International journal of cardiology | 2019
Impact of concomitant treatment of non-chronic total occlusion lesions at the time of chronic total occlusion intervention.
Abstract
BACKGROUND\nDuring chronic total occlusion (CTO) percutaneous coronary intervention (PCI), sometimes non-CTO lesions are also treated.\n\n\nMETHODS\nWe compared the clinical and procedural characteristics and outcomes of CTO PCIs with and without concomitant treatment of a non-CTO lesion in a contemporary multicenter CTO registry.\n\n\nRESULTS\nOf the 3598 CTO PCIs performed at 21 centers between 2012 and 2018, 814 (23%) also included PCI of at least one non-CTO lesion. Patients in whom non-CTO lesions were treated were older (65\u202f±\u202f10 vs. 64\u202f±\u202f10\u202fyears, p\u202f=\u202f0.03), more likely to present with an acute coronary syndrome (32% vs. 23%, p\u202f<\u202f0.01), and less likely to undergo PCI of a right coronary artery (RCA) CTO (46% vs. 58%, p\u202f<\u202f0.01). The most common non-CTO lesion location was the left anterior descending artery (31%), followed by the circumflex (29%) and the RCA (25%).Combined non-CTO and CTO-PCI procedures had similar technical (88% vs. 87%, p\u202f=\u202f0.33) and procedural (85% vs. 85%, p\u202f=\u202f0.74) success and major in-hospital complication rates (3.4% vs. 2.7%, p\u202f=\u202f0.23), but had longer procedure duration (131 [88, 201] vs. 117 [75, 179] minutes, p\u202f<\u202f0.01), higher patient air kerma radiation dose (3.0 [1.9, 4.8] vs. 2.8 [1.5, 4.6] Gray, p\u202f<\u202f0.01) and larger contrast volume (300 [220, 380] vs. 250 [180, 350] ml, p\u202f<\u202f0.01).\n\n\nCONCLUSIONS\nCombined CTO PCI with PCI of non-CTO lesions is associated with similar success and major in-hospital complication rates compared with cases in which only CTOs were treated, but requires longer procedure duration and higher radiation dose and contrast volume.