title: Chronic Total Occlusion - Percutaneous Coronary Intervention (CTO-PCI) Experience in a Single, Multi-operator Australian Centre: Need for dedicated CTO-PCI programs.
abstract: BACKGROUND
  Chronic total occlusions (CTOs) represent a unique set of lesions for percutaneous coronary intervention (PCI) because of the complexity of techniques required to treat them.
  
  
  METHODS
  We retrospectively reviewed the CTO-PCI experience between January 2010 and December 2012, in a multi-operator single centre, which is one of the largest volume PCI centres in Australia.
  
  
  RESULTS
  Eighty-two patients (62.6±11.3 years, 85% males) who had CTO-PCIs were included. The most common site of CTO was the right coronary artery (44%), followed by the left circumflex (30%) and left anterior descending (26%) arteries. Using the Japanese CTO scoring system, 34% of lesions were classified as easy, 37% intermediate, 23% difficult and 6% very difficult. All PCIs were performed by antegrade approach. Selected procedural characteristics included: re-attempt procedure 10%; multiple access sites 21%; more than one guidewire 77%; additional support modality 60%; drug-eluting stents 97%; stent number 1.6±0.8; total stent length 40.1±24.5mm; fluoroscopy time 33±17min; contrast volume 257.2±110.8mL. Overall CTO success rate was 60%. In-hospital adverse outcomes included 1.2% mortality, 9.8% peri-procedural myocardial infarction, 4.9% emergency bypass surgery, 3% cardiac tamponade and 4.9% contrast induced nephropathy.
  
  
  CONCLUSIONS
  We report modest success rates in a single Australian centre experience in a relatively conservative cohort of CTO-PCI prior to the initiation of a dedicated CTO revascularisation program.
authors.affiliation: Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, Monash Health and Monash University, Melbourne, Vic, Australia. Electronic address: vimalcardio@yahoo.com.
authors.forename: Vimalraj
authors.initials: V
authors.lastname: BoganaShanmugam
authors.affiliation: Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, Monash Health and Monash University, Melbourne, Vic, Australia; School of Medicine, University of Adelaide and Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Psaltis
authors.affiliation: Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, Monash Health and Monash University, Melbourne, Vic, Australia.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Wong
authors.affiliation: Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, Monash Health and Monash University, Melbourne, Vic, Australia.
authors.forename: Sujith
authors.initials: S
authors.lastname: Seneviratne
authors.affiliation: Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, Monash Health and Monash University, Melbourne, Vic, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Cameron
authors.affiliation: Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, Monash Health and Monash University, Melbourne, Vic, Australia.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Meredith
authors.affiliation: Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, Monash Health and Monash University, Melbourne, Vic, Australia.
authors.forename: Yuvaraj
authors.initials: Y
authors.lastname: Malaiapan
mesh_terms: D000368:Aged; D054059:Coronary Occlusion / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology*; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies
keywords: CTO program; CTO-PCI; Chronic total occlusion; Complex coronary intervention; Percutaneous coronary intervention