Impact of Successful Antegrade & Retrograde CTO PCI on Short Term Prognosis

Abstract Background Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) carries risk of complications and should be attempted when the anticipated benefits exceed the potential risks. The primary indication for CTO-PCI is symptom improvement. However, the impact of CTO PCI on angina and subsequent incidence of major adverse cardiovascular event (MACE) rate remains controversial. Objective Our aim was to study the impact of the antegrade and retrograde approaches for elective CTO PCI on the procedural success rate & short-term MACE. Patients and Methods The current study was a prospective cohort study that included a total of 80 patients who were referred to our center (Ain Shams University Hospitals) for elective CTO PCI and underwent technically successful CTO PCI. Data was collected on patient arrival to our department and then the patients were observed during hospital admission to record any In-Hospital MACE. These patients were then followed up for 6 months to record improvement or worsening of their symptoms and to assess occurrence of any MACE including hospitalization and undergoing symptom driven coronary angiography. Results The mean age of our patients was 56±9.6 years and 91% of the patients were men. Seventy- seven % of patients were done via an ante-grade approach and 23% were done via a retro-grade approach with an overall procedural success rate of 91.25% (Antegrade 93.5%, Retrograde 83.3%). The overall mean procedure time was 102 minutes, the mean contrast volume used was 371 ml and the mean cumulative Air Kerma dose was 7.2 Gy. The retrograde group required longer procedure times, larger volumes of contrast and higher exposure to radiation. The overall in-hospital MACE was 8.75%. 81.25% of patients in our study showed an improvement in the grade of their exertional dyspnea or angina within the 6-month follow-up period. 16.25% of patients in our study needed re-hospitalization within a 6-month period after PCI. The overall Target lesion re-vascularization rate at 6 months was 8.75%. Three out of the 7 patients (42.86%) who suffered from in-hospital MACE developed another Major adverse cardiac event during the 6 months follow up period. This was a higher percentage than the patients who did not suffer from in-hospital MACE and was statistically significant. Conclusion Technically successful CTO PCI in a well-equipped center with highly qualified CTO operators resulted in high procedural success rates and low incidence of short-term MACE.