Percutaneous Intervention of Circumflex Chronic Total Occlusions Is Associated With Worse Procedural Outcomes: Insights From a Multicentre US Registry

Georgios Christopoulos, Dimitri Karmpaliotis, Michael R. Wyman, Khaldoon Alaswad, James McCabe, William L. Lombardi, J. Aaron Grantham, Steven P. Marso, Anna P. Kotsia, Bavana V. Rangan, Santiago A. Garcia, Nicholas Lembo, David Kandzari, James Lee, Anna Kalynych, Harold Carlson, Craig A. Thompson, Subhash Banerjee, Emmanouil S. Brilakis

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32 Scopus citations


Background: We sought to determine whether outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary according to CTO target vessel: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). Methods: We evaluated the clinical and angiographic characteristics and procedural outcomes of 636 patients who underwent CTO PCI at 6 high-volume centres in the United States between January 2012 and March2014. Results: The CTO target vessel was the RCA in 387 cases (61%), LAD in 132 (21%), and LCX in 117 (18%). LCX lesions were more tortuous and RCA lesions had greater occlusion length and Japanese Chronic Total Occlusion (J-CTO) score, but were less likely to have a side branch at the proximal cap and had more developed collateral circulation. The rate of procedural success was lower in LCX CTOs (84.6%), followed by RCA (91.7%), and LAD (94.7%) CTOs (. P= 0.016). Major complications tended to occur more frequently in LCX PCI (4.3% vs 1.0% for RCA vs 2.3% for LAD; P= 0.07). LCX and RCA CTO PCI required longer fluoroscopy times (45 [interquartile range (IQR), 30-74] minutes vs 45 [IQR, 21-69] minutes for RCA vs 34 [IQR, 20-60] minutes for LAD; P= 0.018) and LCX CTOs required more contrast administration (280 [IQR, 210-370] mL vs 250 [IQR, 184-350] mL for RCA and 280 [IQR, 200-400] mL for LAD). Conclusions: In a contemporary, multicentre CTO PCI registry, LCX was the least common target vessel. Compared with LAD and RCA, PCI of LCX CTOs was associated with a lower rate of procedural success, less efficiency, and a nonsignificant trend for higher rates of complications.

Original languageEnglish (US)
Pages (from-to)1588-1594
Number of pages7
JournalCanadian Journal of Cardiology
Issue number12
StatePublished - Dec 1 2014

Bibliographical note

Funding Information:
Dr Marso: consultant for St Jude Medical, Novo Nordisk, and the Medicines Company; research grants from Bristol-Myers Squibb , Novo Nordisk , Terumo , The Medicines Company , and Volcano Corporation . Dr Garcia: consulting fees from Medtronic. Dr Lembo: speaker bureau: Medtronic; advisory board: Abbott Vascular and Medtronic. Dr. Kandzari: research/grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular, and research/grant support from Abbott . Dr Thompson: employee of Boston Scientific. Dr Banerjee: research grants from Gilead and the Medicines Company ; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCARE Global (spouse); and intellectual property in HygeiaTel. Dr Brilakis: consulting honoraria/speaker fees from Sanofi, Janssen, St Jude Medical, Terumo, Asahi, Abbott Vascular, and Boston Scientific; research grant from Guerbet ; spouse is an employee of Medtronic. The remaining authors have no conflicts of interest to disclose.

Funding Information:
Dr Karmpaliotis: speaker bureau, Abbott Vascular and Medtronic; consultant, Bridgepoint Medical. Dr Wyman: honoraria/consulting/speaking fees from Boston Scientific, Abbott Vascular, and Asahi. Dr Alaswad: consulting fees from Terumo and Boston Scientific; consultant, no financial, Abbott Laboratories. Dr Lombardi: equity with Bridgepoint Medical. Dr Grantham: speaking fees, consulting, and honoraria from Boston Scientific, and Asahi Intecc; research grants from Boston Scientific , Asahi Intecc , Abbott Vascular , and Medtronic .

Funding Information:
Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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