Author + information
- Received September 16, 2019
- Revision received January 27, 2020
- Accepted February 18, 2020
- Published online June 1, 2020.
- Hussein Othman, MDa,∗ (, )
- Milan Seth, MSb,
- Rami Zein, DOa,
- Howard Rosman, MDa,
- Thomas Lalonde, MDa,
- Hiroshi Yamasaki, MDa,
- Khaldoon Alaswad, MDc,
- Daniel Menees, MDb,
- Rajendra H. Mehta, MDd,
- Hitinder Gurm, MBBSb,
- Edouard Daher, MDa,
- on behalf of the BMC2 Investigators
- aAscension St. John Hospital, Detroit, Michigan
- bUniversity of Michigan, Ann Arbor, Michigan
- cHenry Ford Health System, Detroit, Michigan
- dDuke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Hussein Othman, St. John Hospital and Medical Center, Department of Cardiology, 205 Page Avenue, Suite B, Jackson, Michigan 49201.
Objectives The aim of this study was to describe the performance and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in Michigan.
Background CTO PCI has been associated with reduction in angina, but previous registry analyses showed a higher rate of major adverse cardiac events with this procedure.
Methods To study uptake and outcomes of CTO PCI in Michigan, patients enrolled in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry (2010 to 2017) were evaluated. CTO PCI was defined as intervention in a 100% occluded coronary artery ≥3 months old.
Results Among 210,172 patients enrolled in the registry, 7,389 CTO PCIs (3.5%) were attempted, with 4,614 (58.3%) achieving post-procedural TIMI (Thrombolysis In Myocardial Infarction) flow grade 3. The proportion of PCIs performed on CTOs increased over the study period (from 2.67% in 2010 to 4.48% in 2017). Thirty of 47 hospitals performed >50 CTO interventions in 2017. Pre-procedural angina class ≤2 was present in one-quarter, and functional assessment for ischemia was performed in 46.6% of patients. Major complications occurred in 245 patients (3.3%) and included death (1.4%), post-procedural stroke (0.4%), cardiac tamponade (0.5%), and urgent coronary artery bypass graft surgery (1.3%). Procedural success improved modestly from 44.5% in 2010 to 54.9% in 2017 (p for trend < 0.001). Rates of in-hospital mortality (p for trend = 0.247) and major adverse cardiac event (p for trend = 0.859) for CTO PCI remained unchanged over the study period.
Conclusions The rate of CTO PCI in Michigan increased over the study period. Although the success rate of CTO PCI has increased modestly in contemporary practice, it remained far below the >80% reported by select high-volume CTO operators. The rate of periprocedural major adverse cardiac events or death remained unchanged over time. These data suggest room for improvement in the selection and functional assessment of CTO lesions before subjecting patients to the increased procedural risk associated with CTO PCI.
This work was supported by the Blue Cross Blue Shield of Michigan and Blue Care Network as part of the Blue Cross Blue Shield of Michigan Value Partnerships program. The funding source supported data collection at each site and funded the data-coordinating center but had no role in study concept, interpretation of findings, or the preparation, final approval, or decision to submit the manuscript. Dr. Gurm is a consultant for Osprey Medical; and has received research funding from the National Institutes of Health Center for Accelerated Innovation and Blue Cross Blue Shield of Michigan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received September 16, 2019.
- Revision received January 27, 2020.
- Accepted February 18, 2020.
- 2020 American College of Cardiology Foundation
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