Author + information
- Received October 24, 2012
- Revision received July 25, 2013
- Accepted August 1, 2013
- Published online January 1, 2014.
- Tomohiko Teramoto, MD, PhD∗∗ (, )
- Etsuo Tsuchikane, MD, PhD∗,
- Hitoshi Matsuo, MD, PhD†,
- Yoriyasu Suzuki, MD‡,
- Tsuyoshi Ito, MD∗,
- Tatsuya Ito, MD‡,
- Maoto Habara, MD∗,
- Kenya Nasu, MD∗,
- Masashi Kimura, MD, PhD∗,
- Yoshihisa Kinoshita, MD∗,
- Mitsuyasu Terashima, MD, PhD∗,
- Yasushi Asakura, MD∗,
- Tetsuo Matsubara, MD∗ and
- Takahiko Suzuki, MD, PhD∗
- ∗Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
- †Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
- ‡Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Aichi, Japan
- ↵∗Reprint requests and correspondence:
Dr. Tomohiko Teramoto, Department of Cardiovascular Medicine, Toyohashi Heart Center, 21-1, Gobudori, Ohyama-cho, Toyohashi, Aichi, 441-8530, Japan.
Objectives This study sought to compare the initial success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in a native coronary artery (NCA) in patients with and without previous coronary artery bypass grafting (CABG) and to assess predictive factors.
Background Landmark novel wiring techniques for CTO-PCI have contributed to improvement in the initial success of CTO-PCI. However, challenges persist in CTO-PCI in NCA in pCABG patients.
Methods Patients who underwent CTO-PCI in an NCA were selected and classified into 2 groups: pCABG (206 PCIs in 153 patients) and nCABG (1,431 PCIs in 1,139 patients).
Results CTO was located more often in the left anterior descending artery (p = 0.0003), and severe calcified lesions were observed more frequently in the pCABG group (p < 0.0001). Although the retrograde attempt was tried more frequently in the pCABG group, the CTO-PCI success rate was significantly lower in the pCABG patients than in the nCABG patients (71% vs. 83%). Longer procedural time and greater radiation exposure were needed in the pCABG patients. Logistic regression analysis among the pCABG patients revealed that intravascular ultrasound use and parallel wiring were positive factors, and lesion tortuosity was a negative factor.
Conclusions The initial success rate of CTO-PCI of an NCA in the pCABG group was significantly decreased compared with that in the nCABG group. Anatomic complexity and unstable hemodynamic state were unfavorable conditions. This study reveals that the issues to be overcome are lying with CTO revascularization in an NCA in pCABG patients.
Dr. Tsuchikane is a consultant for Abbott Vascular Japan, Boston Scientfic Japan, and Asahi Intecc Japan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 24, 2012.
- Revision received July 25, 2013.
- Accepted August 1, 2013.
- American College of Cardiology Foundation