Abstract 20748: The Impact of Calcification in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry
Introduction: We sought to examine the impact of calcification on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: We examined the baseline clinical and angiographic characteristics and outcomes of 1,476 consecutive CTO PCIs performed in 1,453 patients between 2012 and 2016 at 11 US centers.
Results: Mean patient age was 65.5 ± 10 years, 85% were men, 45% had diabetes mellitus and approximately 29% had congestive heart failure. Moderate or severe calcification was present in 57.7% of lesions. Calcified lesions were more tortuous (46% vs. 24%, p<0.001), more likely to have proximal cap ambiguity (37% vs. 24%, p<0.001) and interventional collaterals (63% vs. 53%, p= 0.002). PCI of moderately/severely calcified CTOs more often required use of the retrograde approach (54% vs. 30%, p<0.001) and was associated with longer procedure (155 [109, 216] min vs. 111 [76, 160] min, p<0.001) and fluoroscopy (61 [38, 94] min vs. 35 [22, 57] min, p<0.001) time and higher air kerma radiation dose (3.90 [2.34, 5.80] Gray vs. 2.50 [1.52, 4.10] Gray, p<0.001) and contrast volume (280 [205, 380] vs. 250 [189, 350] mL, p=0.0002). Moderate or severe calcification was associated with lower technical (86.6% vs. 93.75%, p<0.001) and procedural (84.35% vs. 92.66%, p<0.001) success rates and higher incidence of major adverse cardiac events (3.69% vs. 1.79%, p=0.033) (Figure 1A). However on multivariate analysis calcification was not independently associated with technical success. Different techniques and their outcomes for lesion preparation are shown in Figure 1B.
Conclusion: In a contemporary, multicenter registry moderate or severe calcification was present in more than half of CTO lesions attempted, more often required use of the retrograde approach, and was associated with lower success and higher complication rates.
Author Disclosures: J. Karacsonyi: None. D. Karmpaliotis: Speakers Bureau; Modest; speaker bureau, Abbott Vascular, Medtronic, and Boston Scientific. K. Alaswad: Consultant/Advisory Board; Modest; consulting fees from Terumo and Boston Scientific; consultant, no financial, Abbott Laboratories. F.A. Jaffer: Consultant/Advisory Board; Modest; consultant to Boston Scientific, Siemens, and Merck, nonfinancial research support from Abbott Vascular, research grant from National Institutes of Health (HL-R01-108229). R.W. Yeh: Research Grant; Modest; Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute.. M. Patel: None. J. Bahadorani: None. W. Lombardi: Honoraria; Modest; equity with Bridgepoint Medical. M.R. Wyman: Honoraria; Modest; Honoraria/consulting/speaking fees from Boston Scientific, Abbott Vascular, and Asahi. A. Grantham: Consultant/Advisory Board; Modest; Speaking fees, consulting, and honoraria from Boston Scientific, Asahi Intecc. Research grants from Boston Scientific, Asahi Intecc, Abbott Vascular, Medtronic. A. Doing: None. J.W. Moses: None. A. Kirtane: None. M. Parikh: Other; Modest; speaker bureau: Abbot Vascular, Medtronic, CSI, BSc; advisory boards: Medtronic, Abbott Vascular, Philips. Z. Ali: Other; Modest; grant support and consultant for St Jude Medical and InfraReDx. D. Kandzari: Honoraria; Modest; research/grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular, and research/grant support from Abbott. N. Lembo: Speakers Bureau; Modest; speaker bureau: Medtronic; advisory board Abbott Vascular and Medtronic. S. Garcia: Consultant/Advisory Board; Modest; consulting fees from Medtronic. B.A. Danek: None. A. Karatasakis: None. E. Resendes: None. P. Kalsaria: None. B.V. Rangan: Honoraria; Modest; InfraRedex, Spectranetics. I. Ungi: None. C.A. Thompson: Employment; Modest; employee of Boston Scientific. S. Banerjee: Honoraria; Modest; research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCARE Global (spouse); intellectual property in HygeiaTel. E. Brilakis: Consultant/Advisory Board; Modest; consulting/speaker honoraria from Abbott Vascular, Asahi, Cardinal Health, Elsevier, GE Healthcare, and St Jude Medical; research support from InfraRedx spouse is employee of Medtronic.
- © 2016 by American Heart Association, Inc.