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Long-term outcomes of a dedicated Chronic Total Occlusion – Percutaneous Coronary Intervention (CTO-PCI) program
Session:
Sessão de Posters 29 - Intervenção coronária percutânea
Speaker:
Rita Amador
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Rita Amador; Rita Carvalho; Catarina Brízido; Henrique Mesquita Gabriel; Rui Campante Teles; Afonso Félix Oliveira; Sergio Madeira; Sílvio Leal; João Brito; Manuel Almeida
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The success and safety of Percutaneous Coronary Intervention (PCI) for Chronic Total Occlusion (CTO) has made great progress over the past decades, with dedicated CTO-PCI programs expanding operator experience and improving patient outcomes. Our aim was to evaluate the 5-year-outcomes of patients treated in a high-volume dedicated CTO-PCI centre. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We performed a single-centre retrospective analysis of patients included in a CTO-PCI dedicated program between January 2011 and December 2018. Baseline characteristics, procedural-related features and patient status at 5 years regarding symptoms, myocardial infarction (MI), target lesion revascularization (TLR) and all-cause mortality were analysed. Our primary endpoint was a composite of all-cause mortality, MI and target lesion revascularization (TLR). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">During our study period, 161 patients were included in our CTO-PCI dedicated program (mean age 64 ± 9 years, 78% male). There were 156 patients with single vessel CTO and 11 patients with double vessel occlusion (6 treated within the same procedure). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">CTO-PCI was attempted in 172 lesions with a median J-CTO Score of 2 (IQR 1 – 2), with 64% of lesions showing a J-CTO Score ≥ 2. Success rate was 81% per CTO and 79% (n = 127) per patient. Higher J-CTO scores predicted procedural failure (HR 2.7, 95%CI 1.3-5.7; p < 0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We verified a total of 5 severe complications, with a procedural mortality of 1%. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">At 5 years, Most patients were asymptomatic (83%), and 9% showed CCS I angina, displaying a significant improvement in CCS Class since the procedure (from a median of 2 [IQR 2 - 2] to 0 [IQR 0 - 0], p < 0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">All-cause mortality rate was 14,8% (n=23), the incidence of MI was 3,5% and TLR was 11,5%. Successfully treated CTO-PCI patients had better outcomes at 5-years regarding our primary composite endpoint (Figure 1). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusions: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We report favourable PCI success rates without significant safety concerns in a cohort of patients with chronic total occlusions. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">At 5-years, these patients showed long-lasting symptom improvement and a lower rate of coronary events and death comparing to unsuccessfully treated patients.</span></span></p>
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