Abstract
Background
We sought to determine the effect of lesion age on procedural techniques and outcomes
of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods
We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age,
performed between 2012 and 2016 at 11 experienced US centres.
Results
Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical
and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular
event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ±
62 months and 12 months (interquartile range, 3-64 months), respectively. Patients
were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months).
Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ±
11 years; P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; P = 0.001). Older lesions more often required use of the retrograde approach and antegrade
dissection/re-entry for successful lesion crossing. There was no difference in technical
(87.8% vs 89.6% vs 93.0%; P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; P = 0.31) for older vs younger occlusions.
Conclusions
Older CTO lesions exhibit angiographic complexity and more frequently necessitate
the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized
with high technical and procedural success and acceptable MACE rates. Lesion age appears
unlikely to be a significant determinant of CTO PCI success.
Résumé
Introduction
Nous avons cherché à établir l’effet de l’âge des lésions sur les techniques employées
lors de l’intervention coronarienne percutanée (ICP) et sur l’issue de cette intervention
chez les patients présentant une occlusion chronique totale.
Méthodes
Nous avons analysé, chez des patients présentant une occlusion chronique totale, les
caractéristiques et les issues de 394 ICP effectuées entre 2012 et 2016 dans 11 centres
expérimentés aux États-Unis.
Résultats
L’âge moyen des patients, dont 85,6 % étaient de sexe masculin, était de 66 ± 10 ans.
Dans l’ensemble, les taux d’efficacité de la technique et de l’intervention ont été
de 90,1 % et de 87,5 %, respectivement. Seize (4,1 %) patients ont présenté un événement
cardiovasculaire majeur. Les âges moyen et médian des lésions étaient, respectivement,
de 43 ± 62 mois et de 12 mois (intervalle interquartile de 3 à 64 mois). Les patients
ont été stratifiés en tertiles en fonction de l’âge de la lésion (de 3 à 5 mois, de
5 à 36,3 mois et > 36,3 mois). Les lésions les plus vieilles étaient associées à des
patients plus âgés (68 ± 8 vs 65 ± 10 vs 64 ± 11 ans; P = 0,009), à des antécédents de pontage aortocoronarien par greffe (62 % vs 42 % vs
30 %; P < 0,001) et à une calcification modérée ou grave (75 % vs 53 % vs 59 %; P = 0,001). Les lésions plus vieilles exigeaient plus souvent une approche par voie
rétrograde ainsi qu’une dissection et une réintroduction par voie antérograde permettant
de franchir efficacement la lésion. Aucune différence n’a été notée concernant l’efficacité
de la technique (87,8 % vs 89,6 % vs 93,0 %; P = 0,37) ou de l’intervention (86,3 % vs 87,4 % vs 89,0 %; P = 0,80) utilisée ou la fréquence des événements cardiovasculaires majeurs (3,1 %
vs 3 0 % vs 6,3 %; P = 0,31) pour les occlusions plus vieilles par rapport aux plus récentes.
Conclusions
Les occlusions chroniques totales plus vieilles présentent une complexité angiographique
et dictent plus fréquemment l’approche par voie rétrograde ou la dissection ou la
réintroduction par voie antérograde. En présence d’une occlusion chronique totale,
la recanalisation est possible avec un haut taux de succès de la technique et de l’intervention
et un taux acceptable d’événements cardiovasculaires majeurs. Il est peu probable
que l’âge de la lésion ait un lien significatif avec l’efficacité de l’ICP en présence
d’occlusion chronique totale.
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Article info
Publication history
Published online: April 21, 2016
Accepted:
April 17,
2016
Received:
March 15,
2016
Footnotes
See page 1438 for disclosure information.
Identification
Copyright
Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
