title: Percutaneous intervention of circumflex chronic total occlusions is associated with worse procedural outcomes: insights from a Multicentre US Registry.
abstract: BACKGROUND
  We sought to determine whether outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary according to CTO target vessel: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA).
  
  
  METHODS
  We evaluated the clinical and angiographic characteristics and procedural outcomes of 636 patients who underwent CTO PCI at 6 high-volume centres in the United States between January 2012 and March 2014.
  
  
  RESULTS
  The CTO target vessel was the RCA in 387 cases (61%), LAD in 132 (21%), and LCX in 117 (18%). LCX lesions were more tortuous and RCA lesions had greater occlusion length and Japanese Chronic Total Occlusion (J-CTO) score, but were less likely to have a side branch at the proximal cap and had more developed collateral circulation. The rate of procedural success was lower in LCX CTOs (84.6%), followed by RCA (91.7%), and LAD (94.7%) CTOs (P = 0.016). Major complications tended to occur more frequently in LCX PCI (4.3% vs 1.0% for RCA vs 2.3% for LAD; P = 0.07). LCX and RCA CTO PCI required longer fluoroscopy times (45 [interquartile range (IQR), 30-74] minutes vs 45 [IQR, 21-69] minutes for RCA vs 34 [IQR, 20-60] minutes for LAD; P = 0.018) and LCX CTOs required more contrast administration (280 [IQR, 210-370] mL vs 250 [IQR, 184-350] mL for RCA and 280 [IQR, 200-400] mL for LAD).
  
  
  CONCLUSIONS
  In a contemporary, multicentre CTO PCI registry, LCX was the least common target vessel. Compared with LAD and RCA, PCI of LCX CTOs was associated with a lower rate of procedural success, less efficiency, and a nonsignificant trend for higher rates of complications.
authors.affiliation: Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.affiliation: Department of Cardiology, Columbia University, New York, New York, USA.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Department of Cardiology, Torrance Memorial Center, Los Angeles, California, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Wyman
authors.affiliation: Department of Cardiology, Appleton Medical Center and Theda Clark Medical Center, Appleton, Wisconsin, USA.
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: Department of Cardiology, University of Washington, Seattle, Washington, USA.
authors.forename: James
authors.initials: J
authors.lastname: McCabe
authors.affiliation: Department of Cardiology, University of Washington, Seattle, Washington, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.affiliation: Department of Cardiology, Saint Luke's Mid America Heart Institute and The University of Missouri-Kansas City, Kansas City, Missouri, USA.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: Department of Cardiology, Saint Luke's Mid America Heart Institute and The University of Missouri-Kansas City, Kansas City, Missouri, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
authors.affiliation: Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Anna P
authors.initials: AP
authors.lastname: Kotsia
authors.affiliation: Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: Department of Cardiology, Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Santiago A
authors.initials: SA
authors.lastname: Garcia
authors.affiliation: Department of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lembo
authors.affiliation: Department of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA.
authors.forename: David
authors.initials: D
authors.lastname: Kandzari
authors.affiliation: Department of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA.
authors.forename: James
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Kalynych
authors.affiliation: Department of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA.
authors.forename: Harold
authors.initials: H
authors.lastname: Carlson
authors.affiliation: Department of Cardiology, Boston Scientific, Natick, Massachusetts, USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address: emmanouil.brilakis@utsouthwestern.edu.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology