title: Procedural and in-hospital outcomes after percutaneous coronary intervention for chronic total occlusions of coronary arteries 2002 to 2008: impact of novel guidewire techniques.
abstract: The aim of this study was to examine the procedural success and in-hospital outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions in the current era during contemporary practice. The technique of PCI has improved over time with the introduction of novel equipment and guidewire crossing techniques. However, there is limited data available from contemporary practice in the recent years. We evaluated the procedural and in-hospital outcomes in a consecutive series of 904 procedures performed at Toyohashi Heart Center for PCI of chronic total occlusions of >3 months in duration. Technical and procedural success was achieved in 87.5% and 86.2%, respectively. In-hospital major adverse cardiac events occurred in only 1.9% of the patients. Single antegrade wire was the predominant strategy for guidewire crossing; however, retrograde guidewire crossing was used in 7.2% of the cases and controlled antegrade and retrograde subintimal tracking in 9.9% of the cases as the final strategy. Logistic regression analysis identified severe tortuosity and moderate-to-severe calcification as significant predictors of procedural failure. This is the first reported large series of patients undergoing PCI for chronic total occlusion with improved wire crossing techniques. We have reported high success rates in recent years and very low complication rates despite the use of more aggressive devices and techniques.
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. sudhirrathore@hotmail.com
authors.forename: Sudhir
authors.initials: S
authors.lastname: Rathore
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuo
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Mariko
authors.initials: M
authors.lastname: Ehara
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Asakura
authors.forename: Osamu
authors.initials: O
authors.lastname: Katoh
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D002114:Calcinosis / Q000150:complications; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D019992:Databases as Topic; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome