Incidence and in-hospital outcomes of single-vessel coronary chronic total occlusion treated with percutaneous coronary intervention

Rajkumar Doshi, Nirav Patel, Rajat Kalra, Harpreet Arora, Navkaranbir S. Bajaj, Garima Arora, Pankaj Arora

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Coronary chronic total occlusion (CTO) using percutaneous coronary intervention (PCI) presents a distinct challenge in the field of cardiology owing to multiple reasons including the increased risk of peri-procedural complications. We sought to explore rates of hospitalization, outcomes, use of mechanical circulatory support devices, and economic burden associated with single-vessel coronary CTO undergoing PCI for stable coronary artery disease (CAD). Methods: The National Inpatient Sample spanning from 2008 through 2014 was queried to identify hospitalizations associated with single-vessel coronary CTO-PCI for stable CAD by excluding hospitalizations with ST-elevation and non-ST elevation myocardial infarction. Survey-Specific logistic regression was used to analyze adjusted incidence of in-hospital mortality and acute renal failure. Results: A total of 109,094 hospitalizations were identified as having single-vessel coronary CTO-PCI for stable CAD from 2008 to 2014. An increasing number of coronary CTO-PCI hospitalizations (2465 to 2688 per 100,000 PCI procedures, P trend < 0.001) with an overall in-hospital mortality of 0.5% was observed. The rate of in-hospital mortality remained unchanged (P trend = 0.13), but an increasing rate of acute renal failure was observed in the multivariate-adjusted analysis (P trend < 0.001). Furthermore, a rise in the utilization of intra-aortic balloon pumps and percutaneous left ventricular assist devices during single-vessel coronary CTO-PCI was noted. Taken together, these may account for increasing costs of hospitalization for single-vessel coronary CTO-PCI ($13,909 in 2008 to $17,729 in 2014, P trend < 0.001). Conclusion: In a large retrospective study, slightly increased rates of single-vessel coronary CTO-PCI for stable CAD were observed. This is accompanied by a rise in morbidity and growing healthcare costs.

Original languageEnglish (US)
Pages (from-to)61-66
Number of pages6
JournalInternational Journal of Cardiology
Volume269
DOIs
StatePublished - Oct 15 2018

Bibliographical note

Funding Information:
This work was supported in part by the Walter B. Frommeyer, Junior Fellowship in Investigative Medicine that was awarded to Dr. Pankaj Arora by the University of Alabama at Birmingham . Dr. Nirav Patel is supported by National Institutes of Health (NIH) grant 5T32HL129948-02 . Dr. Navkaranbir S. Bajaj is supported by NIH grant 5T32HL094301-07 . Dr. Pankaj Arora is supported by American Heart Association Career Development Award 18CDA34110135 .

Funding Information:
This work was supported in part by the Walter B. Frommeyer, Junior Fellowship in Investigative Medicine that was awarded to Dr. Pankaj Arora by the University of Alabama at Birmingham. Dr. Nirav Patel is supported by National Institutes of Health (NIH) grant 5T32HL129948-02. Dr. Navkaranbir S. Bajaj is supported by NIH grant 5T32HL094301-07. Dr. Pankaj Arora is supported by American Heart Association Career Development Award 18CDA34110135.

Publisher Copyright:
© 2018 Elsevier B.V.

Keywords

  • Chronic total occlusion
  • Coronary artery disease
  • Epidemiology
  • Percutaneous coronary intervention

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