Abstract 17326: Short and Long-term Outcomes After Retrograde Coronary Intervention for Chronic Total Occlusions: Comparison With the Antegrade Approach
Objectives: This study sought to examine the short and long-term outcomes of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Background: Little data is available about safety, feasibility, and long-term outcome after retrograde CTO PCI.
Methods and Results: From a single-center prospective registry, 1343 consecutive patients underwent CTO PCI from January 2004 to January 2012. Of these, 144 (10.7%) had retrograde CTO PCI (0, 1.3, 10.2, 6.2, 15.6, 10.9, 16.1, 23.4% from 2004 to 2011). Patients with retrograde CTO were significantly younger (61.2±10.7 vs 63.9±11.4 years, p<0.01), more frequently dyslipidemic (72.9 vs 62.3%, p<0.01), right coronary artery CTO (65.3 vs 43.7%, p<0.01), longer lesion length (27.2±21.9 vs 19.6±16.5 mm, p<0.01) and less tapered morphology (31.7 vs 46.5%, p<0.01). Procedural success rate of antegrade and retrograde approach was 73.7 and 70.8% (p=0.46). Coronary perforations (10.5 vs 3.0%, p<0.01) and need for pericardial drainage (3.6 vs 1.0%, p=0.02) were more frequent among retrograde compared to antegrade approach. However, need for emergency cardiac surgery were similar (0 vs 0.9%, p=0.57). Retrograde CTO PCI was related with longer procedure time (149.7±58.6 vs 80.7±40.2 min. p<0.01), fluorocopy time (75.8±39.1 vs 42.5±99.8 min. p<0.01) and higher contrast dose (385±180 vs 257±158 ml, p<0.01). The incidence of in-hospital non Q-wave myocardial infarction (0.7 vs 0.1%, p=0.20) and death were similar (0.7 vs 1.1%, p=0.66). The 3-year cumulative incidence of myocardial infarction (2.6% vs 1.3%, p=0.81) and cardiac death (4.8% vs 4.7%, p=0.83) were similar between retrograde and antegrade approach. Among patients with successful CTO PCI, the 3-year cumulative target lesion revascularization (TLR) rate was significantly higher in retrograde approach compared with antegrade (12.6% vs 6.9%, p=0.045).
Conclusions: Higher incidences of coronary perforation and pericardial drainage, but no emergency cardiac surgery were observed after retrograde CTO PCI. Although long-term TLR rate was higher, retrograde CTO PCI was associated with acceptable procedural success rate and similar short and long-term adverse events compared with antegrade CTO PCI
- © 2013 by American Heart Association, Inc.