280The impact of epicardial collateral use on the outcomes of retrograde chronic total occlusion percutaneous coronary intervention

Background

The impact of the type of collateral vessel used on the outcomes of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.

Methods

We reviewed the baseline clinical and angiographic characteristics and procedural outcomes of 1,501 retrograde CTO PCIs performed in 1494 patients between 2012 and 2019 at 26 centres.

Purpose

We sought to examine the impact of the type of collateral vessel used on the outcomes of retrograde CTO PCI.

Results

Mean patient age was 65.0±10 years and 86% were men. Septal collaterals or bypass grafts were used in 66%, epicardial collaterals in 34% of lesions. Compared with cases in which only septal collaterals and bypass grafts were used, use of epicardial collaterals were associated with larger vessel diameter (3.0 [2.5; 3.0] vs. 3.0 [2.5, 3.2] mm, p=0.005), more moderate/severe tortuosity (55% vs. 42%, p<0.0001), more moderate/severe calcification (73% vs. 65%, p=0.002), and higher Japan chronic total occlusion score (3.34±1.02 vs. 3.11±1.07, p<0.0001). Epicardial collateral use was associated with lower technical (76.3% vs. 80.6%, p=0.053) and procedural (71.9% vs. 77.8%, p=0.011) success rates, but similar incidence of major cardiac adverse events (4.72% vs. 4.56%, p=0.889). Epicardial collaterals were associated with more perforations (10.63% vs. 7.30%, p=0.028). Epicardial collateral use was associated with longer fluoroscopy time (82 [64, 104] 76 [(55, 102] p=0.0003) and higher contrast volume (300 [221; 414] ml vs. 270 [200; 370] ml, p<0.0001).

Conclusion

In a contemporary, multicenter registry epicardial collaterals were used in approximately one-third of retrograde CTO PCIs. Use of epicardial collaterals was associated with lower success but similar major complication rates.

Acknowledgement/Funding

Minneapolis Heart Institute Foundation

Impact of diabetes mellitus on acute outcomes of percutaneous coronary intervention in chronic total occlusions: insights from a US multicentre registry

AIM

To examine the impact of diabetes mellitus on procedural outcomes of patients who underwent percutaneous coronary intervention for chronic total occlusion.

METHODS

We assessed the impact of diabetes mellitus on the outcomes of percutaneous coronary intervention for chronic total occlusion among 1308 people who underwent such procedures at 11 US centres between 2012 and 2015.

RESULTS

The participants' mean ± sd age was 66 ± 10 years, 84% of the participants were men and 44.6% had diabetes. As compared with participants without diabetes, participants with diabetes were more likely to have undergone coronary artery bypass graft surgery (38 vs 31%; P = 0.006), and to have had previous heart failure (35 vs 22%; P = 0.0001) and peripheral arterial disease (19 vs 13%; P = 0.002). They also had a higher BMI (31 ± 6 kg/m² vs 29 ± 6 kg/m² ; P = 0.001), similar Japanese chronic total occlusion scores (2.6 ± 1.2 vs 2.5 ± 1.2; P = 0.82) and similar final successful crossing technique: antegrade wire escalation (46 vs 47%; P = 0.66), retrograde (30 vs 28%; P = 0.66) and antegrade dissection re-entry (24 vs 25%; P = 0.66). Technical (91 vs 90%; P = 0.80) and procedural (89 vs 89%; P = 0.93) success was similar in the two groups, as was the incidence of major adverse cardiac events (2.2 vs 2.5%; P = 0.61).

CONCLUSIONS

In a contemporary cohort of people undergoing percutaneous coronary intervention for chronic total occlusion, nearly one in two (45%) had diabetes mellitus. Procedural success and complication rates were similar in people with and without diabetes.