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One‐year outcomes after successful chronic total occlusion percutaneous coronary intervention: The impact of dissection re‐entry techniques

Lookup NU author(s): Dr Alan Bagnall, Dr Mohaned Egred

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Abstract

© 2017 Wiley Periodicals, Inc. We aimed to determine clinical outcomes 1 year after successful chronic total occlusion (CTO) PCI and, in particular, whether use of dissection and re-entry strategies affects clinical outcomes. Hybrid approaches have increased the procedural success of CTO percutaneous coronary intervention (PCI) but longer-term outcomes are unknown, particularly in relation to dissection and re-entry techniques. Data were collected for consecutive CTO PCIs performed by hybrid-trained operators from 7 United Kingdom (UK) centres between 2012 and 2014. The primary endpoint (death, myocardial infarction, unplanned target vessel revascularization) was measured at 12 months along with angina status. One-year follow up data were available for 96% of successful cases (n=805). In total, 85% of patients had a CCS angina class of 2-4 prior to CTO PCI. Final successful procedural strategy was antegrade wire escalation 48%; antegrade dissection and re-entry (ADR) 21%; retrograde wire escalation 5%; retrograde dissection and re-entry (RDR) 26%. Overall, 47% of CTOs were recanalized using dissection and re-entry strategies. During a mean follow up of 11.5±3.8 months, the primary endpoint occurred in 8.6% (n=69) of patients (10.3% (n=39/375) in DART group and 7.0% (n=30/430) in wire-based cases). The majority of patients (88%) had no or minimal angina (CCS class 0 or 1). ADR and RDR were used more frequently in more complex cases with greater disease burden, however, the only independent predictor of the primary endpoint was lesion length. CTO PCI in complex lesions using the hybrid approach is safe, effective and has a low one-year adverse event rate. The method used to recanalize arteries was not associated with adverse outcomes.


Publication metadata

Author(s): Wilson WM, Walsh SJ, Bagnall A, Yan AT, Hanratty CG, Egred M, Smith E, Oldroyd KG, McEntegart M, Irving J, Douglas H, Strange J, Spratt JC

Publication type: Article

Publication status: Published

Journal: Catheterization and Cardiovascular Interventions

Year: 2017

Volume: 90

Issue: 5

Pages: 703-712

Print publication date: 01/11/2017

Online publication date: 15/03/2017

Acceptance date: 17/01/2017

ISSN (print): 1522-1946

ISSN (electronic): 1522-726X

Publisher: John Wiley and Sons Inc.

URL: https://doi.org/10.1002/ccd.26980

DOI: 10.1002/ccd.26980


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