Does Percutaneous Coronary Interventions of Coronary Chronic Total Occlusions to Patients with Prior Coronary Artery Bypass Graft Surgery Have Poorer Pocedural Outcome?

Corresponding Author

Masaki Tanabe, MD, Director of Cardiovascular Center, Department of Cardiology, Kyoto Okamoto Memorial Hospital-58, Nishinokuchi Sayama, Kumiyama, Kyoto, Japan - 611-0034, Japan, Tel +81(774)48-5500; Fax+81(774)48-5522; E-mail: shaishaibeam@yahoo.co.jp

Citation

Tanabe, M. Does Percutaneous Coronary Interventions of Coronary Chronic Total Occlusions to Patients with Prior Coronary Artery Bypass Graft Surgery Have Poorer Pocedural Outcome? (2016) J Heart Cardiol 2(2): 68- 75.

Abstract

Objectives: This study aimed to investigate procedural outcomes of Percutaneous Coronary Intervention (PCI) for Chronic Total Occlusion (CTO) in patients with prior Coronary Artery Bypass Graft (CABG).
Background: Patients with prior CABG often have more comorbidities, complex coronary anatomy, and poorer outcomes than those without prior CABG. Success of PCI for CTO may be more challenging in patients with prior CABG.
Methods: We evaluated clinical characteristics and procedural outcomes in 317 consecutive patients undergoing CTO-PCI, and compared the results between patients with (n = 70) and without prior CABG (n = 247).
Results: Patients with prior CABG were older and had more coronary artery disease risk factors than those without prior CABG. CTO-PCI was more often performed in the right coronary artery. Patients with prior CABG had significantly higher mean J-CTO score (2.3 ± 1.2 vs. 1.7 ± 1.3, P = 0.0019). Detailed investigation of the characteristics of J-CTO score indicated the greatest impact of the presence of calcifications. Patients with prior CABG were treated more frequently with the retrograde approach (41.4% vs. 17.8%, P = 0.0004) and had longer fluoroscopic times, higher radiation dose, and more contrast administration. Technical and procedural success were achieved in 80.0% vs. 85.0% (P = 0.35) and 78.6% vs. 83.6% (P = 0.38), respectively; these differences were not significant.
Conclusions: CTO-PCIs of patients with prior CABG did not indicate poorer procedural outcome. However, patients with prior CABG had more complex CTO lesions, and CTOPCIs of them were required higher use of the retrograde approach.