Angiographic success and procedural complications in patients undergoing retrograde percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 3,482 patients from 26 studies.
BACKGROUND
The efficacy and safety profile of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We sought to perform a weighted meta-analysis of the success and complication rates of retrograde CTO PCI.


METHODS
We conducted a meta-analysis of 26 studies published between 2006 and April 2013 reporting in-hospital outcomes of retrograde CTO PCI. Data on procedural success, frequency of death, emergent coronary artery bypass graft surgery (CABG), stroke, myocardial infarction (MI), perforation, tamponade, stent thrombosis, major vascular or bleeding events, contrast nephropathy, and radiation skin injury were collected.


RESULTS
A total of 26 studies with 3482 patients and 3493 target CTO lesions were included. Primary retrograde CTO PCI was attempted in 52.4%. Pooled estimates of outcomes were as follows: procedural success 83.3% [95% confidence interval (CI): 79.0% to 87.7%]; death 0.7% (95% CI: 0.5% to 1.2%); urgent CABG 0.7% (95% CI: 0.4% to 1.2%); tamponade 1.4% (95% CI: 1.0% to 2.2%); collateral perforation 6.9% (95% CI: 4.6% to 10.4%); coronary perforation 4.3% (95% CI: 1.2% to 15.4%); donor vessel dissection 2% (95% CI: 0.9% to 4.5%); stroke 0.5% (95% CI: 0.2% to 1.0%); MI 3.1% (95% CI: 0.2% to 5.0%); Q wave MI 0.6% (95% CI: 0.4% to 1.1%); vascular access complications 2% (95% CI: 0.9% to 4.5%); contrast nephropathy 1.8% (95% CI: 0.8% to 3.7%); and wire fracture and equipment entrapment 1.2% (95% CI: 0.6% to 2.5%).


CONCLUSIONS
Retrograde CTO PCI is associated with high procedural success rate and acceptable risk for procedural complications.
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Abdallah
A
El Sabbagh
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Vishal G
VG
Patel
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Omar M
OM
Jeroudi
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Tesfaldet T
TT
Michael
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Mohammed E
ME
Alomar
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Owen
O
Mogabgab
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Eric
E
Fuh
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Michele
M
Roesle
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Bavana V
BV
Rangan
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Shuaib
S
Abdullah
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Jeffrey L
JL
Hastings
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Jerrold
J
Grodin
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Dharam J
DJ
Kumbhani
University of Patras, Patras, Greece.
Dimitrios
D
Alexopoulos
Medical College of Wisconsin, Milwaukee, WI, USA.
Panayotis
P
Fasseas
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA.
Subhash
S
Banerjee
VA North Texas Health Care System, The University of Texas Southwestern Medical School, Dallas, TX, USA. Electronic address: esbrilakis@gmail.com.
Emmanouil S
ES
Brilakis
D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012074:Remission Induction
Chronic total occlusion; Complications; Outcomes; Percutaneous coronary intervention; Retrograde