In-Hospital Outcomes of Contemporary Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion

Insights From the J-CTO Registry (Multicenter CTO Registry in Japan)

Yoshihiro Morino, MD,* Takeshi Kimura, MD, Yasuhiko Hayashi, MD, Toshiya Muramatsu, MD, Masahiko Ochiai, MD, Yuichi Noguchi, MD, Kenichi Kato, MD,** Yoshisato Shibata, MD, Yoshikazu Hiasa, MD, Osamu Doi, MD,Takehiro Yamashita, MD, Takeshi Morimoto, MD, Mitsuru Abe, MD, Tomoaki Hinohara, MD, Kazuaki Mitsudo, MD,***for the J-CTO Registry Investigators

Objectives: Our aim was to investigate in-hospital outcomes of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) using contemporary techniques.

Background: Despite its increasing popularity and technical complexity, clinical outcomes of PCI for CTO using contemporary techniques have not been adequately evaluated.

Methods: The J-CTO registry (multicenter CTO registry in Japan) is a large scale, multicenter registry enrolling consecutive patients undergoing PCI for CTO from 12 Japanese centers. In-hospital clinical outcomes were evaluated in 498 patients with 528 CTO lesions.

Results: Multiple wiring strategies were frequently attempted (parallel wiring 31% and retrograde approach 25%) with relatively long guidewire manipulation time (median 30 min). Utilizing these complex strategies, high procedural success rates (88.6% in the first attempt cases and 68.5% in the retry cases) were accomplished. In-hospital adverse event rates were strikingly low (cardiac death 0.2%, Q-wave myocardial infarction 0.2%, and stroke 0%). Potential disadvantages of these procedures, including a large amount of contrast volume (median 293 ml) and long fluoroscopic time (median 45 min), were not associated with serious clinical sequelae (contrast induced nephropathy 1.2% and radiation dermatitis 0%). Although coronary perforations were documented frequently by angiography (antegrade 7.2% and retrograde 13.6%), clinically significant perforation resulting in cardiac tamponade was rare (0.4%).

Conclusions: Most CTO lesions can be safely and successfully treated with PCI utilizing contemporary advanced techniques. Invasiveness and potential risks of these strategies, which have been the greatest concerns of CTO treatment, may be acceptable in the majority of cases considering the actual incidences of related adverse events and the procedural success rates. (J Am Coll Cardiol Intv 2010;3:143–51) © 2010 by the American College of Cardiology Foundation

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