CTO Intervention Predictors, Dr Shahriyari

INITIAL SUCCESS RATE AND INITIAL SUCCESS RATE AND PREDICTORS OF PROCEDURAL PREDICTORS OF PROCEDURAL

FAILURE IN PERCUTANEOUS FAILURE IN PERCUTANEOUS CORONARY INTERVENTION ON CORONARY INTERVENTION ON

CHRONIC TOTAL OCCULUSION(CHRONIC TOTAL OCCULUSION(CTOCTO)) LESIONSLESIONS

Shahriyari Afshar M.Shahriyari Afshar M.

Arefi HArefi H..Nadi S.Nadi S.

Shariati Hospital, Cardiovascular DepartmentShariati Hospital, Cardiovascular DepartmentTehran University of Medical Sciences,2006Tehran University of Medical Sciences,2006

ObjectiveObjective The aim of this study was The aim of this study was

investigation ofinvestigation of initial success rate initial success rate and the and the early clinical outcomeearly clinical outcome and and predicators of procedural failurepredicators of procedural failure in in percutaneous coronary intervention percutaneous coronary intervention on Chronic Total Occlusion with on Chronic Total Occlusion with conventional angioplasty wires atconventional angioplasty wires atShariati hospital, April 2005-2006.Shariati hospital, April 2005-2006.

MethodsMethods Forty six patients, Forty six patients, 37 men37 men and and

9 women9 women, 28-81 years old, with , 28-81 years old, with Chronic Chronic Total OcclusionTotal Occlusion enrolled in this study. enrolled in this study.

Forty eight Forty eight Chronic Total OcclusionsChronic Total Occlusions were confirmed in 46 patients with were confirmed in 46 patients with angiography.angiography.

The end points were The end points were technical and technical and procedural successprocedural success, and , and in hospital in hospital major adverse cardiac eventsmajor adverse cardiac events occurrence and occurrence and predictors of procedural predictors of procedural failurefailure..

80.4

19.6

MaleFemale

30 35 40 45 50 55 60 65 70 75 80Age

0123456789

Age

ResultsResults

Relative frequency of risk factorsRelative frequency of risk factors Diabetes mellitusDiabetes mellitus 1313 %% HypertensionHypertension 2828 %% DyslipidemiaDyslipidemia 4747 %% Cigarette smokingCigarette smoking 4545 %% Positive family historyPositive family history 6.56.5 %% No risk factorNo risk factor 1313 %%

ResultsResults Cont, Cont,

84 %84 % had history of had history of myocardial myocardial infarctioninfarction

Mean durationMean duration of MI to procedure of MI to procedure was was 73 days73 days..


Location of CTOLocation of CTO RCARCA 5050 %% LADLAD 31.131.1%% LCXLCX 18.818.8%%

Portion of CTOPortion of CTO Proximal partProximal part 47.947.9%% Mid part of vesselsMid part of vessels 52.152.1%%


Length of OcclusionLength of Occlusion < 1< 1 cmcm 6.76.7 %% 1 ~ 31 ~ 3 cm cm 5656 %% > 3> 3 cmcm 33.333.3 %%

Collateral flowCollateral flow SeenSeen 89.689.6 %% Not seenNot seen 10.410.4 %%

TIMI flowTIMI flow SeenSeen 56.256.2 %% Not seenNot seen 43.843.8 %%


Taper StumpTaper Stump SeenSeen 79.279.2%% Not seenNot seen 20.820.8%%

Coronary CalcificationCoronary Calcification SeenSeen 10.410.4%% Not seenNot seen 89.689.6%%


Other lesion in Culprit VesselOther lesion in Culprit Vessel SeenSeen 3535 %% Not seenNot seen 6565 %%

Lesion in other VesselsLesion in other Vessels SeenSeen 52.252.2%% Not seenNot seen 47.847.8%%


The most common type of guide The most common type of guide wire was wire was BMW, 0.014”BMW, 0.014”

Type of GWType of GW FrequencyFrequency PercentagePercentage

BMWBMW 3434 70.870.8BHWBHW 66 12.512.5

CougarCougar 66 12.512.5Asahi Asahi

FIELDER FIELDER 11 2.12.1

choISE choISE FloppyFloppy 11 2.12.1

Guide wire passage:

Successful 81.3 %

Unsuccessful 8.7 %

Results Cont,


Predilation pressurePredilation pressure > 10 atm> 10 atm 6262 %% < 10 atm< 10 atm 3838 %%

In one case only In one case only balloonballoon was not was not passedpassed


Type of StentType of Stent Bare Metal Stent (BMS)Bare Metal Stent (BMS) 8080 %% Drug Eluting Stent (DES)Drug Eluting Stent (DES) 2020 %%

In all cases In all cases TIMI 3TIMI 3 and and residual residual stenosis < 30 %stenosis < 30 % were achieved were achieved

No Major Adverse Cardiac Events No Major Adverse Cardiac Events (MACE)(MACE) in hospital was noted in hospital was noted


Technical Technical andand procedural procedural successsuccess was obtained in was obtained in 79.2 79.2 %% of of Chronic Total Chronic Total OcclusionsOcclusions..


Univariate and multivariate analysis of Univariate and multivariate analysis of predictors of PCI failurepredictors of PCI failure AgeAge SexSex History of InfarctionHistory of Infarction Location of InfarctionLocation of Infarction Duration of InfarctionDuration of Infarction

SmokingSmoking was a significant predictors of was a significant predictors of Percutaneous Coronary Intervention Percutaneous Coronary Intervention failure.failure.Smoke Odds ratio = 0.16, P value = 0.034Smoke Odds ratio = 0.16, P value = 0.034

DiabetesDiabetes DyslipidemiaDyslipidemia HypertensionHypertension Family History of IHDFamily History of IHD Smoking Smoking

PredictorsPredictors P ValueP Value Odd Ratio (95% CI)Odd Ratio (95% CI)AgeAge 0.080.08 0.94 0.94 (0.89 - 1.00)(0.89 - 1.00)

SexSex 0.440.44 2.4 2.4 (0.26 - 21.84)(0.26 - 21.84)

MI HistoryMI History 0.750.75 1.33 1.33 (0.22 - 0.89)(0.22 - 0.89)

MI LocationMI Location 0.780.78 0.92 0.92 (0.53 - 1.61)(0.53 - 1.61)

MI DurationMI Duration 0.210.21 0.99 0.99 (0.98 - 1.00)(0.98 - 1.00)

DMDM 0.790.79 1.36 1.36 (0.14 - 13.20)(0.14 - 13.20)

DLPDLP 0.770.77 0.81 0.81 (0.20 - 3.27)(0.20 - 3.27)

HTNHTN 0.160.16 0.36 0.36 (0.08 - 1.50)(0.08 - 1.50)

Cigarette Cigarette SmokingSmoking 0.0340.034 0.16 0.16 (0.03 - 0.87)(0.03 - 0.87)

FHFH 0.160.16 0.22 0.22 (0.03 - 1.82)(0.03 - 1.82)


ConclusionsConclusions

Using Using conventional angioplasty conventional angioplasty wires wires inin CTO CTO High percentage of Successful High percentage of Successful

Percutaneous Coronary InterventionPercutaneous Coronary Intervention was achieved was achieved

Low incidence of complicationsLow incidence of complications was was seenseen

SmokingSmoking was a significant was a significant predictor of procedural failurepredictor of procedural failure

Smoking was a significant predictor of procedural failure

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CTO Intervention Predictors, Dr Shahriyari