Background We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres. Results Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs 89.6% vs 93.0%; P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; P = 0.31) for older vs younger occlusions. Conclusions Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success.
Bibliographical noteFunding Information:
Supported by Clinical and Translational Science Award (CTSA) National Institutes of Health grant UL1-RR024982.
Dr Karmpaliotis: speaker's bureau: Abbott Vascular, MEDTRONIC; consultant fees/honoraria: Asahi, Boston Scientific. Dr Alaswad: consultant fees/honoraria: Asahi, Terumo and Boston Scientific; speaker's bureau: Abbott Vascular. Dr Jaffer: consultant fees/honoraria: Abbott Vascular, Boston Scientific; research grant from National Institutes of Health (HL-R01-108229), Kowa Ltd, Merck, Siemens. Dr Yeh: career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute; consultant fees/honoraria: Boston Scientific, Gilead Sciences. Dr Wyman: consultant fees/honoraria: Boston Scientific, Abbott Vascular, and Asahi. Dr Grantham: consultant fees/honoraria: Abbott Vascular, Asahi, Boston Scientific. Research grants: Boston Scientific, Asahi, Abbott Vascular, MEDTRONIC, Bridgepoint Medical. Dr Kandzari: consultant fees/honoraria: Boston Scientific, Medicines Company, MEDTRONIC. Dr Lembo: consultant fees/honoraria: Abbott Vascular, Boston Scientific, MEDTRONIC. Dr Moses: Research grants: Abiomed. Dr Kirtane: research grants: Boston Scientific, MEDTRONIC, Abbott Vascular, Abiomed, St. Jude Medical, GlaxoSmithKline, and Eli Lilly. Dr Ali: consultant fees/honoraria: St Jude Medical, AstraZeneca Pharmaceuticals; ownership interest/partnership/principal: Shockwave Medical, VitaBx Inc; research grants: MEDTRONIC, St Jude Medical. Dr Garcia: consulting fees from Medtronic and Surmodics. Dr Rangan: research grant from InfraReDx and Spectranetics. Dr Thompson: salary: Boston Scientific. Dr 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. Dr Brilakis: consultant fees/honoraria: Abbott Vascular, Asahi, Boston Scientific, Elsevier, Somahlution, St Jude, Terumo; research grants: Boston Scientific, InfraReDx; salary: MEDTRONIC (spouse). The remaining authors have no conflicts of interest to disclose.