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Clinical Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Native Coronary Arteries vs Saphenous Vein Grafts

Shoaib, Ahmad; Johnson, Thomas W.; Banning, Adrian; Ludman, Peter; Rashid, Muhammad; Potts, Jessica; Shing Kwok, Chun; Kontopantelis, Evan; Azam, Ziyad A.; Kinnaird, Tim; Mamas, Mamas A.

Authors

Ahmad Shoaib

Thomas W. Johnson

Adrian Banning

Peter Ludman

Chun Shing Kwok

Evan Kontopantelis

Ziyad A. Azam

Tim Kinnaird



Abstract

Background. There are limited data comparing outcomes of patients with previous coronary artery bypass grafting (CABG) presenting with stable angina who undergo percutaneous coronary intervention (PCI) to either a saphenous vein grafts (SVG) or a chronic total occlusion (CTO) in the native coronary arteries. We compared clinical characteristics and outcomes of these two groups in a national cohort. Methods and Results. We formed a longitudinal cohort (2007-2014; n = 11,132) of patients who underwent SVG-PCI (group 1; n = 8619) or CTO-PCI in native arteries (group 2; n = 2513) in the British Cardiovascular Intervention Society (BCIS) database. Median age was 68 years in both groups, but patients in group 2 were less likely to be female, had a higher prevalence of diabetes mellitus, hypertension, hypercholesterolemia, and previous myocardial infarction, as well as worsened angina and breathlessness, but history of prior stroke, renal diseases, and the presence of left ventricular systolic dysfunction were similar to group 1. Following multivariable analysis, no significant difference in mortality was observed during index hospital admission (odds ratio [OR], 1.70; 95% confidence interval [CI], 0.63-4.58; P=.29), at 30 days (OR, 1.81; 95% CI, 0.99-3.3; P=.05), and 1 year (OR, 1.11; 95% CI, 0.85-1.44; P=.43), nor was a significant difference found in in-hospital MACE rates (OR, 1.36; 95% CI, 0.85-2.19; P=.19). However, CTO-PCI was associated with more procedural complications (OR, 2.88; 95% CI, 2.38-3.47; P<.01) and vessel perforation (OR, 4.82; 95% CI, 2.80-8.28; P<.01) as compared with the SVG-PCI group. Risk of target-vessel revascularization at 1 year was similar (SVG-PCI 5.6% vs CTO-PCI 6.9%; P=.08). Conclusion. In this national cohort, CTO-PCI was performed in higher-risk patients, and was associated with more procedural complications but similar short-term or long-term mortality and in-hospital MACE.

Citation

Shoaib, A., Johnson, T. W., Banning, A., Ludman, P., Rashid, M., Potts, J., …Mamas, M. A. (2020). Clinical Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Native Coronary Arteries vs Saphenous Vein Grafts. Journal of Invasive Cardiology,

Journal Article Type Conference Paper
Online Publication Date Aug 10, 2020
Publication Date 2020-09
Deposit Date Jun 21, 2023
Journal Journal of Invasive Cardiology
Print ISSN 1557-2501
Publisher HMP Global (Healthcare Made Practical)
Peer Reviewed Peer Reviewed
Keywords chronic total occlusion, coronary artery bypass grafting, percutaneous coronary intervention, saphenous vein grafts
Publisher URL https://www.hmpgloballearningnetwork.com/site/jic/articles/clinical-outcomes-percutaneous-coronary-intervention-chronic-total-occlusion-native-coronary-arteries-vs-saphenous-vein-grafts