TY - JOUR
T1 - Recent Trends in the Percutaneous Treatment of Chronic Total Coronary Occlusions
AU - Abbott, J. Dawn
AU - Kip, Kevin E.
AU - Vlachos, Helen A.
AU - Sawhney, Neil
AU - Srinivas, Vankeepuran S.
AU - Jacobs, Alice K.
AU - Holmes, David R.
AU - Williams, David O.
N1 - Funding Information:
The Dynamic Registry is supported by Grants HL-33292-14 and HL-33292-16 from the National Heart, Lung and Blood Institutes of Health, Bethesda, Maryland.
PY - 2006/6/15
Y1 - 2006/6/15
N2 - Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has a lower success rate than PCI for non-CTO lesions. We sought to determine trends in the treatment of CTOs within the current interventional era. Using 4 sequential recruitment waves of the National Heart, Lung, and Blood Institute Dynamic Registry, we assessed the relative prevalence and success rates in treating CTO (n = 371) versus non-CTO (n = 4,802) lesions over a 7-year period (1997 to 2004). Characteristics of attempted lesions and factors associated with PCI outcome were evaluated. CTO lesion attempts decreased by 41% over time, from 9.6% (1997 to 1998) to 5.7% (2004, p <0.0001 for trend). More contemporary CTO lesions were longer (22.4 vs 17.0 mm, p = 0.006 for trend), had thrombus less often (21.3% vs 35.4%, p = 0.03 for trend), and were more often treated with stents (69.8% vs 45.4% p = 0.02). The rate of successful intervention for CTO lesions decreased nonsignificantly during this time, from 79.7% to 71.4% (p = 0.18). Using multivariable analysis, female gender (adjusted odds ratio 0.42, 95% confidence interval 0.20 to 0.88, p = 0.02), and thrombus (adjusted odds ratio 0.31, 95% confidence interval 0.15 to 0.61, p = 0.0008) were associated with higher success rates, whereas the presence of severe noncardiac disease (adjusted odds ratio 1.91, 95% confidence interval 1.05 to 3.45, p = 0.03) was associated with a higher risk for PCI failure. Recruitment wave and patient age were not independently related to lesion success. In conclusion, during the PCI period of 1997 to 2004, CTO lesions were attempted less frequently and success rates did not increase, indicating a need for new operator techniques or device technologies to treat this important lesion subset by a percutaneous approach.
AB - Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has a lower success rate than PCI for non-CTO lesions. We sought to determine trends in the treatment of CTOs within the current interventional era. Using 4 sequential recruitment waves of the National Heart, Lung, and Blood Institute Dynamic Registry, we assessed the relative prevalence and success rates in treating CTO (n = 371) versus non-CTO (n = 4,802) lesions over a 7-year period (1997 to 2004). Characteristics of attempted lesions and factors associated with PCI outcome were evaluated. CTO lesion attempts decreased by 41% over time, from 9.6% (1997 to 1998) to 5.7% (2004, p <0.0001 for trend). More contemporary CTO lesions were longer (22.4 vs 17.0 mm, p = 0.006 for trend), had thrombus less often (21.3% vs 35.4%, p = 0.03 for trend), and were more often treated with stents (69.8% vs 45.4% p = 0.02). The rate of successful intervention for CTO lesions decreased nonsignificantly during this time, from 79.7% to 71.4% (p = 0.18). Using multivariable analysis, female gender (adjusted odds ratio 0.42, 95% confidence interval 0.20 to 0.88, p = 0.02), and thrombus (adjusted odds ratio 0.31, 95% confidence interval 0.15 to 0.61, p = 0.0008) were associated with higher success rates, whereas the presence of severe noncardiac disease (adjusted odds ratio 1.91, 95% confidence interval 1.05 to 3.45, p = 0.03) was associated with a higher risk for PCI failure. Recruitment wave and patient age were not independently related to lesion success. In conclusion, during the PCI period of 1997 to 2004, CTO lesions were attempted less frequently and success rates did not increase, indicating a need for new operator techniques or device technologies to treat this important lesion subset by a percutaneous approach.
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U2 - 10.1016/j.amjcard.2005.12.067
DO - 10.1016/j.amjcard.2005.12.067
M3 - Article
C2 - 16765115
AN - SCOPUS:33744549480
SN - 0002-9149
VL - 97
SP - 1691
EP - 1696
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 12
ER -