We sought to examine the impact of previous failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic characteristics and procedural outcomes of 1,213 consecutive patients who underwent 1,232 CTO PCIs from 2012 to 2015 at 12 US centers. Mean age was 65 ± 10 years, and 84.8% of patients were men. A previously failed attempt had been performed in 215 patients (17.5%). As compared with patients without previous CTO PCI failure, patients with previous failure had higher Multicenter CTO Registry in Japan CTO score (2.40 ± 1.13 vs 3.28 ± 1.29, p <0.0001) and were more likely to have in-stent restenosis (10.5% vs 28.4%, p <0.0001) and to undergo recanalization attempts using the retrograde approach (41% vs 50%, p = 0.011). Technical (90% vs 88%, p = 0.390) and procedural (89% vs 86%, p = 0.184) success were similar in the 2 study groups; however, median procedure time (125 vs 142 minutes, p = 0.026) and fluoroscopy time (45 vs 55 minutes, p = 0.015) were longer in the previous failure group. In conclusion, a previously failed CTO PCI attempt is associated with higher angiographic complexity, longer procedural duration, and fluoroscopy time, but not with the success and complication rates of subsequent CTO PCI attempts.
Bibliographical noteFunding Information:
Supported by CTSA NIH Grant UL1-RR024982. Dr. Karmpaliotis is on the speaker''s bureau of Abbott Vascular, Medtronic, and Boston Scientific. Dr. Alaswad receives consulting fees from Terumo and Boston Scientific and is a consultant, no financial, Abbott Laboratories. Dr. Yeh receives Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr. Jaffer is a consultant to Boston Scientific, Siemens, and Merck, and receives nonfinancial research support from Abbott Vascular, research grant HL-R01-108229 from National Institutes of Health. Dr. Wyman receives honoraria/consulting/speaking fees from Boston Scientific, Abbott Vascular, and Asahi. Dr. Lombardi: equity with Bridgepoint Medical. Dr. Grantham receives speaking fees, consulting, and honoraria from Boston Scientific, Asahi Intecc. He also receives research grants from Boston Scientific, Asahi Intecc, Abbott Vascular, and Medtronic. Dr. Kandzari receives research/grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular, and research/grant support from Abbott. Dr. Lembo is on the speaker''s bureau of Medtronic; advisory board Abbott Vascular and Medtronic. Dr. Kirtane receives institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, Glaxo SmithKline, and Eli Lilly. Dr. Garcia receives consulting fees from Medtronic. Dr. Thompson is an employee of Boston Scientific. Dr. Banerjee receives research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCARE Global (spouse); intellectual property in HygeiaTel. Dr. Brilakis receives consulting/speaker honoraria from Abbott Vascular, Asahi, Boston Scientific, Elsevier, Somahlution, St Jude Medical, and Terumo; research support from Boston Scientific and InfraRedx; spouse is employee of Medtronic. The other authors have no conflicts of interest to disclose.