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Procedural and In-Hospital Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions of Coronary Arteries 2002 to 2008

Impact of Novel Guidewire Techniques

Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan

^_* Reprint requests and correspondence: Dr. Sudhir Rathore, Department of Cardiology, Toyohashi Heart Center, 21-1, Gobudori, Oyama-cho, Toyohashi 441-8530, Japan (Email: sudhirrathore{at}hotmail.com).

The aim of this study was to examine the procedural success and in-hospital outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions in the current era during contemporary practice. The technique of PCI has improved over time with the introduction of novel equipment and guidewire crossing techniques. However, there is limited data available from contemporary practice in the recent years. We evaluated the procedural and in-hospital outcomes in a consecutive series of 904 procedures performed at Toyohashi Heart Center for PCI of chronic total occlusions of >3 months in duration. Technical and procedural success was achieved in 87.5% and 86.2%, respectively. In-hospital major adverse cardiac events occurred in only 1.9% of the patients. Single antegrade wire was the predominant strategy for guidewire crossing; however, retrograde guidewire crossing was used in 7.2% of the cases and controlled antegrade and retrograde subintimal tracking in 9.9% of the cases as the final strategy. Logistic regression analysis identified severe tortuosity and moderate-to-severe calcification as significant predictors of procedural failure. This is the first reported large series of patients undergoing PCI for chronic total occlusion with improved wire crossing techniques. We have reported high success rates in recent years and very low complication rates despite the use of more aggressive devices and techniques.

Key Words: chronic total occlusion • percutaneous coronary intervention • in-hospital major adverse cardiac events • procedural success • controlled antegrade and retrograde tracking

Abbreviations and Acronyms   CABG = coronary artery bypass surgery   CART = controlled antegrade and retrograde tracking   CK = creatinine kinase   CTO = chronic total occlusion   IVUS = intravascular ultrasound   MACE = major adverse cardiac events   MI = myocardial infarction   PCI = percutaneous coronary intervention   TIMI = Thrombolysis In Myocardial Infarction

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