The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Contemporary Outcomes of the Retrograde Approach to Chronic Total Occlusion Interventions: Insights from an International CTO Registry.

DOI: 10.4244/EIJ-D-19-00441

1. Minneapolis Heart Institute at Abbott Northwestern Hospital, Cardiology, Minneapolis, Minnesota, United States
2. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, USA
3. Columbia University, New York, USA
4. Columbia University, New York, USA
5. Henry Ford Hospital, Detroit, USA
6. Massachusetts General Hospital, Boston, USA
7. VA San Diego Healthcare System and University of California San Diego, La Jolla, USA
8. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, USA
9. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, USA
10. Meshalkin Siberian Federal Biomedical Research Center, Novosibirsk, Russian Federation
11. Korgialeneio-Benakeio Hellenic Red Cross Hospital of Athens, Athens, Greece
12. Emory University, Atlanta, USA
13. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, USA, UNITED STATES
14. Beth Israel Deaconess Medical Center, Boston, MA, USA
15. Beth Israel Deaconess Medical Center, Boston, MA, USA
16. VA San Diego Healthcare System and University of California San Diego, La Jolla, USA
17. Baylor Heart and Vascular Hospital, Dallas, USA
18. Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
19. Cleveland Clinic, Cleveland, USA
20. Korgialeneio-Benakeio Hellenic Red Cross General Hospital of Athens, Athens, Greece
21. Medical Center of the Rockies, Loveland, USA
22. Medical Center of the Rockies, Loveland, USA
23. University of Pittsburgh Medical Center, Pittsburgh, USA
24. VA Central Arkansas Healthcare System, Little Rock, USA
25. Emory University, Atlanta, USA
26. Tristar Centennial Medical Center, Nashville, USA
27. Tristar Centennial Medical Center, Nashville, USA
28. The Heart Hospital Baylor Plano, Plano, USA
29. Piedmont Heart Institute, Atlanta, USA
30. Torrance Memorial Medical Center, Torrance, USA
31. VA North Texas Health Care System and University of Texas Southwestern Medical Center. Dallas, USA
32. Columbia University, New York, USA
33. Columbia University, New York, USA
34. Columbia University, New York, USA
35. Columbia University, New York, USA
36. Columbia University, New York, USA
37. Columbia University, New York, USA
38. Columbia University, New York, USA
39. University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
40. University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary
41. VA North Texas Health Care System and University of Texas Southwestern Medical Center. Dallas, USA
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Aims: The retrograde approach is critical for achieving high success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but has been associated with higher risk of complications.

Methods and results: We compared the technical and procedural outcomes of retrograde (n=1,515) and antegrade-only CTO PCIs (n=2,686) in a contemporary multicenter CTO registry. The mean age of patients undergoing retrograde PCI was 65±10 years and 86% were men, with high prevalence of prior myocardial infarction (51%), prior PCI (71%), and coronary artery bypass graft surgery (45%). The mean J-CTO (3±1 vs 2±1 p<0.001) was higher in retrograde PCIs. The most commonly used collateral channels were septals (65%), epicardials (32%), saphenous venous grafts (14%) and left internal mammary artery grafts (2%). Overall technical (79% vs 91%, p<0.001) and procedural (75% vs 90%, p<0.001) success rates were lower with the retrograde approach, and patients had higher in-hospital major complications rate than antegrade-only PCIs (5.1% vs 0.8%, p<0.001), due to higher mortality (1.1% vs. 0.1%, p<0.001), acute myocardial infarction (1.9% vs 0.2%, p<0.001), repeat-PCI (0.7% vs 0.1%, p=0.001), and pericardiocentesis (1.7% vs 0.3%, p<0.001).

Conclusions: In summary, retrograde approach to CTO PCI is performed in higher complexity lesions and is associated with lower success and higher major complications rates.

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