Predictors and Outcomes of Side-Branch Occlusion in Coronary Chronic Total Occlusion Interventions
| Autor: | Phuong-Khanh J, Nguyen-Trong, Bavana V, Rangan, Aris, Karatasakis, Barbara A, Danek, Georgios E, Christakopoulos, Jose Roberto, Martinez-Parachini, Erica, Resendes, Colby R, Ayers, Michael, Luna, Shuaib, Abdullah, Dharam J, Kumbhani, Tayo, Addo, Jerrold, Grodin, Subhash, Banerjee, Emmanouil S, Brilakis |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Myocardial Infarction Middle Aged Vascular System Injuries Coronary Angiography Coronary Vessels United States Outcome and Process Assessment Health Care Percutaneous Coronary Intervention Postoperative Complications Coronary Occlusion Chronic Disease Humans Female Intraoperative Complications Aged Retrospective Studies |
| Zdroj: | The Journal of invasive cardiology. 28(4) |
| ISSN: | 1557-2501 |
| Popis: | We investigated whether side-branch loss during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) could adversely impact clinical outcomes.Side-branch occlusion during PCI has been associated with periprocedural myocardial infarction and higher incidence of major adverse cardiac event (MACE), but has received limited study in CTO-PCI.We retrospectively reviewed the medical records and coronary angiograms for 109 consecutive CTOPCI cases performed at our institution during 2012 and 2013. Post-PCI patency of ≥1 mm diameter side branches and associated clinical outcomes were assessed.Mean age was 65 ± 8 years and 99.1% of the patients were men. The CTO target vessel was the right coronary artery (54%), circumflex (26%), and left anterior descending artery (20%). Side-branch loss occurred in 28 cases (25.7%) due to antegrade dissection/reentry (n = 9), retrograde dissection/reentry (n = 5), stenting over the branch (n = 12), and dissection during antegrade crossing attempts (n = 2). Recanalization of the occluded side branch was pursued in 8 cases (28.6%) and was successful in 4 patients. Patients with side-branch loss had higher post-PCI increase in CK-MB levels (8.4 ng/mL [interquartile range, 2.7-33.5 ng/mL] vs 1.8 ng/mL [interquartile range, 0.025-6.775 ng/mL]; P.001) and higher 12-month incidence of all-cause death (17.3% vs 2.8%; P=.02) and cardiovascular death (7.4% vs 0.0%; P=.02).Side-branch loss occurs in approximately 1 in 4 CTO-PCIs and is associated with higher risk for periprocedural myocardial infarction and higher mortality. |
| Databáze: | OpenAIRE |
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