title: Clinical, angiographic, and procedural predictors of periprocedural complications during chronic total occlusion percutaneous coronary intervention.
abstract: OBJECTIVE
  To identify clinical, angiographic, and procedural factors associated with increased risk of periprocedural complications during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Successful CTO PCI can provide significant clinical benefit; however, procedural risks have received limited study. We sought to identify factors associated with increased CTO PCI periprocedural risk that could be utilized to guide patient and lesion selection.
  
  
  METHODS
  The clinical, angiographic, and procedural records of 336 consecutive CTO PCI procedures performed at a single center from May 2005 through 2012 were reviewed, and data on periprocedural complications were recorded. Logistic regression was performed to identify independent predictors of periprocedural complications during CTO PCI.
  
  
  RESULTS
  The incidence of major and minor complications was 3.9% and 10.4%, respectively. Minor bleeding and vascular events were the most common complications (4.8%), followed by perforation (2.4%), contrast-induced nephropathy (1.8%), and transient hypotension (0.6%). Major complications were uncommon: death (0.3%); emergency coronary artery bypass grafting (0.6%); stroke (0.3%); tamponade (0.3%); clinical myocardial infarction (0.9%); donor vessel injury (0.6%); and major bleeding or vascular events (0.9%). Patients who experienced any complication had higher preprocedure troponin levels and were more likely to undergo treatment using the retrograde approach. In multivariable analysis, use of the retrograde approach was independently associated with increased risk of periprocedural complications (odds ratio, 2.057; 95% confidence interval, 1.045-4.051; P=.04).
  
  
  CONCLUSIONS
  Major complications of CTO PCI are infrequent, but are more common with use of the retrograde approach.
authors.affiliation: Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, TX 75216 USA. esbrilakis@yahoo.com.
authors.forename: Vishal G
authors.initials: VG
authors.lastname: Patel
authors.forename: Tesfaldet T
authors.initials: TT
authors.lastname: Michael
authors.forename: Owen
authors.initials: O
authors.lastname: Mogabgab
authors.forename: Eric
authors.initials: E
authors.lastname: Fuh
authors.forename: Avantika
authors.initials: A
authors.lastname: Banerjee
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Brayton
authors.forename: Daisha J
authors.initials: DJ
authors.lastname: Cipher
authors.forename: Shuaib M
authors.initials: SM
authors.lastname: Abdullah
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D057772:Vascular System Injuries / Q000453:epidemiology
chemical_list: D003287:Contrast Media