Predictors of Complications During Chronic Total Occlusion PCI

109 9
Predictors of Complications During Chronic Total Occlusion PCI

Results

Incidence of Periprocedural Complications


Between 2005 and 2012, a total of 336 patients underwent CTO PCI at our institution. A total of 45 patients (13.4%) experienced 48 complications (3 patients had both a major and minor complication) (Table 1). The majority of these complications were minor (35 events, 10.4%). There were 13 major complications (3.9%) as follows: death (0.3%); emergent CABG (0.6%); stroke/transient ischemic attack (0.3%); clinical myocardial infarction (0.9%); tamponade (0.3%, occurred in a patient with distal wire perforation that developed tamponade 1 hour after the end of a successful procedure); donor vessel injury (0.6%); and major bleeding/vascular events (0.9%).

The 1 death in our series occurred after right coronary artery (RCA) CTO PCI that was complicated by acute marginal occlusion that could not be recanalized. Although stable during the procedure, the patient arrested from pulseless electrical activity arrest hours later and was unable to be resuscitated. Emergency CABG was required in 2 patients in our series. One patient undergoing PCI of a left anterior descending coronary artery using the retrograde approach developed RCA dissection. Although the patient remained hemodynamically stable, the RCA could not be recanalized and emergency CABG was performed. Another patient underwent emergency CABG because of entrapment of a Tornus catheter (Asahi Intecc) during attempts to cross an RCA CTO.

The most common minor complications were minor bleeding/vascular events (4.8%), followed by perforation (2.4%) and contrast-induced nephropathy (1.8%). The remaining minor complications were infrequent, occurring in ≤0.6% of cases.

Baseline Clinical Characteristics


Compared to patients who did not experience a major or minor periprocedural complication, those who did were similar in age, coronary risk factors, ejection fraction, and history of prior CABG (Table 2). The clinical presentation was also similar in the two groups. However, precatheterization creatine kinase (CK)-MB and troponin levels were higher in those who experienced a complication.

Angiographic Characteristics


Patients who experienced no complications had similar target CTO vessel occlusion duration and anatomic characteristics compared to those who had a major or minor complication (Table 3). The most common CTO target vessel was the RCA, and most CTOs were >12 months old. Tapered proximal cap with mild lesion calcification, slight proximal tortuosity, and good distal opacification were the most common anatomic features. A side branch at the proximal cap and an adequate distal landing zone were present in approximately half of the cases.

Procedural Characteristics


Patients who experienced a minor complication had similar procedural characteristics compared to those who experienced no complications; however, patients with major complications were more likely to have bifemoral access, and to have undergone crossing attempts using the retrograde approach compared to those without periprocedural complications (Table 4). Patients with major complications had longer procedure time (212.1 minutes vs 135.8 minutes; P<.001) and fluoroscopy time (65.2 minutes vs 38.2 minutes; P<.001), higher contrast utilization (501.7 mL vs 351.7 mL; P<.001), and higher radiation dose area product (504323 Gray cm vs 327483 Gray cm; P<.001) compared to those with no complications. There was no difference in the rates of technical success or the number of stents implanted in patients with no complications compared to those with major or minor complications.

Predictors of Procedural Complications


Candidate parameters associated with any (major or minor) periprocedural complication during CTO PCI included precatheterization troponin level, hyperlipidemia, and use of the retrograde approach. In multiple logistic regression analysis, use of the retrograde approach was associated with an increased risk of any periprocedural complication during CTO PCI (odds ratio, 2.057; P=.04; Figure 1). No other significant predictors or confounders were identified. There was a higher rate of all major complications with the retrograde approach compared to the non-retrograde approach (Table 5).



(Enlarge Image)



Figure 1.



Multivariable analysis of factors associated with periprocedural complications during chronic total occlusion interventions.





Source...
Subscribe to our newsletter
Sign up here to get the latest news, updates and special offers delivered directly to your inbox.
You can unsubscribe at any time

Leave A Reply

Your email address will not be published.