March 26, 2019
PROGRESS-CTO Registry Studies CTO PCI in Patients With and Without Previous CABG
March 26, 2019—Data from the PROGRESS-CTO international registry—which examined procedural outcomes of chronic total occlusion percutaneous coronary intervention (CTO PCI) in patients with previous coronary artery bypass grafting (CABG)—were published by Peter Tajti, MD, et al in Circulation: Cardiovascular Interventions. The investigators concluded that patients with previous CABG have a lower tamponade rate and a similar overall risk for complications, but they also have a lower success rate and a higher mortality rate.
As summarized in Circulation: Cardiovascular Interventions, the international, multicenter registry studied 3,486 CTO PCIs performed in patients at 21 centers with previous CABG (n = 1,101) and without (n = 2,317) previous CABG. The clinical angiographic characteristics and outcomes of the two procedures were compared.
The investigators reported that, compared to patients without previous CABG, patients with previous CABG demonstrated the following:
- A generally older age range (67 ± 9 vs 63 ± 10 years; P < .001)
- More comorbidities and lower left ventricular ejection fraction (50% [40–58] vs 55% [45–60]; P < .001)
- The right coronary (56%), circumflex (26%), and left anterior descending artery (17%) as the CTO target vessel
- Higher mean J-CTO and PROGRESS-CTO scores
- More frequent use of the retrograde (53% vs 30%; P < .001) and antegrade dissection re-entry (35% vs 28%; P < .001) techniques
- Lower technical (84% vs 89%; P < .001) and procedural (82% vs 87%; P < .001) success
- A similar incidence of in-hospital major complications (3.1% vs 2.5%; P = .287)
- A more frequent occurrence of in-hospital mortality (1% vs 0.4%; P = .016) and coronary perforation (7.1% vs 3.1%; P < .001), but a lower incidence of pericardial tamponade (0.1% vs 1.0%; P = .002) and pericardiocentesis (0% vs 1.3%; P < .001)