in a cohort of patients with technically difficult lesions (as classified by J-CTO score). Our dedicated CTO-PCI program resulted in long lasting symptom improvement with low rates of repeated revascularization.</p>
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