Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry

Ilias Nikolakopoulos; Evangelia Vemmou; Judit Karacsonyi; Khaldoon Alaswad; Dimitri Karmpaliotis; Nidal Abi Rafeh; Daniel Schimmel; Keith Benzuly; James D. Flaherty; Paul Poommipanit; Ahmed M. ElGuindy; M. Nicholas Burke; Emmanouil S. Brilakis

doi:10.1016/j.hjc.2022.02.005

Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry

Ilias Nikolakopoulos, Evangelia Vemmou, Judit Karacsonyi, Khaldoon Alaswad, Dimitri Karmpaliotis, Nidal Abi Rafeh, Daniel Schimmel, Keith Benzuly, James D. Flaherty, Paul Poommipanit, Ahmed M. ElGuindy, M. Nicholas Burke, Emmanouil S. Brilakis^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Letter › peer-review

7 Scopus citations

Abstract

Background: The impact of bifurcations at the proximal or distal cap on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the clinical, angiographic, and procedural data of 4,584 cases performed in patients between 2012 and 2020 in a global CTO PCI registry. We compared 4 groups according to the bifurcation location: “proximal cap,” “distal cap,” “proximal and distal cap,” and “no bifurcation.” Results: The CTO involved a bifurcation in 67% cases, as follows: proximal cap (n = 1451, 33%), distal cap (n = 622, 14%), or both caps (n = 954, 21%). “Proximal and distal cap” cases had higher J-CTO compared with “proximal cap,” “distal cap,” and “no bifurcation” cases (2.9 ± 1.1 vs 2.5 ± 1.1 vs 2.4 ± 1.2 vs 2.0 ± 1.2, P < 0.0001), and they were also associated with a lower technical success rate (79% vs 85% vs 85% vs 90%, P < 0.0001), higher pericardiocentesis rate (1% vs 1% vs 0.2% vs 0.3%, P = 0.02), and higher emergency coronary artery bypass graft surgery rate (0.3% vs 0% vs 0% vs 0%, P = 0.01). Conclusion: More than two-thirds of CTO PCIs involve a bifurcation, which is associated with lower technical success and higher risk of complications.

Original language	English (US)
Pages (from-to)	80-83
Number of pages	4
Journal	Hellenic Journal of Cardiology
Volume	66
DOIs	https://doi.org/10.1016/j.hjc.2022.02.005
State	Published - Jul 1 2022

Funding

Dr. Nikolakopoulos: nothing to disclose; Dr. Vemmou: nothing to disclose; Dr. Karacsonyi: nothing to disclose; Dr. Alaswad: consulting fees from Terumo and Boston Scientific; consultant, no financial, Abbott Laboratories; Dr. Karmpaliotis: speaker honoraria: Abbott Vascular, Boston Scientific, Medtronic, Vascular Solutions. Dr. Poomimanit: proctor—Asahi Intecc, Inc, proctor—Abbott Vascular, and faculty—Medtronic National Fellows Course; Dr. Abi Rafeh: proctor and speaker honoraria from Boston Scientific and Abbott Vascula; Dr.ElGuindy: proctorship fees from Boston Scientific; Dr. Burke: shareholder in Egg Medical and MHI Ventures; Dr. Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, IMDS, Medicure, Medtronic, Siemens, and Teleflex; research support: Boston Scientific, GE Healthcare; owner, Hippocrates LLC; shareholder: MHI Ventures, Cleerly Health, Stallion Medical.

Keywords

bifurcation
chronic total occlusion
percutaneous coronary intervention

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.hjc.2022.02.005

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Nikolakopoulos, I., Vemmou, E., Karacsonyi, J., Alaswad, K., Karmpaliotis, D., Abi Rafeh, N., Schimmel, D., Benzuly, K., Flaherty, J. D., Poommipanit, P., ElGuindy, A. M., Burke, M. N., & Brilakis, E. S. (2022). Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry. Hellenic Journal of Cardiology, 66, 80-83. https://doi.org/10.1016/j.hjc.2022.02.005

@article{4e5a8413ba7c44d79f0fb2792abd2024,

title = "Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry",

abstract = "Background: The impact of bifurcations at the proximal or distal cap on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the clinical, angiographic, and procedural data of 4,584 cases performed in patients between 2012 and 2020 in a global CTO PCI registry. We compared 4 groups according to the bifurcation location: “proximal cap,” “distal cap,” “proximal and distal cap,” and “no bifurcation.” Results: The CTO involved a bifurcation in 67% cases, as follows: proximal cap (n = 1451, 33%), distal cap (n = 622, 14%), or both caps (n = 954, 21%). “Proximal and distal cap” cases had higher J-CTO compared with “proximal cap,” “distal cap,” and “no bifurcation” cases (2.9 ± 1.1 vs 2.5 ± 1.1 vs 2.4 ± 1.2 vs 2.0 ± 1.2, P < 0.0001), and they were also associated with a lower technical success rate (79% vs 85% vs 85% vs 90%, P < 0.0001), higher pericardiocentesis rate (1% vs 1% vs 0.2% vs 0.3%, P = 0.02), and higher emergency coronary artery bypass graft surgery rate (0.3% vs 0% vs 0% vs 0%, P = 0.01). Conclusion: More than two-thirds of CTO PCIs involve a bifurcation, which is associated with lower technical success and higher risk of complications.",

keywords = "bifurcation, chronic total occlusion, percutaneous coronary intervention",

author = "Ilias Nikolakopoulos and Evangelia Vemmou and Judit Karacsonyi and Khaldoon Alaswad and Dimitri Karmpaliotis and {Abi Rafeh}, Nidal and Daniel Schimmel and Keith Benzuly and Flaherty, {James D.} and Paul Poommipanit and ElGuindy, {Ahmed M.} and Burke, {M. Nicholas} and Brilakis, {Emmanouil S.}",

note = "Publisher Copyright: {\textcopyright} 2022 Hellenic Society of Cardiology",

year = "2022",

month = jul,

day = "1",

doi = "10.1016/j.hjc.2022.02.005",

language = "English (US)",

volume = "66",

pages = "80--83",

journal = "Hellenic Journal of Cardiology",

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publisher = "Hellenic Cardiological Society",

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Nikolakopoulos, I, Vemmou, E, Karacsonyi, J, Alaswad, K, Karmpaliotis, D, Abi Rafeh, N, Schimmel, D , Benzuly, K , Flaherty, JD, Poommipanit, P, ElGuindy, AM, Burke, MN & Brilakis, ES 2022, 'Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry', Hellenic Journal of Cardiology, vol. 66, pp. 80-83. https://doi.org/10.1016/j.hjc.2022.02.005

TY - JOUR

T1 - Percutaneous coronary intervention of chronic total occlusions involving a bifurcation

T2 - Insights from the PROGRESS-CTO registry

AU - Nikolakopoulos, Ilias

AU - Vemmou, Evangelia

AU - Karacsonyi, Judit

AU - Alaswad, Khaldoon

AU - Karmpaliotis, Dimitri

AU - Abi Rafeh, Nidal

AU - Schimmel, Daniel

AU - Benzuly, Keith

AU - Flaherty, James D.

AU - Poommipanit, Paul

AU - ElGuindy, Ahmed M.

AU - Burke, M. Nicholas

AU - Brilakis, Emmanouil S.

PY - 2022/7/1

Y1 - 2022/7/1

N2 - Background: The impact of bifurcations at the proximal or distal cap on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the clinical, angiographic, and procedural data of 4,584 cases performed in patients between 2012 and 2020 in a global CTO PCI registry. We compared 4 groups according to the bifurcation location: “proximal cap,” “distal cap,” “proximal and distal cap,” and “no bifurcation.” Results: The CTO involved a bifurcation in 67% cases, as follows: proximal cap (n = 1451, 33%), distal cap (n = 622, 14%), or both caps (n = 954, 21%). “Proximal and distal cap” cases had higher J-CTO compared with “proximal cap,” “distal cap,” and “no bifurcation” cases (2.9 ± 1.1 vs 2.5 ± 1.1 vs 2.4 ± 1.2 vs 2.0 ± 1.2, P < 0.0001), and they were also associated with a lower technical success rate (79% vs 85% vs 85% vs 90%, P < 0.0001), higher pericardiocentesis rate (1% vs 1% vs 0.2% vs 0.3%, P = 0.02), and higher emergency coronary artery bypass graft surgery rate (0.3% vs 0% vs 0% vs 0%, P = 0.01). Conclusion: More than two-thirds of CTO PCIs involve a bifurcation, which is associated with lower technical success and higher risk of complications.

AB - Background: The impact of bifurcations at the proximal or distal cap on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the clinical, angiographic, and procedural data of 4,584 cases performed in patients between 2012 and 2020 in a global CTO PCI registry. We compared 4 groups according to the bifurcation location: “proximal cap,” “distal cap,” “proximal and distal cap,” and “no bifurcation.” Results: The CTO involved a bifurcation in 67% cases, as follows: proximal cap (n = 1451, 33%), distal cap (n = 622, 14%), or both caps (n = 954, 21%). “Proximal and distal cap” cases had higher J-CTO compared with “proximal cap,” “distal cap,” and “no bifurcation” cases (2.9 ± 1.1 vs 2.5 ± 1.1 vs 2.4 ± 1.2 vs 2.0 ± 1.2, P < 0.0001), and they were also associated with a lower technical success rate (79% vs 85% vs 85% vs 90%, P < 0.0001), higher pericardiocentesis rate (1% vs 1% vs 0.2% vs 0.3%, P = 0.02), and higher emergency coronary artery bypass graft surgery rate (0.3% vs 0% vs 0% vs 0%, P = 0.01). Conclusion: More than two-thirds of CTO PCIs involve a bifurcation, which is associated with lower technical success and higher risk of complications.

KW - bifurcation

KW - chronic total occlusion

KW - percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85135707654&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85135707654&partnerID=8YFLogxK

U2 - 10.1016/j.hjc.2022.02.005

DO - 10.1016/j.hjc.2022.02.005

M3 - Letter

C2 - 35247542

AN - SCOPUS:85135707654

SN - 1109-9666

VL - 66

SP - 80

EP - 83

JO - Hellenic Journal of Cardiology

JF - Hellenic Journal of Cardiology

ER -

Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry

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