Contemporary Incidence, Management, and Long-Term Outcomes of Percutaneous Coronary Interventions for Chronic Coronary Artery Total Occlusions

Insights From the VA CART Program

Thomas T. Tsai, Maggie A. Stanislawski, Kendrick A. Shunk, Ehrin J. Armstrong, Gary K. Grunwald, Alan H. Schob, Javier A. Valle, Carlos E. Alfonso, Brahmajee K. Nallamothu, P. Michael Ho, John S. Rumsfeld, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objectives The aim of this study was to describe the contemporary incidence of chronic total occlusions (CTOs) and the success rates of CTO percutaneous coronary intervention (PCI), as well as the complications and long-term outcomes of these patients. Background The contemporary prevalence and management of coronary CTOs is understudied. Methods Consecutive veterans undergoing coronary angiography at 79 Veterans Affairs sites between 2007 and 2013 were examined. Detailed baseline clinical, angiographic, and follow-up outcomes were evaluated using national data from the Veterans Affairs Clinical Assessment Reporting and Tracking program. Results Among 111,273 patients with obstructive coronary artery disease, 29,399 (26.4%) had ≥1 CTO, most commonly in the right coronary artery distribution (n = 18,986 [64.6%]). Elective CTO PCI was attempted in 2,394 patients (8.1%), with a procedural success rate of 79.7%. The odds of CTO PCI success increased over the years of the study (odds ratio: 1.08; 95% confidence interval [CI]: 1.01 to 1.16; p = 0.03). Compared with failed CTO PCI, successful CTO PCI was associated with a decreased adjusted risk for mortality (hazard ratio: 0.67; 95% CI: 0.47 to 0.95; p = 0.02) and coronary artery bypass graft surgery (hazard ratio: 0.14; 95% CI: 0.08 to 0.24; p < 0.01) at 2 years but no significant change in the risk for hospitalization for myocardial infarction (hazard ratio: 0.89; 95% CI: 0.58 to 1.36; p = 0.58). Conclusions Approximately 1 in 4 patients with obstructive coronary artery disease on coronary angiography had CTOs. Among patients who went on to elective CTO PCI, the success rate was 79.7%. Compared with failed CTO PCI, successful CTO PCI was associated with a decreased risk for mortality as well as a decreased need for subsequent coronary artery bypass graft surgery.

Original languageEnglish (US)
Pages (from-to)866-875
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume10
Issue number9
DOIs
StatePublished - May 8 2017
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Arteries
Incidence
Veterans
Confidence Intervals
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Disease
Transplants
Mortality
Coronary Vessels
Hospitalization
Odds Ratio
Myocardial Infarction

Keywords

  • chronic total occlusion
  • coronary artery disease
  • outcomes
  • percutaneous coronary interventions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Contemporary Incidence, Management, and Long-Term Outcomes of Percutaneous Coronary Interventions for Chronic Coronary Artery Total Occlusions : Insights From the VA CART Program. / Tsai, Thomas T.; Stanislawski, Maggie A.; Shunk, Kendrick A.; Armstrong, Ehrin J.; Grunwald, Gary K.; Schob, Alan H.; Valle, Javier A.; Alfonso, Carlos E.; Nallamothu, Brahmajee K.; Ho, P. Michael; Rumsfeld, John S.; Brilakis, Emmanouil S.

In: JACC: Cardiovascular Interventions, Vol. 10, No. 9, 08.05.2017, p. 866-875.

Research output: Contribution to journalArticle

Tsai, TT, Stanislawski, MA, Shunk, KA, Armstrong, EJ, Grunwald, GK, Schob, AH, Valle, JA, Alfonso, CE, Nallamothu, BK, Ho, PM, Rumsfeld, JS & Brilakis, ES 2017, 'Contemporary Incidence, Management, and Long-Term Outcomes of Percutaneous Coronary Interventions for Chronic Coronary Artery Total Occlusions: Insights From the VA CART Program', JACC: Cardiovascular Interventions, vol. 10, no. 9, pp. 866-875. https://doi.org/10.1016/j.jcin.2017.02.044
Tsai, Thomas T. ; Stanislawski, Maggie A. ; Shunk, Kendrick A. ; Armstrong, Ehrin J. ; Grunwald, Gary K. ; Schob, Alan H. ; Valle, Javier A. ; Alfonso, Carlos E. ; Nallamothu, Brahmajee K. ; Ho, P. Michael ; Rumsfeld, John S. ; Brilakis, Emmanouil S. / Contemporary Incidence, Management, and Long-Term Outcomes of Percutaneous Coronary Interventions for Chronic Coronary Artery Total Occlusions : Insights From the VA CART Program. In: JACC: Cardiovascular Interventions. 2017 ; Vol. 10, No. 9. pp. 866-875.
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abstract = "Objectives The aim of this study was to describe the contemporary incidence of chronic total occlusions (CTOs) and the success rates of CTO percutaneous coronary intervention (PCI), as well as the complications and long-term outcomes of these patients. Background The contemporary prevalence and management of coronary CTOs is understudied. Methods Consecutive veterans undergoing coronary angiography at 79 Veterans Affairs sites between 2007 and 2013 were examined. Detailed baseline clinical, angiographic, and follow-up outcomes were evaluated using national data from the Veterans Affairs Clinical Assessment Reporting and Tracking program. Results Among 111,273 patients with obstructive coronary artery disease, 29,399 (26.4{\%}) had ≥1 CTO, most commonly in the right coronary artery distribution (n = 18,986 [64.6{\%}]). Elective CTO PCI was attempted in 2,394 patients (8.1{\%}), with a procedural success rate of 79.7{\%}. The odds of CTO PCI success increased over the years of the study (odds ratio: 1.08; 95{\%} confidence interval [CI]: 1.01 to 1.16; p = 0.03). Compared with failed CTO PCI, successful CTO PCI was associated with a decreased adjusted risk for mortality (hazard ratio: 0.67; 95{\%} CI: 0.47 to 0.95; p = 0.02) and coronary artery bypass graft surgery (hazard ratio: 0.14; 95{\%} CI: 0.08 to 0.24; p < 0.01) at 2 years but no significant change in the risk for hospitalization for myocardial infarction (hazard ratio: 0.89; 95{\%} CI: 0.58 to 1.36; p = 0.58). Conclusions Approximately 1 in 4 patients with obstructive coronary artery disease on coronary angiography had CTOs. Among patients who went on to elective CTO PCI, the success rate was 79.7{\%}. Compared with failed CTO PCI, successful CTO PCI was associated with a decreased risk for mortality as well as a decreased need for subsequent coronary artery bypass graft surgery.",
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author = "Tsai, {Thomas T.} and Stanislawski, {Maggie A.} and Shunk, {Kendrick A.} and Armstrong, {Ehrin J.} and Grunwald, {Gary K.} and Schob, {Alan H.} and Valle, {Javier A.} and Alfonso, {Carlos E.} and Nallamothu, {Brahmajee K.} and Ho, {P. Michael} and Rumsfeld, {John S.} and Brilakis, {Emmanouil S.}",
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T1 - Contemporary Incidence, Management, and Long-Term Outcomes of Percutaneous Coronary Interventions for Chronic Coronary Artery Total Occlusions

T2 - Insights From the VA CART Program

AU - Tsai, Thomas T.

AU - Stanislawski, Maggie A.

AU - Shunk, Kendrick A.

AU - Armstrong, Ehrin J.

AU - Grunwald, Gary K.

AU - Schob, Alan H.

AU - Valle, Javier A.

AU - Alfonso, Carlos E.

AU - Nallamothu, Brahmajee K.

AU - Ho, P. Michael

AU - Rumsfeld, John S.

AU - Brilakis, Emmanouil S.

PY - 2017/5/8

Y1 - 2017/5/8

N2 - Objectives The aim of this study was to describe the contemporary incidence of chronic total occlusions (CTOs) and the success rates of CTO percutaneous coronary intervention (PCI), as well as the complications and long-term outcomes of these patients. Background The contemporary prevalence and management of coronary CTOs is understudied. Methods Consecutive veterans undergoing coronary angiography at 79 Veterans Affairs sites between 2007 and 2013 were examined. Detailed baseline clinical, angiographic, and follow-up outcomes were evaluated using national data from the Veterans Affairs Clinical Assessment Reporting and Tracking program. Results Among 111,273 patients with obstructive coronary artery disease, 29,399 (26.4%) had ≥1 CTO, most commonly in the right coronary artery distribution (n = 18,986 [64.6%]). Elective CTO PCI was attempted in 2,394 patients (8.1%), with a procedural success rate of 79.7%. The odds of CTO PCI success increased over the years of the study (odds ratio: 1.08; 95% confidence interval [CI]: 1.01 to 1.16; p = 0.03). Compared with failed CTO PCI, successful CTO PCI was associated with a decreased adjusted risk for mortality (hazard ratio: 0.67; 95% CI: 0.47 to 0.95; p = 0.02) and coronary artery bypass graft surgery (hazard ratio: 0.14; 95% CI: 0.08 to 0.24; p < 0.01) at 2 years but no significant change in the risk for hospitalization for myocardial infarction (hazard ratio: 0.89; 95% CI: 0.58 to 1.36; p = 0.58). Conclusions Approximately 1 in 4 patients with obstructive coronary artery disease on coronary angiography had CTOs. Among patients who went on to elective CTO PCI, the success rate was 79.7%. Compared with failed CTO PCI, successful CTO PCI was associated with a decreased risk for mortality as well as a decreased need for subsequent coronary artery bypass graft surgery.

AB - Objectives The aim of this study was to describe the contemporary incidence of chronic total occlusions (CTOs) and the success rates of CTO percutaneous coronary intervention (PCI), as well as the complications and long-term outcomes of these patients. Background The contemporary prevalence and management of coronary CTOs is understudied. Methods Consecutive veterans undergoing coronary angiography at 79 Veterans Affairs sites between 2007 and 2013 were examined. Detailed baseline clinical, angiographic, and follow-up outcomes were evaluated using national data from the Veterans Affairs Clinical Assessment Reporting and Tracking program. Results Among 111,273 patients with obstructive coronary artery disease, 29,399 (26.4%) had ≥1 CTO, most commonly in the right coronary artery distribution (n = 18,986 [64.6%]). Elective CTO PCI was attempted in 2,394 patients (8.1%), with a procedural success rate of 79.7%. The odds of CTO PCI success increased over the years of the study (odds ratio: 1.08; 95% confidence interval [CI]: 1.01 to 1.16; p = 0.03). Compared with failed CTO PCI, successful CTO PCI was associated with a decreased adjusted risk for mortality (hazard ratio: 0.67; 95% CI: 0.47 to 0.95; p = 0.02) and coronary artery bypass graft surgery (hazard ratio: 0.14; 95% CI: 0.08 to 0.24; p < 0.01) at 2 years but no significant change in the risk for hospitalization for myocardial infarction (hazard ratio: 0.89; 95% CI: 0.58 to 1.36; p = 0.58). Conclusions Approximately 1 in 4 patients with obstructive coronary artery disease on coronary angiography had CTOs. Among patients who went on to elective CTO PCI, the success rate was 79.7%. Compared with failed CTO PCI, successful CTO PCI was associated with a decreased risk for mortality as well as a decreased need for subsequent coronary artery bypass graft surgery.

KW - chronic total occlusion

KW - coronary artery disease

KW - outcomes

KW - percutaneous coronary interventions

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