Chronic total occlusion percutaneous coronary intervention in Latin America

Abstract

Objectives To report clinical, angiographic characteristics, outcomes, and predictors of unsuccessful procedures in patients who underwent chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in Latin America. Background CTO PCI has been increasingly performed worldwide, but there is a lack of information in this region. Methods An international multicenter registry was developed to collect data on CTO PCI performed in centers in Latin America. Patient, angiographic, procedural and outcome data were evaluated. Predictors of unsuccessful procedures were assessed by multivariable analysis. Results We have included data related to 1,040 CTO PCIs performed in seven countries in Latin America (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, and Puerto Rico). The mean age was 64 ± 10 years, and CTO PCI was performed mainly for angina control (81%) or treatment of a large ischemic area (30%). Overall technical success rate was 82.5%, and it was achieved with antegrade wire escalation in 81%, antegrade dissection/re‐entry in 8% and with retrograde techniques in 11% of the successful procedures. Multivariable analysis identified moderate/severe calcification, a blunt proximal cap and a previous attempt as independent predictors of unsuccessful procedures. In‐hospital major adverse cardiovascular events (MACE) occurred in 3.1% of the cases, death in 1% and cardiac tamponade in 0.9% Conclusions CTO PCI in Latin America has been performed mainly for ischemia relief. Procedures were associated with a success rate above 80% and low incidence of MACE. Predictors of unsuccessful procedures were similar to those previously reported in the literature.

In‐stent chronic total occlusion angioplasty in the LATAM‐CTO registry

“…IS‐CTO PCI was defined as a PCI attempt in a coronary segment with prior metallic stent(s) and occlusive stenosis 5 mm proximal or within the stent. Clinical, angiographic, procedural, and postprocedure outcomes used standard definitions from the LATAM CTO registry 9 . In‐hospital major adverse cardiovascular events (MACE) was defined as all‐cause death, myocardial infarction, or stroke.…”

“…Clinical, angiographic, procedural, and postprocedure outcomes used standard definitions from the LATAM CTO registry. 9 In-hospital major adverse cardiovascular events (MACE) was defined as all-cause death, myocardial infarction, or stroke. Myocardial infarction was defined using the universal definition of MI (type 4a MI) (22).…”

Chronic total occlusion percutaneous coronary intervention: The Latin American experience

“…And second, what is the best way to achieve procedural success with fewer complications? Quadros et al 4 have contributed to the answers, and we hope their efforts continue.…”

“…An opportune study is published in this issue of the journal by Quadros et al, 4 providing further insight into this matter in the Latin American population. Using the LATAM CTO international registry, the authors analyzed the CTO PCI experience in 1,040 patients who underwent PCI in different Latin American countries, of which 59% were in Brazil.…”

Retrograde approach for chronic total occlusion angioplasty: At your own risk

“…Coronary chronic total occlusion (CTO) percutaneous coronary interventions (PCI) are becoming increasingly performed worldwide with increasing success rates 1,2 . Although the antegrade approach is usually preferred, the retrograde approach is used in about a third of CTO PCI procedures to increase the chance of procedural success 2 . Red flags had been raised to retrograde approach since some studies found increased risk of complications, but this was not consistent across the literature 1 .…”