The frequency and outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of more than one CTO during the same procedure have received limited study. We compared the clinical and angiographic characteristics and procedural outcomes of patients who underwent treatment of single versus >1 CTOs during the same procedure in 20 centers from the United States, Europe, and Russia. A total of 2,955 patients were included: mean age was 65 ± 10 years and 85% were men with high prevalence of previous myocardial infarction (46%), and previous coronary artery bypass graft surgery (33%). More than one CTO lesions were attempted during the same procedure in 58 patients (2.0%) and 70% of them were located in different major epicardial arteries. Compared with patients who underwent PCI of a single CTO, those who underwent PCI of >1 CTOs during the same procedure had similar J-CTO (2.4 ± 1.3 vs 2.5 ± 1.3, p = 0.579) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (1.5 ± 1.2 vs 1.3 ± 1.0 p = 0.147) scores. The multi-CTO PCI group had similar technical success (86% vs 87%, p = 0.633), but higher risk of in-hospital major complications (10.3% vs 2.7%, p = 0.005), and consequently numerically lower procedural success (79% vs 85%, p = 0.197). The multi-CTO PCI group had higher in-hospital mortality (5.2% vs 0.5%, p = 0.005) and stroke (5.2%vs 0.2%, p <0.001), longer procedure duration (162 [117 to 242] vs 122 [80 to 186] minutes, p <0.001) and higher radiation dose (3.6 [2.1 to 6.4] vs 2.9 [1.7 to 4.7] Gray, p = 0.033). In conclusion, staged revascularization may be the preferred approach in patients with >1 CTO lesions requiring revascularization, as treatment during a single procedure was associated with higher risk for periprocedural complications.
Bibliographical noteFunding Information:
The PROGRESS-CTO registry has received support from the Abbott Northwestern Hospital Foundation, Minneapolis, Minnesota.
Khaldoon Alaswaad, MD: consulting fees from Terumo and Boston Scientific; consultant, no financial, Abbott Laboratories. Dimitri Karmpaliotis, MD, PhD: Speaker honoraria: Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Farouc A. Jaffer, MD, PhD: Consultant: Abbott Vascular and Boston Scientific. Research grant: Canon, Siemens and National Institutes of Health. Robert W. Yeh, MD: Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Mitul Patel, MD: speakers' bureau for Astra Zeneca. Ehtisham Mahmud, MD: 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. M. Nicholas Burke, MD: consulting and speaker honoraria from Abbott Vascular and Boston Scientific. R. Michael Wyman, MD: Honoraria/consulting/speaking fees from Boston Scientific, Abbott Vascular, and Asahi. David E. Kandzari, MD: research/grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular, and research/grant support from Abbott. Santiago Garcia, MD: consulting fees from Medtronic. Jeffrey W. Moses, MD: consultant to Boston Scientific and Abiomed. Nicholas J. Lembo, MD: speaker bureau: Medtronic; advisory board Abbott Vascular and Medtronic. Manish Parikh, MD: speaker bureau: Abbot Vascular, Medtronic, CSI, BSC, Trireme; advisory boards: Medtronic, Abbott Vascular, Philips. Ajay J. Kirtane, MD: 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, MD: 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, BDS, MPH: Research grants from InfraReDx, Inc., and The Spectranetics Corporation. Subhash Banerjee, MD: 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, MD, PhD: consulting/speaker honoraria from Abbott Vascular, ACIST, Amgen, Asahi, CSI, Elsevier, GE Healthcare, Medicure, Medtronic, and Nitiloop; research support from Boston Scientific and Osprey. Board of Directors: Cardiovascular Innovations Foundation. Board of Trustees: Society of Cardiovascular Angiography and Interventions.