title: Influence about the flow of distal branch after intervention of the right coronary artery chronic total occlusion.
abstract: OBJECTIVE
  Limited data are available for the clinical outcomes after the recanalization of right coronary artery (RCA) chronic total occlusion (CTO). The study aims to assess the clinical outcomes in the antegrade flow of the distal branch after successful RCA CTO percutaneous coronary intervention (PCI).
  
  
  METHODS
  Between January 2002 and December 2012, 538 patients who underwent RCA CTO PCI were enrolled. The clinical outcomes as myocardial infarction (MI), target vessel revascularization, cardiac death, major adverse cardiac events, and all-cause mortality, were compared to the antegrade flow of distal branch after successful RCA CTO PCI.
  
  
  RESULTS
  The CTOs were located in proximal segments (57.6%), mid segments (27.5%) and distal segments (14.9%). The average Syntax score was 18.4±9.6 and 47.8% patients had a Syntax score greater than 27.5. A total of 62.8% patients had final thrombolysis of myocardial infarction (TIMI)-3 flow of distal branch, 16.9% patients had final TIMI-3 flow of only one major branch, 11.3% patients had TIMI-1-2 flow, and 8.9% patients had no antegrade flow. The incidence of periprocedural MI was lower in both side branches were preserved (13.9% vs. 23.0% and 18.8%, p=0.01). The clinical outcomes were similar between the groups with and without good antegrade flow of distal side branch. End stage renal disease (ESRD) and left ventricular ejection fraction (LVEF) <40% predicted three-year cardiac death.
  
  
  CONCLUSIONS
  There is no significant difference of clinical outcomes when distal side branches of RCA are recanalized successfully. ESRD and LVEF <40% were the predictors for three-year cardiac death.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hsiu-Yu
authors.initials: HY
authors.lastname: Fang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: leeweichieh@yahoo.com.tw.
authors.forename: Wei-Chieh
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D054059:Coronary Occlusion / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Chronic total occlusion; Posterior descending artery; Posterolateral branch; Right coronary artery