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
Author Information
Ilias Nikolakopoulos: Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Evangelia Vemmou: Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Judit Karacsonyi: Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Khaldoon Alaswad: Henry Ford Hospital, Detroit, MI, USA.
Dimitri Karmpaliotis: Columbia University, New York, NY, USA.
Nidal Abi Rafeh: St. George Hospital University Medical Center, Beirut, Lebanon.
Daniel Schimmel: Division of Cardiology (V.S.J., D.R.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Keith Benzuly: Division of Cardiology (V.S.J., D.R.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
James D Flaherty: Division of Cardiology (V.S.J., D.R.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Paul Poommipanit: Harrington Heart and Vascular Institute, University Hospitals-Parma Medical Center, Parma, OH, USA.
Ahmed M ElGuindy: Aswan Heart Centre, Magdi Yacoub Foundation, Egypt.
M Nicholas Burke: Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Emmanouil S Brilakis: Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA. Electronic address: esbrilakis@gmail.com.
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.
