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Performance and safety outcomes of a structured chronic total occlusion (CTO) PCI program
Session:
Comunicações Orais - Sessão 06 - Intervenção coronária
Speaker:
Nazar Ilchyshyn
Congress:
CPC 2023
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Nazar Ilchyshyn; Luís Leite; Elisabete Jorge; Joana Silva; Ana Vera Marinho; Rui Baptista; Marco Costa; Lino Gançalves
Abstract
<p><strong>Background: </strong>Coronary chronic total occlusions (CTOs) are routinely found in patients undergoing coronary angiography. In recent years, the success rate of CTO intervention has increased, driven by advances in material and interventional techniques, without compromising patient safety. We aimed to describe the characteristics, procedural aspects and clinical outcomes of a structured CTO program.</p> <p><strong>Methods:</strong> We conducted a prospective, cohort study including all consecutive patients enrolled in our CTO program since December 2013. Angiographic and clinical data were collected. We defined a co-primary safety outcome as procedure-related complications and a co-primary efficacy outcome as procedural success. A follow-up with a median duration of 508 days was conducted. Secondary, exploratory endpoints during the follow up included death, myocardial infarction (MI), target lesion revascularization (TVR), CCS grade, NYHA class and impact on left ventricular ejection fraction (LVEF).</p> <p><strong>Results:</strong> A total of 195 patients with 202 CTO lesions were included. Most patients were hypertensive (79.3%), had dyslipidemia (82.4%) and a body mass index (BMI) > 25.kg/m 2 (87.1%); 35.6% were diabetic, 32.6% were smokers and a third had a prior history of MI. The indication for a CTO PCI was angina in 78.0%, viable heart failure in 9.2% and ventricular arrhythmias in 1.2%. Multivessel coronary disease was present in 54,5%. Regarding the technical procedure, 89.7% of PCI CTOs were performed via the anterograde approach with wire-escalation technique. The mean J-CTO score was 2.0±0.8. J-CTO and not EuroCTO (CASTLE) score predict successful CTO PCI.</p> <p>The overall success rate for CTO PCIs was 92.8% (85.6% with one attempt). The primary safety co-endpoint occurred in 9 patients (4.0%). During follow up, 7 patients (4.6%) died (2 of cardiovascular causes). Admissions for MI occurred in 3 patients (1.5%). TVR occurred in 5 patients (2.6%). CCS grade decreased following a successful CTO treatment in 90.3% of patients (2.1 ±0.9 vs 0.6±0.6, p=0.01). LVEF significantly increased (48,73±10% vs 52,55±8,26%, p=0.01) after a successful CTO intervention.</p> <p><strong>Conclusions: </strong>During implementation of a dedicated CTO PCI program a high success rate with low rate of complications were achieved. A successful CTO PCI was associated with important symptomatic relief and a significant increase in LVEF. J-CTO score remains the best predictors of successful CTO and the use of other more complex scores did not seem to be advantageous.</p>
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