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CTO PCI outcomes improving for patients with prior CABG
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Compared with patients who did not have a history of CABG, those who did had similar rates of procedural complications and slightly lower rates of procedural success with chronic total occlusion PCI using the hybrid approach.
“In an earlier report from some of the same centers and operators included in the present study before the routine application of the ‘hybrid’ approach, the CTO PCI success rates were significantly lower among patients with previous CABG … The present study demonstrates that the gap is closing … with a greater absolute increase in success rates among patients with previous CABG,” the researchers wrote. “Importantly, this improved success was achieved while maintaining a low risk for major complications, which occurred at similar rates between patients with and without previous CABG.”
In the study, the researchers examined success and complication rates of CTO PCI using the hybrid crossing algorithm among 496 consecutive patients with (n=176) and without (n=320) a history of CABG.
Eligible participants underwent this procedure at one of five high-volume PCI centers in the United States between January 2012 and August 2013.
Demographic results indicated that patients in the CABG group were older, had more CAD risk factors and poorer angiographic characteristics for CTO at baseline.
Technical success rates were 88.1% for the CABG group and 93.4% for the non-CABG group (P=.044). Procedural success rates also were lower in the CABG arm (87.5% vs. 92.5%; P=.07).
The retrograde approach of CTO PCI was used in 39% of CABG patients and 24% of non-CABG patients (P<.001). Patients in the CABG group also received higher air kerma radiation exposure: 4.8 Gray (interquartile range [IQR], 3-6.4) vs. 3.1 Gray (IQR, 1.9-5.3; P<.001). Fluoroscopy times were 59 minutes (38-77) for the CABG arm and 34 minutes (21-55; P<.001) for patients who did not undergo CABG.
The major procedural complication rates were 1.1% in the CABG arm and 2.1% among patients without previous CABG, which the researchers noted was statistically similar (P=.40).
Disclosure: The researchers report financial disclosures with Abbott Laboratories, Abbott Vascular, Asahi, Boston Scientific/BridgePoint Medical, Covidien, Gilead, Guerbert, Hygeia Tel, Janssen, MDCARE, Medtronic, Sanofi, St. Jude Medical, Terumo and The Medicines Company.
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