Predictors of Failure of Percutaneous Coronary Intervention in Patients with Chronic Total Coronary Occlusion at National Cardiovascular Center Indonesia
Abstract
Background. Percutaneous Coronary Intervention (PCI) in patients with Chronic Total Coronary Occlusion (CTO) is associated with higher rate of failure and higher rate of complication compared to non-CTO angioplasty. Improvement in technique, logistic and patient’s selection method lead to a better success rate. Identification of predictor of failure could be an important step in patient selection. The aim of the study is to know the predictors of failure of PCI in patients with CTO.Methods and results. A retrospective analysis of clinical and angiographic data of 78 consecutive eligible CTO patients who underwent PCI selected in series of 1205 total occluded vessel of 3654 angiographic patients in the year of 2005 in our catheterization laboratory. We analysed 25 variables, 12 clinical variables (age, sex, family history, smoking, diabetes mellitus, hypertension, history of myiocardial infarction, history of coronary bypass operation, age of occlusion >1 year, severe angina and poor left ventricle systolic dysfunction)and 13 angiographic variables (true CTO, CTO location, ostial lesion, calcification, tortousity, non-tapered type, side branch type, bridging collateral, diffuse disease, vessel diameter < 3mm, CTO length > 15mm, multi-lesion and multi vessel disease)by univariate and multivariate analysis (logistic regression) in association between 21 cases of procedural failure group and 57 cases of procedural success group. Procedural success was achieved in 57 patients (73%) and complication occured in one patient (1%). Majority of patients are male with mean age 55 year. Presence of calcification is the only predictor identified by univariate analysis (OR 3,28. p 0,04. 95%CI 1.05-10,18). Multivariate analysis identified multivessel disease (OR 7,1. p 0,07 .95%CI 0,85-59,21) and diffuse disease (OR 2,7. p 0,06 .95%CI 0,93-8,08) as predictors of procedural failure.
Conclusions. We identified multivessel disease and diffuse disease as two predictors of procedural failure of PCI in our series of CTO patients with 73% success rate and 1% complication rate in the year of 2005.
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References
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Stone GW, Kandzari DE, Mehran R et al. Percutaneous reca-nalization of chronically occluded coronary arteries: a consen-sus document: part I. Circulation2005; 112:2364 –2372.
Stone GW, Reifart NJ, Moussa I. et al. Percutaneous recanali-zation of chronically occluded coronary arteries: a consensus document: part II. Circulation.2005;112:2530-2537
Katsuragawa M, Fujiwara H, Miyamae M, et al. Histo-logic studies in percutaneous transluminal coronary angioplasty for chronic total occlusion: comparison of tapering and abrupt types of occlusion and short and long occluded segments. J Am Coll Cardiol 1993; 21: 604-11.
Srivatsa SS, Edwards WD, Boos CM, et al. Histo-logic corre-lates of angiographic chronic total coronary artery occlusions influence of occlusion duration on neovascular channel pat-terns and intimal plaque composition. J Am Coll Cardiol. 1997;29:955–963.
Melchior JP, Meier B, Urban P, et al. Percutaneous transluminal coronary angioplasty for chronic total coronary arterial occlu-sion. Am J Cardiol. 1987; 59:535–538.
Stone GW, Rutherford BD, McConahay DR et. al. Procedural outcome of angioplasty for total coronary artery occlusion: An analysis of 971 lesions in 905 patients. J Am Coll Cardiol 1990;15:849-56
Bell RM, Berger PB, Bresnahan JF, et al. Initial and longterm outcome of 354 patients after coronary balloon angioplasty of total coronary occlusions. Circulation 1992;85:1003-1011.
Maiello L, Colombo A, Gianrossi R et. al. Coronary angioplasty of chronic occlusions: Factors predictive of procedural success. Am Heart J1992;24:581
Ivanhoe RJ, Weintraub WS, Douglas JS Jr, et al.. 847 Percuta-neous transluminal coronary angio-plasty of chronic total oc-clusions: primary success, restenosis, and long-term clinical fol-low-up. Circulation. 1992;85:106– 115.
Tan KH, Sulke N, Taub NA, et.al. Determinants of success of coronary angioplasty in patients with a chronic total occlu-sion: a multiple logistic regression model to improve selection of patients. Br Heart J. 1993;70:126 –131.
Kaltenbach M, Hartmann A, Vallbracht C. Procedural results and patient selection in recanalization of chronic coronary oc-clusion by low speed rotational angioplasty. Eur Heart J 1993;14(6):826–830.
Kinoshita I, Katoh O, Nariyama J, et al. Coronary angioplasty of chronic total occlusions with bridging collateral vessels: Im-mediate and follow-up outcome from a large single-center ex-perience. J Am Coll Cardiol1995;26(2):409–415.
Noguchi T, Miyazaki MDS, Morii I, et.al. Percutaneous translu-minal coronary angioplasty of chronic total occlusions: deter-minants of primary success and long-term outcome. Cathet Cardiovasc Intervent. 2000;49:258 –264.
Suero JA, Marso SP, Jones PG, et.al. Procedural outcomes and long - term survival among patientsundergoing percutane-ous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol. 2001;38: 409–414.
Kahn JK. Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hos-pital setting. Am Heart J. 1993;126:561–564.
Olivari Z, Rubartelli P, Piscione F, Ettori F, Fontanelli A, Salemme L, Giachero C, Di Mario C, Gabrielli G, Spedicato L, Bedogni F, for the TOAST-GISE Investigators. Immediate results and one-year clinical outcome after percutaneous coro-nary interventions in chronic total occlusions: study (TOAST-GISE). J Am Coll Cardiol. 2003;41: 1672–1678.
Serruys PW, Hamburger JN, Koolen JJ, et.al Total occlusion trial with angioplasty by using laser guidewire. Eur Heart J. 2000;21:797–1805.
Hoye A, van Domburg RT, Sonnenschein K, et.al. Percutane-ous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992 – 2002. Eur Heart J 2005;26:2630.
Silber S, Albertsson P, Avile´s FF, et.al. The Task Force for Per-cutaneous Coronary Interventions of the European Society of Cardiology. Guidelines for Percutaneous Coronary Interven-tions. Eur Heart J2005; 26: 804–847
Freed MS, Safian RD. Chronic total occlusion. In The Manual of Interventional Cardiology. 3rd Edition. 2004. Physician Press. p 287.
Mitsudo K. New approaches to chronic total occlu-sions. In Antonio Colombo, Goran Stankovic. Colombo”s Tips&Tricks with Drug-Eluting Stents. Taylor and Francis. (2005). p.117.
Ochiai M, Ashida K, Araki H, Ogata N, et al. The latest wire technique for chronic total occlusion. Ital Heart J2005; 6 (6): 489-493
Muramatsu et al. Longterm outcome of 1000 CTO lesions. www.summitmd.com
Beth Dawson. Robert G Trapp. Basic & Clinical Biostatistics. 4th edition. Lange medical book. McGraw Hill.(2004). p. 245.
Stone GW, Kandzari DE, Mehran R et al. Percutaneous reca-nalization of chronically occluded coronary arteries: a consen-sus document: part I. Circulation2005; 112:2364 –2372.
Stone GW, Reifart NJ, Moussa I. et al. Percutaneous recanali-zation of chronically occluded coronary arteries: a consensus document: part II. Circulation.2005;112:2530-2537
Katsuragawa M, Fujiwara H, Miyamae M, et al. Histo-logic studies in percutaneous transluminal coronary angioplasty for chronic total occlusion: comparison of tapering and abrupt types of occlusion and short and long occluded segments. J Am Coll Cardiol 1993; 21: 604-11.
Srivatsa SS, Edwards WD, Boos CM, et al. Histo-logic corre-lates of angiographic chronic total coronary artery occlusions influence of occlusion duration on neovascular channel pat-terns and intimal plaque composition. J Am Coll Cardiol. 1997;29:955–963.
Melchior JP, Meier B, Urban P, et al. Percutaneous transluminal coronary angioplasty for chronic total coronary arterial occlu-sion. Am J Cardiol. 1987; 59:535–538.
Stone GW, Rutherford BD, McConahay DR et. al. Procedural outcome of angioplasty for total coronary artery occlusion: An analysis of 971 lesions in 905 patients. J Am Coll Cardiol 1990;15:849-56
Bell RM, Berger PB, Bresnahan JF, et al. Initial and longterm outcome of 354 patients after coronary balloon angioplasty of total coronary occlusions. Circulation 1992;85:1003-1011.
Maiello L, Colombo A, Gianrossi R et. al. Coronary angioplasty of chronic occlusions: Factors predictive of procedural success. Am Heart J1992;24:581
Ivanhoe RJ, Weintraub WS, Douglas JS Jr, et al.. 847 Percuta-neous transluminal coronary angio-plasty of chronic total oc-clusions: primary success, restenosis, and long-term clinical fol-low-up. Circulation. 1992;85:106– 115.
Tan KH, Sulke N, Taub NA, et.al. Determinants of success of coronary angioplasty in patients with a chronic total occlu-sion: a multiple logistic regression model to improve selection of patients. Br Heart J. 1993;70:126 –131.
Kaltenbach M, Hartmann A, Vallbracht C. Procedural results and patient selection in recanalization of chronic coronary oc-clusion by low speed rotational angioplasty. Eur Heart J 1993;14(6):826–830.
Kinoshita I, Katoh O, Nariyama J, et al. Coronary angioplasty of chronic total occlusions with bridging collateral vessels: Im-mediate and follow-up outcome from a large single-center ex-perience. J Am Coll Cardiol1995;26(2):409–415.
Noguchi T, Miyazaki MDS, Morii I, et.al. Percutaneous translu-minal coronary angioplasty of chronic total occlusions: deter-minants of primary success and long-term outcome. Cathet Cardiovasc Intervent. 2000;49:258 –264.
Suero JA, Marso SP, Jones PG, et.al. Procedural outcomes and long - term survival among patientsundergoing percutane-ous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol. 2001;38: 409–414.
Kahn JK. Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hos-pital setting. Am Heart J. 1993;126:561–564.
Olivari Z, Rubartelli P, Piscione F, Ettori F, Fontanelli A, Salemme L, Giachero C, Di Mario C, Gabrielli G, Spedicato L, Bedogni F, for the TOAST-GISE Investigators. Immediate results and one-year clinical outcome after percutaneous coro-nary interventions in chronic total occlusions: study (TOAST-GISE). J Am Coll Cardiol. 2003;41: 1672–1678.
Serruys PW, Hamburger JN, Koolen JJ, et.al Total occlusion trial with angioplasty by using laser guidewire. Eur Heart J. 2000;21:797–1805.
Hoye A, van Domburg RT, Sonnenschein K, et.al. Percutane-ous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992 – 2002. Eur Heart J 2005;26:2630.
Silber S, Albertsson P, Avile´s FF, et.al. The Task Force for Per-cutaneous Coronary Interventions of the European Society of Cardiology. Guidelines for Percutaneous Coronary Interven-tions. Eur Heart J2005; 26: 804–847
Freed MS, Safian RD. Chronic total occlusion. In The Manual of Interventional Cardiology. 3rd Edition. 2004. Physician Press. p 287.
Mitsudo K. New approaches to chronic total occlu-sions. In Antonio Colombo, Goran Stankovic. Colombo”s Tips&Tricks with Drug-Eluting Stents. Taylor and Francis. (2005). p.117.
Ochiai M, Ashida K, Araki H, Ogata N, et al. The latest wire technique for chronic total occlusion. Ital Heart J2005; 6 (6): 489-493
Muramatsu et al. Longterm outcome of 1000 CTO lesions. www.summitmd.com
Beth Dawson. Robert G Trapp. Basic & Clinical Biostatistics. 4th edition. Lange medical book. McGraw Hill.(2004). p. 245.
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How to Cite
Gumiwang, I., Munawar, M., & Kaligis, R. (1). Predictors of Failure of Percutaneous Coronary Intervention in Patients with Chronic Total Coronary Occlusion at National Cardiovascular Center Indonesia. Indonesian Journal of Cardiology, 28(1), 44-52. https://doi.org/10.30701/ijc.v28i1.266
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Clinical Research
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