Chronic Total Occlusion PCI: NCDR Report | Journal Scan

Study Questions:

What are the contemporary frequency, predictors, and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in the United States?

Methods:

The authors analyzed the frequency and outcomes of CTO PCI compared with non-CTO PCI in elective patients, and of successful versus failed CTO PCI between July 1, 2009, and March 31, 2013, in the NCDR CathPCI Registry. Generalized estimating equations logistic regression modeling was used to define predictors of procedural success and procedural complications.

Results:

CTO PCI was performed in 22,365 of the 594,510 PCI procedures (3.8%) performed for stable coronary artery disease. Compared with non-CTO PCI, CTO PCI required greater contrast volume and longer fluoroscopy time, and had lower procedural success (59% vs. 96%, p < 0.001) and higher major adverse cardiac events (1.6% vs. 0.8%, p < 0.001). Independent predictors of procedural failure were older age, current smoking, previous myocardial infarction, previous coronary artery bypass grafting, peripheral arterial disease, previous cardiac arrest, right coronary artery CTO target vessel, and less operator experience), whereas operators’ annual CTO PCI volume was associated with improved success with no difference in major complications.

Conclusions:

CTO PCI is currently performed infrequently in the United States for stable coronary artery disease, and is associated with lower procedural success and higher complication rates compared with non-CTO PCI.

Perspective:

The most notable finding of this study is that greater CTO (but not total PCI) experience is associated with a greater likelihood of success. Specifically, there was a 5% increase in success for each 10 CTO PCI procedures performed per year. This would suggest that institutions should concentrate their CTO expertise in the hands of a few committed operators, and patients should specifically seek out these operators if they need CTO PCI.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Coronary Artery Disease, Interventions and Imaging, Nuclear Imaging

Keywords: Percutaneous Coronary Intervention, Coronary Artery Disease, Fluoroscopy, National Cardiovascular Data Registries, Treatment Outcome, Logistic Models


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