Contemporary success and complication rates of percutaneous coronary intervention for chronic total coronary occlusions: results from the ALKK quality control registry of 2006.
OBJECTIVE
Despite successful prevention of lesion recurrence by drug-eluting stents (DES), and the advancement in procedural techniques in the treatment of chronic total coronary occlusions (CTO), the number of CTOs treated by percutaneous coronary intervention (PCI) is still low as compared to their prevalence. This study aims to assess the outcome of PCI for CTOs in a contemporary survey of PCI in interventional centres in Germany.


RESULTS
The basis of this analysis is the 2006 quality assessment database of PCI conducted by the ALKK (working group of cardiology centres). Thirty-five centres contributed to this database, representing about 10% of all interventional centres of Germany. From a total of 20,502 patients, 8,882 patients with stable angina were selected. Of these 674 patients (7.6%) underwent PCI for a CTO. Their procedural characteristics and the hospital outcome were compared with patients treated for non-occlusive lesions. As compared to non-occlusive lesions, less patients underwent ad hoc PCI for a CTO. The fluoroscopy time was almost double of that in non-occlusive lesions, and contrast usage was significantly higher. The success rate was 60.1% as compared to 97.3% (p<0.001). Severe intraprocedural and in-hospital complications were similar for CTO and non-CTO lesions. Almost all patients with a CTO received a stent; DES were used in 53.4%, which was higher than the rate in non-CTO lesions (38.9%; p<0.001).


CONCLUSIONS
Although the success rate for PCI in CTOs is still well below that in non-occlusive lesions, this procedure is safe, encouraging its wider application. The low rate of DES use did not reflect the evidence for DES in CTOs.
Werner
Gerald S
GS
Medizinische Klinik I, Klinikum Darmstadt, Germany. gerald.werner@klinikum-darmstadt.de
Hochadel
Matthias
M
Zeymer
Uwe
U
Kerber
Sebastian
S
Schumacher
Burghard
B
Grube
Eberhard
E
Hauptmann
Karl Eugen
KE
Brueck
Martin
M
Zahn
Ralf
R
Senges
Jochen
J
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000592:standards*; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000453:epidemiology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D011786:Quality Control; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors