Michael Megaly1,2, Abdelrahman Ali3, Marwan Saad4,5, Mohamed Omer1,2, Iosif Xenogiannis1, Gerald S Werner6, Dimitri Karmpaliotis7, Juan J Russo7, Masahisa Yamane8, Roberto Garbo9, Andrea Gagnor10, Imre Ungi11, Stephane Rinfret12, Ashish Pershad13, Jaroslaw Wojcik14, Santiago Garcia1, Kambis Mashayekhi15, Georgios Sianos16, Alfredo R Galassi17, M Nicholas Burke1, Emmanouil S Brilakis1. 1. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota. 2. Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota. 3. Department of Medicine, Mercy Hospital and Medical Center, Chicago, Illinois. 4. Division of Cardiovascular Medicine, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island. 5. Department of Cardiovascular Medicine, Ain Shams University Hospitals, Cairo, Egypt. 6. Medizinische Klinik I (Cardiology and Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany. 7. Department of Cardiology, Columbia University, New York, New York. 8. Department of Cardiology, Sayama Hospital, Saitama, Japan. 9. Department of Invasive Cardiology, San Giovanni Bosco Hospital, Turin, Italy. 10. Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy. 11. Division of Invasive Cardiology, University of Szeged, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary. 12. Division of Interventional Cardiology, McGill University Health Centre, Montreal, Canada. 13. Division of Cardiology, Banner-University Medical Center, Phoenix, Arizona. 14. Department of Cardiology, Hospital of Invasive Cardiology IKARDIA, Nałęczów, Poland. 15. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany. 16. First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece. 17. Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Catania, Italy.
Abstract
OBJECTIVES: The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: The retrograde approach has increased the success rate of CTO PCI but has been associated with a higher risk for complications. METHODS: We conducted a meta-analysis of studies published between 2000 and August 2019 comparing the in-hospital and long-term outcomes with retrograde versus antegrade CTO PCI. RESULTS: Twelve observational studies (10,240 patients) met our inclusion criteria (retrograde approach 2,789 patients, antegrade approach 7,451 patients). Lesions treated with the retrograde approach had higher J-CTO score (2.8 vs. 1.9, p < .001). Retrograde CTO PCI was associated with a lower success rate (80.9% vs. 87.4%, p < .001). Both approaches had similar in-hospital mortality, urgent revascularization, and cerebrovascular events. Retrograde CTO PCI was associated with higher risk of in-hospital myocardial infarction (MI; odds ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p < .001), urgent pericardiocentesis (OR 2.53, 95% CI 1.41-4.51, p = .002), and contrast-induced nephropathy (OR 2.12, 95% CI 1.47-3.08; p < .001). During a mean follow-up of 48 ± 31 months retrograde crossing had similar mortality (OR 1.79, 95% CI 0.84-3.81, p = .13), but a higher incidence of MI (OR 2.07, 95% CI 1.1-3.88, p = .02), target vessel revascularization (OR 1.92, 95% CI 1.49-2.46, p < .001), and target lesion revascularization (OR 2.08, 95% CI 1.33-3.28, p = .001). CONCLUSIONS: Compared with antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions and is associated with a higher risk for acute and long-term adverse events.
OBJECTIVES: The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: The retrograde approach has increased the success rate of CTO PCI but has been associated with a higher risk for complications. METHODS: We conducted a meta-analysis of studies published between 2000 and August 2019 comparing the in-hospital and long-term outcomes with retrograde versus antegrade CTO PCI. RESULTS: Twelve observational studies (10,240 patients) met our inclusion criteria (retrograde approach 2,789 patients, antegrade approach 7,451 patients). Lesions treated with the retrograde approach had higher J-CTO score (2.8 vs. 1.9, p < .001). Retrograde CTO PCI was associated with a lower success rate (80.9% vs. 87.4%, p < .001). Both approaches had similar in-hospital mortality, urgent revascularization, and cerebrovascular events. Retrograde CTO PCI was associated with higher risk of in-hospital myocardial infarction (MI; odds ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p < .001), urgent pericardiocentesis (OR 2.53, 95% CI 1.41-4.51, p = .002), and contrast-induced nephropathy (OR 2.12, 95% CI 1.47-3.08; p < .001). During a mean follow-up of 48 ± 31 months retrograde crossing had similar mortality (OR 1.79, 95% CI 0.84-3.81, p = .13), but a higher incidence of MI (OR 2.07, 95% CI 1.1-3.88, p = .02), target vessel revascularization (OR 1.92, 95% CI 1.49-2.46, p < .001), and target lesion revascularization (OR 2.08, 95% CI 1.33-3.28, p = .001). CONCLUSIONS: Compared with antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions and is associated with a higher risk for acute and long-term adverse events.