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Clinical benefit of right coronary artery chronic total occlusion PCI
Session:
Posters (Sessão 3 - Écran 8) - Intervenção coronária
Speaker:
Hugo Costa
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.4 Coronary Artery Disease – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Hugo Alex Costa; Miguel Espirito Santo; Raquel Fernandes; João Bispo; João Guedes; Daniela Carvalho; Hugo Vinhas; Jorge Mimoso; Ilidio Jesus
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Introduction: </strong>Coronary chronic total occlusions (CTO) are relatively common findings in the context of coronary angiography. The indication for revascularization of this type of lesions remains controversial. Right coronary artery (RCA) is often affected in this context, and the clinical benefit of treatment through percutaneous coronary intervention (PCI) is not consensual. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Objectives: </strong>Characterize the population submitted to CTO PCI. Analyze if RCA CTO patients will benefit in terms of clinical outcomes (recurrence of angina and/or heart failure (HF) symptoms) and hard outcomes (myocardial infarction and/or death) when compared to left coronary artery (LCA) CTO patients. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Methods:</strong> Retrospective study between 2019/2020, with a mean follow-up of 2 years, composed of n=177 patients undergoing CTO-PCI. Created two groups (RCA CTO group and LCA CTO group). Categorical variables are presented as frequencies and percentages, and continuous variables as means and standard deviations, or medians and interquartile ranges for variables with skewed distribution or a significant Shapiro-Wilk test. Multivariate analysis was performed using logistic regression. P value < 0.05 indicates statistical significance.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Results:</strong> A total of 177 patients were identified, with a mean age of 65±11 years, 82.5% male. 75% showed hypertension, 40% with diabetes, 73% with dyslipidemia, 18% with obesity and HF in 15%. RCA CTO group were younger with a mean age of 63,6±10,3 (p=0.047), more use of contralateral access (p<0.001), better creatinine clearance 80.8±24.9 (p=0.038) and a poor left ventricular function (LVEF) at baseline 45.4±10.8, but without statistical significancy (p=0.066). Both groups improved LVEF after intervention (p<0.001). Symptoms recurrence occurred in 15% of patients after 2 years. Total symptoms recurrence was significant higher in RCA CTO group (24% vs 9%, p=0.018), mainly derived by HF symptoms (15% vs 4%, p=0.013), with RCA CTO vessel being an independent predictor for HF symptoms recurrence after PCI, when compared to LCA CTO vessel (p=0.015, OR 4.92, 95% CI 1.37 to 17.7). Myocardial infarction and death were low after 2 years, without difference between groups. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Conclusion: </strong>CTO patients treated by PCI showed clinical benefit after 2 years, with only one sixth of them with symptoms recurrence, and with significant improvement in LVEF in both groups. RCA CTO patients were more associated with symptoms recurrence, mainly HF symptoms, which may imply less clinical benefit in its treatment. </span></span></p>
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