Background: Ostial chronic total occlusions (CTOs) can be challenging to recanalize. Methods: We sought to examine the prevalence, angiographic presentation, and procedural outcomes of ostial (side-branch ostial and aorto-ostial) CTOs among 1000 CTO percutaneous coronary interventions (PCIs) performed in 971 patients between 2015 and 2017 at 14 centres in the US, Europe, and Russia. Results: Ostial CTOs represented 16.9% of all CTO PCIs: 9.6% were aorto-ostial, and 7.3% were side-branch ostial occlusions. Compared with nonostial CTOs, ostial CTOs were longer (44 ± 33 vs 29 ± 19 mm, P < 0.001) and more likely to have proximal-cap ambiguity (55% vs 33%, P < 0.001), moderate/severe calcification (67% vs 45%, P < 0.001), a diffusely diseased distal vessel (41% vs 26%, P < 0.001), interventional collaterals (64% vs 53%, P = 0.012), and previous coronary artery bypass graft surgery (CABG) (51% vs 27%, P < 0.001). The retrograde approach was used more often in ostial CTOs (54% vs 29%, P < 0.001) and was more often the final successful crossing strategy (30% vs 18%, P = 0.003). Technical (81% vs 84%, P = 0.280), and procedural (77% vs 83%, P = 0.112) success rates and the incidence of in-hospital major complication were similar (4.8% vs 2.2%, P = 0.108), yet in-hospital mortality (3.0% vs 0.5%, P = 0.010) and stroke (1.2% vs 0.0%, P = 0.030) were higher in the ostial CTO PCI group. In multivariable analysis, ostial CTO location was not independently associated with higher risk for in-hospital major complications (adjusted odds ratio 1.27, 95% confidence intervals 0.37 to 4.51, P = 0.694). Conclusions: Ostial CTOs can be recanalized with similar rates of success as nonostial CTOs but are more complex, more likely to require retrograde crossing and may be associated with numerically higher risk for major in-hospital complications.
Bibliographical noteFunding Information:
The PROGRESS CTO registry has received support from the Abbott Northwestern Hospital Foundation , Minneapolis, MN.
M. Nicholas Burke: consulting and speaker honoraria from Abbott Vascular and Boston Scientific. Dimitri Karmpaliotis: speaker honoraria: Abbott Vascular, Boston Scientific, Medtronic, Vascular Solutions. Khaldoon Alaswad: consulting fees from Terumo and Boston Scientific; consultant, no financial, Abbott Laboratories. Farouc A. Jaffer: Consultant: Abbott Vascular and Boston Scientific. Research grant: Canon, Siemens and National Institutes of Health. Robert W. Yeh: Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Mitul Patel: speakers' bureau for Astra Zeneca. Ehtisham Mahmud: consulting fees from Medtronic and Corindus; speaker's fees from Medtronic, Corindus, and Abbott Vascular; educational program fees from Abbott Vascular; and clinical events committee fees from St Jude. Santiago Garcia: consulting fees from Medtronic. Jeffrey W. Moses: consultant to Boston Scientific and Abiomed. Nicholas J. Lembo: Speaker bureau: Medtronic; advisory board Abbott Vascular and Medtronic. Manish Parikh: speaker bureau: Abbot Vascular, Medtronic, CSI, BSC, Trireme; advisory boards: Medtronic, Abbott Vascular, Philips. Ajay J. Kirtane: Institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St Jude Medical, Vascular Dynamics, Glaxo SmithKline, and Eli Lilly. Ziad A. Ali: consultant fees/honoraria from St Jude Medical, and AstraZeneca Pharmaceuticals; ownership interest/partnership/principal in Shockwave Medical and VitaBx Inc; and research grants from Medtronic and St Jude Medical. Bavana V. Rangan: Research grants from InfraReDx, Inc., and The Spectranetics Corporation. Subhash Banerjee: research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCARE Global (spouse); intellectual property in HygeiaTel. Emmanouil S. Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, and Medtronic; research support from Siemens, Regeneron, and Osprey. Shareholder: MHI Ventures. Board of Trustees: Society of Cardiovascular Angiography and Interventions. The remaining authors have no conflicts of interest to disclose.
© 2018 Canadian Cardiovascular Society