Prevalence, predictors, and health status implications of periprocedural complications during coronary chronic total occlusion angioplasty

Abstract

Aims: Contemporary coronary chronic total occlusion (CTO) PCI has been associated with increased success rates. However, the rate of periprocedural complications for hybrid CTO PCI remains incompletely defined. We leveraged the OPEN CTO study in order to describe the prevalence, predictors, and health status outcomes of complications during contemporary CTO PCI.

Methods and results: Baseline demographics, procedural characteristics and rates of in-hospital complications were prospectively collected for 1,000 consecutive procedures at 12 expert US centres from 02/2014 to 07/2015. Multivariable logistic regression was used to evaluate the association of pre-specified anatomic and physiologic variables with complications. Patient-reported health status measures over the year following CTO PCI were also compared between those with and those without periprocedural complications. The overall complication rate was 9.7% (n=97/1,000). The most common adverse events were perforation (8.8%), periprocedural myocardial infarction (2.6%), arrhythmia requiring treatment (1.2%), cardiogenic shock (1.1%), and in-hospital death (0.9%). Independent predictors of complications during CTO PCI were: use of the retrograde approach (OR 1.98, 95% CI: 1.32-2.99), age (OR 1.30, 95% CI: 1.07-1.58 per 10-year increment), and J-CTO score (OR 1.20, 95% CI: 1.03-1.41 per one point increment). Mean health status scores over 12 months were worse for patients who experienced complications compared to those who did not, even after adjusting for baseline health status.

Conclusions: Complication rates for CTO PCI are more frequent than those reported for non-CTO PCI and were independently associated with retrograde approach, increasing age, and increasing lesion complexity. In addition, these periprocedural complications were also associated with worse long-term health status outcomes.