Outcome of Retrograde Chronic Total Occlusion PCI | Journal Scan

Study Questions:

What are the results of a European multicenter registry of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI)?

Methods:

The authors describe the outcome and follow-up of the European Registry of CTOs (ERCTO), which included 1,395 patients with 1,582 CTO lesions who underwent retrograde PCI at 44 European centers between January 2008 and December 2012. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization.

Results:

The majority of patients were men (88%), and the mean patient age was 62.0 ± 10.4 years. Procedural success rate was 75% and clinical success rate was 71%; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. In-hospital outcome was good, with a mortality rate of 0.1% and a pericardial effusion with tamponade seen in 1%, and an effusion without tamponade occurred in additional 0.6%. Average follow-up was 2 years. 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%, p = 0.001), further revascularization (8.6% vs. 23.6%, p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, p < 0.001).

Conclusions:

Retrograde PCI is increasingly being performed in Europe, with a high success rate and acceptable procedural safety.

Perspective:

CTO PCI has had a resurgence in recent years, in part related to the focused efforts of dedicated CTO interventionalists. This study describes the work of experienced CTO operators, and even within this group, the success rate was higher for those with greater experience. Retrograde CTO intervention is a viable option with a high success rate in experienced hands, and patients who need CTO PCI should be referred specifically to CTO operators who are experienced in both the antegrade and retrograde approach.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Pericardial Disease, Aortic Surgery

Keywords: Coronary Occlusion, Follow-Up Studies, Mortality, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Pericardial Effusion, Registries, Stroke


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