Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry
Background: The impact of bifurcations at the proximal or distal cap on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the clinical, angiographic, and procedural data of 4,584 cases performed in patients between...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-07-01
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| Series: | Hellenic Journal of Cardiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1109966622000252 |
| _version_ | 1811217449261989888 |
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| author | Ilias Nikolakopoulos Evangelia Vemmou Judit Karacsonyi Khaldoon Alaswad Dimitri Karmpaliotis Nidal Abi Rafeh Daniel Schimmel Keith Benzuly James D. Flaherty Paul Poommipanit Ahmed M. ElGuindy M. Nicholas Burke Emmanouil S. Brilakis |
| author_facet | Ilias Nikolakopoulos Evangelia Vemmou Judit Karacsonyi Khaldoon Alaswad Dimitri Karmpaliotis Nidal Abi Rafeh Daniel Schimmel Keith Benzuly James D. Flaherty Paul Poommipanit Ahmed M. ElGuindy M. Nicholas Burke Emmanouil S. Brilakis |
| author_sort | Ilias Nikolakopoulos |
| collection | DOAJ |
| description | Background: The impact of bifurcations at the proximal or distal cap on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the clinical, angiographic, and procedural data of 4,584 cases performed in patients between 2012 and 2020 in a global CTO PCI registry. We compared 4 groups according to the bifurcation location: “proximal cap,” “distal cap,” “proximal and distal cap,” and “no bifurcation.” Results: The CTO involved a bifurcation in 67% cases, as follows: proximal cap (n = 1451, 33%), distal cap (n = 622, 14%), or both caps (n = 954, 21%). “Proximal and distal cap” cases had higher J-CTO compared with “proximal cap,” “distal cap,” and “no bifurcation” cases (2.9 ± 1.1 vs 2.5 ± 1.1 vs 2.4 ± 1.2 vs 2.0 ± 1.2, P < 0.0001), and they were also associated with a lower technical success rate (79% vs 85% vs 85% vs 90%, P < 0.0001), higher pericardiocentesis rate (1% vs 1% vs 0.2% vs 0.3%, P = 0.02), and higher emergency coronary artery bypass graft surgery rate (0.3% vs 0% vs 0% vs 0%, P = 0.01). Conclusion: More than two-thirds of CTO PCIs involve a bifurcation, which is associated with lower technical success and higher risk of complications. |
| first_indexed | 2024-04-12T06:53:54Z |
| format | Article |
| id | doaj.art-9065c7e9323142898ae87df9a8a0234e |
| institution | Directory Open Access Journal |
| issn | 1109-9666 |
| language | English |
| last_indexed | 2024-04-12T06:53:54Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Hellenic Journal of Cardiology |
| spelling | doaj.art-9065c7e9323142898ae87df9a8a0234e2022-12-22T03:43:12ZengElsevierHellenic Journal of Cardiology1109-96662022-07-01668083Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registryIlias Nikolakopoulos0Evangelia Vemmou1Judit Karacsonyi2Khaldoon Alaswad3Dimitri Karmpaliotis4Nidal Abi Rafeh5Daniel Schimmel6Keith Benzuly7James D. Flaherty8Paul Poommipanit9Ahmed M. ElGuindy10M. Nicholas Burke11Emmanouil S. Brilakis12Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USAMinneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USAMinneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USAHenry Ford Hospital, Detroit, MI, USAColumbia University, New York, NY, USASt. George Hospital University Medical Center, Beirut, LebanonDivision of Cardiology (V.S.J., D.R.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL, USADivision of Cardiology (V.S.J., D.R.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL, USADivision of Cardiology (V.S.J., D.R.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL, USAHarrington Heart and Vascular Institute, University Hospitals-Parma Medical Center, Parma, OH, USAAswan Heart Centre, Magdi Yacoub Foundation, EgyptMinneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USACorresponding author. Emmanouil S. Brilakis, MD, PhD, Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, MN, 55407, USA. Tel.: +1 612 863 3900, Fax: +612 863 6441.; Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USABackground: The impact of bifurcations at the proximal or distal cap on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the clinical, angiographic, and procedural data of 4,584 cases performed in patients between 2012 and 2020 in a global CTO PCI registry. We compared 4 groups according to the bifurcation location: “proximal cap,” “distal cap,” “proximal and distal cap,” and “no bifurcation.” Results: The CTO involved a bifurcation in 67% cases, as follows: proximal cap (n = 1451, 33%), distal cap (n = 622, 14%), or both caps (n = 954, 21%). “Proximal and distal cap” cases had higher J-CTO compared with “proximal cap,” “distal cap,” and “no bifurcation” cases (2.9 ± 1.1 vs 2.5 ± 1.1 vs 2.4 ± 1.2 vs 2.0 ± 1.2, P < 0.0001), and they were also associated with a lower technical success rate (79% vs 85% vs 85% vs 90%, P < 0.0001), higher pericardiocentesis rate (1% vs 1% vs 0.2% vs 0.3%, P = 0.02), and higher emergency coronary artery bypass graft surgery rate (0.3% vs 0% vs 0% vs 0%, P = 0.01). Conclusion: More than two-thirds of CTO PCIs involve a bifurcation, which is associated with lower technical success and higher risk of complications.http://www.sciencedirect.com/science/article/pii/S1109966622000252chronic total occlusionpercutaneous coronary interventionbifurcation |
| spellingShingle | Ilias Nikolakopoulos Evangelia Vemmou Judit Karacsonyi Khaldoon Alaswad Dimitri Karmpaliotis Nidal Abi Rafeh Daniel Schimmel Keith Benzuly James D. Flaherty Paul Poommipanit Ahmed M. ElGuindy M. Nicholas Burke Emmanouil S. Brilakis Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry Hellenic Journal of Cardiology chronic total occlusion percutaneous coronary intervention bifurcation |
| title | Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry |
| title_full | Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry |
| title_fullStr | Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry |
| title_full_unstemmed | Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry |
| title_short | Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry |
| title_sort | percutaneous coronary intervention of chronic total occlusions involving a bifurcation insights from the progress cto registry |
| topic | chronic total occlusion percutaneous coronary intervention bifurcation |
| url | http://www.sciencedirect.com/science/article/pii/S1109966622000252 |
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