Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention

Michaella Alexandrou; Athanasios Rempakos; Deniz Mutlu; Ahmed Al Ogaili; Pedro E.P. Carvalho; Dimitrios Strepkos; James W. Choi; Paul Poommipanit; Khaldoon Alaswad; Mir Babar Basir; Rhian Davies; Farouc A. Jaffer; Phil Dattilo; Anthony H. Doing; Lorenzo Azzalini; Nazif Aygul; Raj H. Chandwaney; Brian K. Jefferson; Sevket Gorgulu; Jaikirshan J. Khatri; Laura D. Young; Oleg Krestyaninov; Dmitrii Khelimskii; Jarrod Frizzell; Omer Goktekin; James D. Flaherty; Daniel R. Schimmel; Keith H. Benzuly; Mahmut Uluganyan; Ramazan Ozdemir; Yousif Ahmad; Bavana V. Rangan; Olga C. Mastrodemos; M. Nicholas Burke; Konstantinos Voudris; Yader Sandoval; Emmanouil S. Brilakis

doi:10.25270/jic/24.00196

Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention

Michaella Alexandrou, Athanasios Rempakos, Deniz Mutlu, Ahmed Al Ogaili, Pedro E.P. Carvalho, Dimitrios Strepkos, James W. Choi, Paul Poommipanit, Khaldoon Alaswad, Mir Babar Basir, Rhian Davies, Farouc A. Jaffer, Phil Dattilo, Anthony H. Doing, Lorenzo Azzalini, Nazif Aygul, Raj H. Chandwaney, Brian K. Jefferson, Sevket Gorgulu, Jaikirshan J. KhatriLaura D. Young, Oleg Krestyaninov, Dmitrii Khelimskii, Jarrod Frizzell, Omer Goktekin, James D. Flaherty, Daniel R. Schimmel, Keith H. Benzuly, Mahmut Uluganyan, Ramazan Ozdemir, Yousif Ahmad, Bavana V. Rangan, Olga C. Mastrodemos, M. Nicholas Burke, Konstantinos Voudris, Yader Sandoval, Emmanouil S. Brilakis^*

^*Corresponding author for this work

Medicine, Cardiology Division

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

1 Scopus citations

Abstract

Background. The impact of peripheral artery disease (PAD) on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is not well studied. Methods. We analyzed the association of PAD with CTO-PCI outcomes using data from the PROGRESS-CTO registry of procedures performed at 47 centers between 2012 and 2023. Results. The prevalence of PAD among 12 961 patients who underwent CTO PCI during the study period was 13.9% (1802). PAD patients were older, more likely to be current smokers, and had higher rates of dyslipidemia, diabetes, cerebrovascular disease, hypertension, prior myocardial infarction, PCI, and coronary artery bypass graft surgery. Their PROGRESS-CTO (1.35 vs 1.22; P < .001) and J-CTO (2.63 vs 2.33; P < .001) scores were higher, lesion length was longer, and angiographic characteristics were more complex. Their access site was more likely to be bifemoral (33.6% vs 30.9%; P= .024) compared with patients with no PAD. Technical (82.9% vs 87.7%; P < .001) and procedural (80.5% vs 86.6%; P <.001) success rates were lower in patients with PAD, while the incidence of major adverse cardiovascular events (MACE) was higher (3.1% vs 1.8%; P < .001), with higher incidence of death (0.8% vs 0.4%; P = .034), acute myocardial infarction (0.9%vs 0.4%; P = .010), and perforation (6.6% vs 4.5%; P < .001). In multivariable analysis, PAD was associated with higher MACE (odds ratio [OR]: 1.53; 95% CI, 1.01-2.26; P = .038) and lower technical success (OR: 0.82; 95% CI, 0.69-0.99; P = .039). Conclusions. PAD patients undergoing CTO PCI have higher comorbidity burden, more complex CTOs, higher MACE, and lower technical success.

Original language	English (US)
Journal	Journal of Invasive Cardiology
Volume	37
Issue number	1
DOIs	https://doi.org/10.25270/jic/24.00196
State	Published - Jan 1 2025

Funding

The authors are grateful for the philanthropic support of their generous anonymous donors (2), and the philanthropic support of Drs Mary Ann and Donald A. Sens; Mr. Raymond Ames and Ms. Barbara Thorndike; Frank J. and Eleanor A. Maslowski Charitable Trust; Joseph F. and Mary M. Fleischhacker Family Foundation; Mrs. Diane and Dr. Cline Hickok; Mrs. Marilyn and Mr. William Ryerse; Mr. Greg and Mrs. Rhoda Olsen; Mrs. Wilma and Mr. Dale Johnson; Mrs. Charlotte and Mr. Jerry Golinvaux Family Fund; the Roehl Family Foundation; and the Joseph Durda Foundation. The generous gifts of these donors to the Minneapolis Heart Institute Foundation\u2019s Science Center for Coronary Artery Disease (CCAD) helped support this research project.

Keywords

CTO-PCI
Chronic Total Occlusion
Percutaneous Coronary Intervention
Peripheral Artery Disease

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.25270/jic/24.00196

Cite this

Alexandrou, M., Rempakos, A., Mutlu, D., Al Ogaili, A., Carvalho, P. E. P., Strepkos, D., Choi, J. W., Poommipanit, P., Alaswad, K., Basir, M. B., Davies, R., Jaffer, F. A., Dattilo, P., Doing, A. H., Azzalini, L., Aygul, N., Chandwaney, R. H., Jefferson, B. K., Gorgulu, S., ... Brilakis, E. S. (2025). Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention. Journal of Invasive Cardiology, 37(1). https://doi.org/10.25270/jic/24.00196

@article{50e94f92c5174e9c9d2cadfb6c19b920,

title = "Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention",

abstract = "Background. The impact of peripheral artery disease (PAD) on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is not well studied. Methods. We analyzed the association of PAD with CTO-PCI outcomes using data from the PROGRESS-CTO registry of procedures performed at 47 centers between 2012 and 2023. Results. The prevalence of PAD among 12 961 patients who underwent CTO PCI during the study period was 13.9\% (1802). PAD patients were older, more likely to be current smokers, and had higher rates of dyslipidemia, diabetes, cerebrovascular disease, hypertension, prior myocardial infarction, PCI, and coronary artery bypass graft surgery. Their PROGRESS-CTO (1.35 vs 1.22; P < .001) and J-CTO (2.63 vs 2.33; P < .001) scores were higher, lesion length was longer, and angiographic characteristics were more complex. Their access site was more likely to be bifemoral (33.6\% vs 30.9\%; P= .024) compared with patients with no PAD. Technical (82.9\% vs 87.7\%; P < .001) and procedural (80.5\% vs 86.6\%; P <.001) success rates were lower in patients with PAD, while the incidence of major adverse cardiovascular events (MACE) was higher (3.1\% vs 1.8\%; P < .001), with higher incidence of death (0.8\% vs 0.4\%; P = .034), acute myocardial infarction (0.9\%vs 0.4\%; P = .010), and perforation (6.6\% vs 4.5\%; P < .001). In multivariable analysis, PAD was associated with higher MACE (odds ratio [OR]: 1.53; 95\% CI, 1.01-2.26; P = .038) and lower technical success (OR: 0.82; 95\% CI, 0.69-0.99; P = .039). Conclusions. PAD patients undergoing CTO PCI have higher comorbidity burden, more complex CTOs, higher MACE, and lower technical success.",

keywords = "CTO-PCI, Chronic Total Occlusion, Percutaneous Coronary Intervention, Peripheral Artery Disease",

author = "Michaella Alexandrou and Athanasios Rempakos and Deniz Mutlu and \{Al Ogaili\}, Ahmed and Carvalho, \{Pedro E.P.\} and Dimitrios Strepkos and Choi, \{James W.\} and Paul Poommipanit and Khaldoon Alaswad and Basir, \{Mir Babar\} and Rhian Davies and Jaffer, \{Farouc A.\} and Phil Dattilo and Doing, \{Anthony H.\} and Lorenzo Azzalini and Nazif Aygul and Chandwaney, \{Raj H.\} and Jefferson, \{Brian K.\} and Sevket Gorgulu and Khatri, \{Jaikirshan J.\} and Young, \{Laura D.\} and Oleg Krestyaninov and Dmitrii Khelimskii and Jarrod Frizzell and Omer Goktekin and Flaherty, \{James D.\} and Schimmel, \{Daniel R.\} and Benzuly, \{Keith H.\} and Mahmut Uluganyan and Ramazan Ozdemir and Yousif Ahmad and Rangan, \{Bavana V.\} and Mastrodemos, \{Olga C.\} and \{Nicholas Burke\}, M. and Konstantinos Voudris and Yader Sandoval and Brilakis, \{Emmanouil S.\}",

year = "2025",

month = jan,

day = "1",

doi = "10.25270/jic/24.00196",

language = "English (US)",

volume = "37",

journal = "Journal of Invasive Cardiology",

issn = "1042-3931",

publisher = "Cliggott Publishing Co.",

number = "1",

}

Alexandrou, M, Rempakos, A, Mutlu, D, Al Ogaili, A, Carvalho, PEP, Strepkos, D, Choi, JW, Poommipanit, P, Alaswad, K, Basir, MB, Davies, R, Jaffer, FA, Dattilo, P, Doing, AH, Azzalini, L, Aygul, N, Chandwaney, RH, Jefferson, BK, Gorgulu, S, Khatri, JJ, Young, LD, Krestyaninov, O, Khelimskii, D, Frizzell, J, Goktekin, O, Flaherty, JD , Schimmel, DR , Benzuly, KH, Uluganyan, M, Ozdemir, R, Ahmad, Y, Rangan, BV, Mastrodemos, OC, Nicholas Burke, M, Voudris, K, Sandoval, Y & Brilakis, ES 2025, 'Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention', Journal of Invasive Cardiology, vol. 37, no. 1. https://doi.org/10.25270/jic/24.00196

TY - JOUR

T1 - Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention

AU - Alexandrou, Michaella

AU - Rempakos, Athanasios

AU - Mutlu, Deniz

AU - Al Ogaili, Ahmed

AU - Carvalho, Pedro E.P.

AU - Strepkos, Dimitrios

AU - Choi, James W.

AU - Poommipanit, Paul

AU - Alaswad, Khaldoon

AU - Basir, Mir Babar

AU - Davies, Rhian

AU - Jaffer, Farouc A.

AU - Dattilo, Phil

AU - Doing, Anthony H.

AU - Azzalini, Lorenzo

AU - Aygul, Nazif

AU - Chandwaney, Raj H.

AU - Jefferson, Brian K.

AU - Gorgulu, Sevket

AU - Khatri, Jaikirshan J.

AU - Young, Laura D.

AU - Krestyaninov, Oleg

AU - Khelimskii, Dmitrii

AU - Frizzell, Jarrod

AU - Goktekin, Omer

AU - Flaherty, James D.

AU - Schimmel, Daniel R.

AU - Benzuly, Keith H.

AU - Uluganyan, Mahmut

AU - Ozdemir, Ramazan

AU - Ahmad, Yousif

AU - Rangan, Bavana V.

AU - Mastrodemos, Olga C.

AU - Nicholas Burke, M.

AU - Voudris, Konstantinos

AU - Sandoval, Yader

AU - Brilakis, Emmanouil S.

PY - 2025/1/1

Y1 - 2025/1/1

N2 - Background. The impact of peripheral artery disease (PAD) on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is not well studied. Methods. We analyzed the association of PAD with CTO-PCI outcomes using data from the PROGRESS-CTO registry of procedures performed at 47 centers between 2012 and 2023. Results. The prevalence of PAD among 12 961 patients who underwent CTO PCI during the study period was 13.9% (1802). PAD patients were older, more likely to be current smokers, and had higher rates of dyslipidemia, diabetes, cerebrovascular disease, hypertension, prior myocardial infarction, PCI, and coronary artery bypass graft surgery. Their PROGRESS-CTO (1.35 vs 1.22; P < .001) and J-CTO (2.63 vs 2.33; P < .001) scores were higher, lesion length was longer, and angiographic characteristics were more complex. Their access site was more likely to be bifemoral (33.6% vs 30.9%; P= .024) compared with patients with no PAD. Technical (82.9% vs 87.7%; P < .001) and procedural (80.5% vs 86.6%; P <.001) success rates were lower in patients with PAD, while the incidence of major adverse cardiovascular events (MACE) was higher (3.1% vs 1.8%; P < .001), with higher incidence of death (0.8% vs 0.4%; P = .034), acute myocardial infarction (0.9%vs 0.4%; P = .010), and perforation (6.6% vs 4.5%; P < .001). In multivariable analysis, PAD was associated with higher MACE (odds ratio [OR]: 1.53; 95% CI, 1.01-2.26; P = .038) and lower technical success (OR: 0.82; 95% CI, 0.69-0.99; P = .039). Conclusions. PAD patients undergoing CTO PCI have higher comorbidity burden, more complex CTOs, higher MACE, and lower technical success.

AB - Background. The impact of peripheral artery disease (PAD) on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is not well studied. Methods. We analyzed the association of PAD with CTO-PCI outcomes using data from the PROGRESS-CTO registry of procedures performed at 47 centers between 2012 and 2023. Results. The prevalence of PAD among 12 961 patients who underwent CTO PCI during the study period was 13.9% (1802). PAD patients were older, more likely to be current smokers, and had higher rates of dyslipidemia, diabetes, cerebrovascular disease, hypertension, prior myocardial infarction, PCI, and coronary artery bypass graft surgery. Their PROGRESS-CTO (1.35 vs 1.22; P < .001) and J-CTO (2.63 vs 2.33; P < .001) scores were higher, lesion length was longer, and angiographic characteristics were more complex. Their access site was more likely to be bifemoral (33.6% vs 30.9%; P= .024) compared with patients with no PAD. Technical (82.9% vs 87.7%; P < .001) and procedural (80.5% vs 86.6%; P <.001) success rates were lower in patients with PAD, while the incidence of major adverse cardiovascular events (MACE) was higher (3.1% vs 1.8%; P < .001), with higher incidence of death (0.8% vs 0.4%; P = .034), acute myocardial infarction (0.9%vs 0.4%; P = .010), and perforation (6.6% vs 4.5%; P < .001). In multivariable analysis, PAD was associated with higher MACE (odds ratio [OR]: 1.53; 95% CI, 1.01-2.26; P = .038) and lower technical success (OR: 0.82; 95% CI, 0.69-0.99; P = .039). Conclusions. PAD patients undergoing CTO PCI have higher comorbidity burden, more complex CTOs, higher MACE, and lower technical success.

KW - CTO-PCI

KW - Chronic Total Occlusion

KW - Percutaneous Coronary Intervention

KW - Peripheral Artery Disease

UR - http://www.scopus.com/inward/record.url?scp=85215440324&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85215440324&partnerID=8YFLogxK

U2 - 10.25270/jic/24.00196

DO - 10.25270/jic/24.00196

M3 - Article

C2 - 39121079

AN - SCOPUS:85215440324

SN - 1042-3931

VL - 37

JO - Journal of Invasive Cardiology

JF - Journal of Invasive Cardiology

IS - 1

ER -

Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this