title: Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry.
abstract: We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
  
  
  
  We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres.
  
  
  
  Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs 89.6% vs 93.0%; P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; P = 0.31) for older vs younger occlusions.
  
  
  
  Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success.
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Danek
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.affiliation: Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Columbia University, New York, New York, USA.
authors.forename: Khaldoon
authors.initials: K
authors.lastname: Alaswad
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Farouc A
authors.initials: FA
authors.lastname: Jaffer
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: VA San Diego Healthcare System and University of California San Diego, La Jolla, California, USA.
authors.forename: Mitul P
authors.initials: MP
authors.lastname: Patel
authors.affiliation: VA San Diego Healthcare System and University of California San Diego, La Jolla, California, USA.
authors.forename: John
authors.initials: J
authors.lastname: Bahadorani
authors.affiliation: PeaceHealth St Joseph Medical Center, Bellingham, Washington, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Lombardi
authors.affiliation: Torrance Memorial Medical Center, Torrance, California, USA.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Wyman
authors.affiliation: Mid America Heart Institute, Kansas City, Missouri, USA.
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
authors.affiliation: Piedmont Heart Institute, Atlanta, Georgia, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.affiliation: Piedmont Heart Institute, Atlanta, Georgia, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Lembo
authors.affiliation: Medical Center of the Rockies, Loveland, Colorado, USA.
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Doing
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Catalin
authors.initials: C
authors.lastname: Toma
authors.affiliation: Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Ali
authors.affiliation: Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
authors.affiliation: Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Phuong-Khanh
authors.initials: PK
authors.lastname: Nguyen-Trong
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Judit
authors.initials: J
authors.lastname: Karacsonyi
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Aya J
authors.initials: AJ
authors.lastname: Alame
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Pratik
authors.initials: P
authors.lastname: Kalsaria
authors.affiliation: Boston Scientific, Natick, Massachusetts, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Thompson
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA. 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 / Q000379:methods; D054059:Coronary Occlusion / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000473:pathology