title: Long-term major adverse cardiac and cerebrovascular events (MACCE) rate : Comparison of retrograde and antegrade recanalization of chronic total coronary occlusions.
abstract: BACKGROUND
  The recanalization success rate of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be increased by the retrograde approach; however, the long-term outcome of patients undergoing retrograde procedures is unknown.
  
  
  OBJECTIVE
  We aimed to evaluate the long-term major adverse cardiac and cerebrovascular event (MACCE) rate (e.g. death, myocardial infarction, coronary artery bypass surgery and stroke) in patients after retrograde versus antegrade CTO-PCI.
  
  
  RESULTS
  In a prospective single center study from January 2008 to June 2012, 396 consecutive patients with CTO (≥3 months old) were enrolled. The mean age was 63.4 ± 10.3 years and 86.4% were male. The success rate of the total patient cohort was 88.6%. The retrograde PCI, only attempted after a failed antegrade intervention, was performed in 18% (n = 71) of patients. Long-term MACCE rate (mean follow up 2.3 ± 1.6 years) was significantly higher in the unsuccessful compared to the successful CTO-PCI group (23.1% versus 9.4%, p = 0.01) and this was also the case in the subgroup of antegrade CTO-PCI. In the retrograde subgroup, however, procedural success had no impact on outcome. Patients with unsuccessful retrograde CTO-PCI had a significantly better collateral connection compared to patients with an unsuccessful antegrade approach. Independent predictors for MACCE were peripheral artery disease and an ejection fraction ≤30%.
  
  
  CONCLUSIONS
  The long-term MACCE rate after unsuccessful recanalization was significantly higher, which was driven by a higher MACCE rate after unsuccessful versus successful antegrade approaches. In contrast, procedural success in the retrograde group had no impact on outcome.
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Wördemannsweg 25-27, 22527, Hamburg, Germany.
authors.forename: Klaudija
authors.initials: K
authors.lastname: Bijuklic
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Wördemannsweg 25-27, 22527, Hamburg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Schwencke
authors.affiliation: Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Wördemannsweg 25-27, 22527, Hamburg, Germany. schofer@herz-hh.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schofer
mesh_terms: D015897:Comorbidity; D023921:Coronary Stenosis / Q000401:mortality* / Q000601:surgery*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D020521:Stroke / Q000401:mortality* / Q000517:prevention & control; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Antegrade approach; Chronic total occlusion; Long term follow-up; MACCE; Retrograde