title: Effect of Previous Failure on Subsequent Procedural Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention (from a Contemporary Multicenter Registry).
abstract: We sought to examine the impact of previous failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic characteristics and procedural outcomes of 1,213 consecutive patients who underwent 1,232 CTO PCIs from 2012 to 2015 at 12 US centers. Mean age was 65 ± 10 years, and 84.8% of patients were men. A previously failed attempt had been performed in 215 patients (17.5%). As compared with patients without previous CTO PCI failure, patients with previous failure had higher Multicenter CTO Registry in Japan CTO score (2.40 ± 1.13 vs 3.28 ± 1.29, p <0.0001) and were more likely to have in-stent restenosis (10.5% vs 28.4%, p <0.0001) and to undergo recanalization attempts using the retrograde approach (41% vs 50%, p = 0.011). Technical (90% vs 88%, p = 0.390) and procedural (89% vs 86%, p = 0.184) success were similar in the 2 study groups; however, median procedure time (125 vs 142 minutes, p = 0.026) and fluoroscopy time (45 vs 55 minutes, p = 0.015) were longer in the previous failure group. In conclusion, a previously failed CTO PCI attempt is associated with higher angiographic complexity, longer procedural duration, and fluoroscopy time, but not with the success and complication rates of subsequent CTO PCI attempts.
authors.affiliation: Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Karacsonyi
authors.affiliation: Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University, New York, New York.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Department of Cardiology, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.affiliation: Department of Cardiology, Torrance Memorial Medical Center, Torrance, California.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Wyman
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Washington.
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.affiliation: Department of Cardiology, Mid America Heart Institute, Kansas City, Missouri.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia.
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.affiliation: Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lembo
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University, New York, New York.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University, New York, New York.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University, New York, New York.
authors.forename: Manish A
authors.initials: MA
authors.lastname: Parikh
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University, New York, New York.
authors.forename: Philip
authors.initials: P
authors.lastname: Green
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University, New York, New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Finn
authors.affiliation: Department of Medicine, Minneapolis Veterans Affairs Health Care System, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Department of Cardiology, Medical Center of the Rockies, Loveland, Colorado.
authors.forename: Anthony
authors.initials: A
authors.lastname: Doing
authors.affiliation: Department of Cardiology, Veterans Affairs San Diego Health Care System, University of California San Diego, San Diego, California.
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Veterans Affairs San Diego Health Care System, University of California San Diego, San Diego, California.
authors.forename: John
authors.initials: J
authors.lastname: Bahadorani
authors.affiliation: Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jose Roberto
authors.initials: JR
authors.lastname: Martinez Parachini
authors.affiliation: Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Erica
authors.initials: E
authors.lastname: Resendes
authors.affiliation: Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
authors.forename: Imre
authors.initials: I
authors.lastname: Ungi
authors.affiliation: Boston Scientific, Natick, Massachusetts.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000601:surgery*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology