Alfredo R Galassi1, Georgios Sianos2, Gerald S Werner3, Javier Escaned4, Salvatore D Tomasello5, Marouane Boukhris6, Marine Castaing5, Joachim H Büttner7, Alexander Bufe8, Artis Kalnins9, James C Spratt10, Roberto Garbo11, David Hildick-Smith12, Simon Elhadad13, Andrea Gagnor14, Bernward Lauer15, Leszek Bryniarski16, Evald H Christiansen17, Leif Thuesen17, Markus Meyer-Geßner18, Omer Goktekin19, Mauro Carlino20, Yves Louvard21, Thierry Lefèvre21, Aigars Lismanis22, Valery L Gelev23, Antonio Serra24, Francesco Marzà5, Carlo Di Mario25, Nicolaus Reifart26. 1. Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Italy. Electronic address: argalassi@gmail.com. 2. Department of Cardiology, American Hellenic Educational Progressive Association University Hospital, Thessaloniki, Greece. 3. Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany. 4. Hospital Clinico San Carlos, Madrid, Spain. 5. Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Italy. 6. Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Italy; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia. 7. Interventional Cardiology - Universitäts-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany. 8. Helios Clinic Krefeld, Department of Cardiology, University Witten/Herdecke, Witten, Germany. 9. Department of Cardiology, Eastern Clinical University Hospital, Riga, Latvia. 10. Department of Cardiology, Forth Valley Royal Hospital, Larbert, United Kingdom. 11. Policlinico San Giovanni Bosco, Turin, Italy. 12. Department of Cardiology, Brighton and Sussex University Hospitals, Brighton, United Kingdom. 13. Department of Cardiology, CH de Lagny, Lagny-sur-Marne, France. 14. Department of Cardiology, Infermi Hospital, Rivoli, Italy. 15. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia; Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany. 16. Department of Interventional Cardiology, Jagiellonian University Medical Hospital, Krakow, Poland. 17. Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. 18. Augusta-Krankenhaus Klinik Kardiologie, Dusseldorf, Germany. 19. Faculty of Medicine, Department of Cardiology, BezmiÂlem Foundation University, Istanbul, Turkey. 20. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia; Invasive Cardiology Unit, San Raffaele Hospital, Milan, Italy. 21. Institut Hospitalier Jacques Cartier, Massy, France. 22. Latvian Center of Cardiology-Pauls Stradins Clinical University Hospital, Riga, Latvia. 23. Hospital N.I.Pirogov, Sofia, Bulgaria. 24. Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 25. NIHR Cardiovascular BRU Royal Brompton Hospital & National Heart and Lung Institute, Imperial College London, London, United Kingdom. 26. Department of Cardiology, Main Taunus Hospitals, Bad Soden University of Frankfurt, Frankfurt, Germany.
Abstract
BACKGROUND: A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs). OBJECTIVES: The authors describe the European experience with and outcomes of retrograde PCI revascularization for coronary CTOs. METHODS: Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization. RESULTS: The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up. CONCLUSIONS: The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.
BACKGROUND: A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs). OBJECTIVES: The authors describe the European experience with and outcomes of retrograde PCI revascularization for coronary CTOs. METHODS: Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization. RESULTS: The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up. CONCLUSIONS: The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.
Authors: Kathleen Kearney; Ravi S Hira; Robert F Riley; Arun Kalyanasundaram; William L Lombardi Journal: Curr Atheroscler Rep Date: 2017-04 Impact factor: 5.113
Authors: Dimitri Karmpaliotis; Aris Karatasakis; Khaldoon Alaswad; Farouc A Jaffer; Robert W Yeh; R Michael Wyman; William L Lombardi; J Aaron Grantham; David E Kandzari; Nicholas J Lembo; Anthony Doing; Mitul Patel; John N Bahadorani; Jeffrey W Moses; Ajay J Kirtane; Manish Parikh; Ziad A Ali; Sanjog Kalra; Phuong-Khanh J Nguyen-Trong; Barbara A Danek; Judit Karacsonyi; Bavana V Rangan; Michele K Roesle; Craig A Thompson; Subhash Banerjee; Emmanouil S Brilakis Journal: Circ Cardiovasc Interv Date: 2016-06 Impact factor: 6.546