Results of percutaneous coronary intervention for chronic total occlusions of coronary arteries: a single center report.

OZET C total occlusions (CTOs) are complex lesions identified in 15-30% of all patients referred for coronary angiography.[1,2] However, percutaneous coronary intervention (PCI) rates for these lesions have been reported as only 10-15%,[3] and most of the patients are treated with either medical therapy or coronary artery bypass grafting (CABG). Several studies have shown that successful PCI for CTO reduces symptoms of angina, improves exercise capacity, improves left ventricular function, and reduces the need for subsequent CABG.[3-7] In addition, successful PCI for CTO has shown a long-term survival benefit and may increase tolerance of future cardiac events compared to patients with an unsuccessful PCI.[8-10] Although success rates are lower than with PCI for non-CTO lesions, they have been seen to improve with the advent of sophisticated materials specifically designed for these lesions.[3,11] Despite the recent developments in the field of interventional cardiology, the data in Turkey about the results of PCI for CTO with novel equipment are insufficient. The purpose of this study was to analyze the relationship between lesion characteristics and procedural success rates and in-hospital outcomes in patients treated with PCI for CTO. PATIENTS AND METHODS Study design and patient population In this single-center observational study, we evaluated the prospectively entered data of 63 consecutive patients undergoing PCI for CTO in 63 lesions at our institute between August 2009 and June 2012. The PCI indication for CTO was the presence of angina and the demonstration of viable myocardium or silent ischemia in the territory of the occluded artery. Procedures were performed by four experienced cardiologists in our hospital. Each operator has performed more than 150 PCIs (including primary and elective) per year. A CTO was defined as proposed by the Euro CTO Club as a lesion with the presence of thrombolysis in myocardial infarction (TIMI) flow grade 0 within an occluded arterial segment of greater than three months’ standing.[12] The duration of occlusion was estimated on the basis of either history of angina or previous MI in the same territory or as proven by previous angiography. Major adverse cardiac events (MACE) were defined as death, non-fatal MI, or urgent revascularization during the same admission. Urgent revascularization was defined as target vessel repeat PCI within 24 hours (h) or urgent CABG. Non-fatal MI was defined as recurrent chest pain and/ or development of new electrocardiography (ECG) changes accompanied by a new rise ≥20% of cardiac biomarkers measured after the recurrent event. The lesion success was defined as restoration of TIMI flow grade 3 with a residual stenosis of 45° assessed by angiography throughout the occluded segment. Quantitative assessment including the variables of occlusion length, proximal vessel diameter, and distal vessel diameter was performed using a commercially available software package (CAAS II [Cardiovascular Angiography Analysis System Mark II] by Pie Medical, The Netherlands). “Occlusion length” was measured from the proximal occlusion to the distal retrograde filling from contralateral collaterals using Turk Kardiyol Dern Ars 506