Outcomes With the Use of the Retrograde Approach for Coronary Chronic Total Occlusion Interventions in a Contemporary Multicenter US Registry

Dimitri Karmpaliotis; Aris Karatasakis; Khaldoon Alaswad; Farouc A Jaffer; Robert W Yeh; R Michael Wyman; William L Lombardi; J Aaron Grantham; David E Kandzari; Nicholas J Lembo; Anthony Doing; Mitul Patel; John N Bahadorani; Jeffrey W Moses; Ajay J Kirtane; Manish Parikh; Ziad A Ali; Sanjog Kalra; Phuong-Khanh J Nguyen-Trong; Barbara A Danek; Judit Karacsonyi; Bavana V Rangan; Michele K Roesle; Craig A Thompson; Subhash Banerjee; Emmanouil S Brilakis

doi:10.1161/CIRCINTERVENTIONS.115.003434

Outcomes With the Use of the Retrograde Approach for Coronary Chronic Total Occlusion Interventions in a Contemporary Multicenter US Registry

Circ Cardiovasc Interv. 2016 Jun;9(6):10.1161/CIRCINTERVENTIONS.115.003434 e003434. doi: 10.1161/CIRCINTERVENTIONS.115.003434.

Authors

Dimitri Karmpaliotis¹, Aris Karatasakis¹, Khaldoon Alaswad¹, Farouc A Jaffer¹, Robert W Yeh¹, R Michael Wyman¹, William L Lombardi¹, J Aaron Grantham¹, David E Kandzari¹, Nicholas J Lembo¹, Anthony Doing¹, Mitul Patel¹, John N Bahadorani¹, Jeffrey W Moses¹, Ajay J Kirtane¹, Manish Parikh¹, Ziad A Ali¹, Sanjog Kalra¹, Phuong-Khanh J Nguyen-Trong¹, Barbara A Danek¹, Judit Karacsonyi¹, Bavana V Rangan¹, Michele K Roesle¹, Craig A Thompson¹, Subhash Banerjee¹, Emmanouil S Brilakis²

Affiliations

¹ From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.).
² From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.). esbrilakis@gmail.com.

PMID: 27307562
PMCID: PMC4911894
DOI: 10.1161/CIRCINTERVENTIONS.115.003434

Abstract

Background: We sought to examine the efficacy and safety of chronic total occlusion percutaneous coronary intervention using the retrograde approach.

Methods and results: We compared the outcomes of the retrograde versus antegrade-only approach to chronic total occlusion percutaneous coronary intervention among 1301 procedures performed at 11 experienced US centers between 2012 and 2015. The mean age was 65.5±10 years, and 84% of the patients were men with a high prevalence of diabetes mellitus (45%) and previous coronary artery bypass graft surgery (34%). Overall technical and procedural success rates were 90% and 89%, respectively, and in-hospital major adverse cardiovascular events occurred in 31 patients (2.4%). The retrograde approach was used in 539 cases (41%), either as the initial strategy (46%) or after a failed antegrade attempt (54%). When compared with antegrade-only cases, retrograde cases were significantly more complex, both clinically (previous coronary artery bypass graft surgery prevalence, 48% versus 24%; P<0.001) and angiographically (mean Japan-chronic total occlusion score, 3.1±1.0 versus 2.1±1.2; P<0.001) and had lower technical success (85% versus 94%; P<0.001) and higher major adverse cardiovascular events (4.3% versus 1.1%; P<0.001) rates. On multivariable analysis, the presence of suitable collaterals, no smoking, no previous coronary artery bypass graft surgery, and left anterior descending artery target vessel were independently associated with technical success using the retrograde approach.

Conclusions: The retrograde approach is commonly used in contemporary chronic total occlusion percutaneous coronary intervention, especially among more challenging lesions and patients. Although associated with lower success and higher major adverse cardiovascular event rates in comparison to antegrade-only crossing, retrograde percutaneous coronary intervention remains critical for achieving overall high success rates.

Keywords: complication; coronary occlusion; outcome; percutaneous coronary intervention.

Publication types

Multicenter Study
Observational Study
Research Support, N.I.H., Extramural

MeSH terms

Aged
Chi-Square Distribution
Coronary Angiography
Coronary Occlusion / diagnostic imaging
Coronary Occlusion / mortality
Coronary Occlusion / therapy*
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Patient Selection
Percutaneous Coronary Intervention / adverse effects
Percutaneous Coronary Intervention / methods*
Percutaneous Coronary Intervention / mortality
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States

Abstract

Publication types

MeSH terms

Grants and funding