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|Title:||Long-Term Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients Who Have Undergone Coronary Artery Bypass Grafting vs Those Who Have Not||Authors:||Azzalini, Lorenzo
La Manna, Alessio
Ybarra, Luiz F.
Demir, Ozan M.
Brilakis, Emmanouil S.
|Issue Date:||2018||Publisher:||ELSEVIER SCIENCE INC||Source:||CANADIAN JOURNAL OF CARDIOLOGY, 34(3), p. 310-318||Abstract:||Background: We aimed to investigate the procedural and long-term outcomes of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in patients who had undergone previous coronary artery bypass grafting (CABG) vs those who had not, and to evaluate the role of the Registry of CrossBoss and Hybrid procedures in France, the Netherlands, Belgium, and United Kingdom (RECHARGE) score in predicting acute and long-term outcomes. Methods: We compiled a multicentre registry of consecutive patients undergoing CTO PCI at 7 centres between January 2009 and April 2017. The primary end point was target-vessel failure (TVF), a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization on follow-up. Results: Overall, 2058 patients were included (patients who underwent CABG, n = 401; CABG-naive patients, n = 1657). Patients who had undergone CABG were older and had a higher prevalence of comorbidities and higher occlusion complexity (RECHARGE score, 3.6 + 1.3 vs 1.8 + 1.2; P < 0.001). Antegrade dissection/re-entry techniques and the retrograde approach were used more frequently in patients who had undergone CABG. Procedural metrics were worse, and technical (82% vs 88%; P = 0.001) and procedural (81% vs 87%; P = 0.001) success was lower in patients who had undergone CABG. They also experienced a higher rate of major complications (3.7% vs 1.5%; P = 0.004). The RECHARGE score was inversely associated with technical success (P < 0.001). Median follow-up was 377 days (interquartile range, 277-766 days). The 24-month TVF rate was higher in patients who had undergone CABG than in CABG-naive patients (16.1% vs 9.0%; P < 0.001). On multivariable analysis, the RECHARGE score (hazard ratio, 1.61; P < 0.001) remained an independent predictor of TVF, together with longer total stent length and not using a drug-eluting stent. Conclusions: Compared with CABG-naive patients, CTO PCI in patients who had undergone CABG shows higher procedural complexity, worse success rates, and higher adjusted risk of TVF on follow-up.||Notes:||[Azzalini, Lorenzo; Benincasa, Susanna; Bellini, Barbara; Candilio, Luciano; Demir, Ozan M.; Carlino, Mauro; Colombo, Antonio] Ist Sci San Raffaele, Cardiothorac Vasc Dept, Intervent Cardiol Unit, Milan, Italy. [Ojeda, Soledad; Hidalgo, Francisco; Pan, Manuel] Univ Cordoba, Reina Sofia Hosp, Div Intervent Cardiol, Maimonides Inst Res Biomed Cordoba IMIBIC, Cordoba, Spain. [Karatasakis, Aris; Karacsonyi, Judit; Brilakis, Emmanouil S.] North Texas Healthcare Syst, Intervent Cardiol Unit, Dallas, TX USA. [Karatasakis, Aris; Karacsonyi, Judit; Brilakis, Emmanouil S.] Univ Texas Southwestern Med Ctr Dallas, Dallas, TX USA. [Maeremans, Joren; Dens, Joseph] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium. [Maeremans, Joren] Univ Hasselt, Fac Med & Life Sci, Hasselt, Belgium. [Tanabe, Masaki] Kyoto Okamoto Mem Hosp, Dept Cardiol, Kyoto, Japan. [La Manna, Alessio; Gravina, Giacomo; Micciche, Eligio; D'Agosta, Guido; Venuti, Giuseppe; Tamburino, Corrado] Univ Catania, Ferrarotto Hosp, Div Cardiol, Catania, Italy. [Dautov, Rustem; Ybarra, Luiz F.; Rinfret, Stephane] McGill Univ, Hlth Ctr, Intervent Cardiol, Royal Victoria Glen Site B03 7200, Montreal, PQ H4A 3J1, Canada. [Dautov, Rustem; Rinfret, Stephane] Quebec Heart & Lung Inst, Div Intervent Cardiol, Quebec City, PQ, Canada. [Dautov, Rustem; Rinfret, Stephane] Laval Univ, Quebec City, PQ, Canada. [Brilakis, Emmanouil S.] Minneapolis Heart Inst, Minneapolis, MN USA.||Document URI:||http://hdl.handle.net/1942/27319||ISSN:||0828-282X||e-ISSN:||1916-7075||DOI:||10.1016/j.cjca.2017.12.016||ISI #:||000426358900014||Category:||A1||Type:||Journal Contribution||Validations:||ecoom 2019|
|Appears in Collections:||Research publications|
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