Clinical outcomes of percutaneous coronary intervention for chronic total occlusion lesions in remote hospitals without on-site surgical support

• Published in: Chinese medical journal Vol. 122; no. 19; pp. 2278 - 2285
• Main Authors: Chen, Shao-liang, Ye, Fei, Zhang, Jun-jie, Lin, Song, Zhu, Zhong-sheng, Tian, Nai-liang, Liu, Zhi-zhong, Sun, Xue-wen, Zhang, Ai-ping, Chen, Feng, Ding, Shi-qin, Chen, Jack
• Format: Journal Article
• Language: English
• Published: China Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China%Chuzhou Municipal People's Hospital, Chuzhou, Anhui 239001, China%Zhangjiagang Municipal People's Hospital, Zhangjiagang, Jiangsu 215600, China%Huainan Oriental General Hospital, Huainan, Anhui 232000, China%Chaohu 2nd People's Hospital, Chaohu, Anhui 235056, China%Shuyang Municipal Hospital of Traditional Chinese Medicine, Shuyang, Anhui 257002, China%Xuancheng Municipal Hospital, Xuancheng, Anhui 257089, China%Huainan 3rd Mineral Coal General Hospital, Huainan, Anhui 232000, China%Huainan Municipal People's Hospital, Huainan, Anhui 232000, China%Wuxi 4th People's Hospital, Wuxi, Jiangsu 214000, China%Huainan Xinhua Hospital, Huainan, Anhui 232000, China%Northside Hospital and Saint Joseph's Translational Research Institute, Atlant 40625254, USA 05-10-2009
• Subjects: Adult; Aged; Angioplasty, Balloon, Coronary - adverse effects; Chronic Disease; Coronary Artery Bypass; Coronary Stenosis - epidemiology; Coronary Stenosis - therapy; Female; Humans; Male; Middle Aged; Survival Rate; Treatment Outcome; major adverse cardiac events; chronic total occlusion; coronary artery perforation
• ISSN: 0366-6999; 2542-5641
• DOI: 10.3760/cma.j.issn.0366-6999.2009.19.017

Background The safety of percutaneous coronary intervention （PCI） for chronic total occlusion （CTO） lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting （CABG） support was available. Methods A total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events （MACE）, defined as cardiac death, myocardial infarction and target-vessel revascularization （TVR）. Results The incidence of CTO was 7.9% in patients who underwent PCI, Successful recanalization was achieved in 132 patients （86.8%）. Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths （（42.32±22.08） mm vs （27.61±22.85） mm, P=0.023）, a higher rate of perforation （25.0% vs 0, P=0.014）, and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure （10.0%, 30.0% and 35.0%） and the success （3.0%, 12.1% and 14.4%） groups （P=0.037, 0.034 and 0.040, respectively）. These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group （P=0.031 and 0.023, respectively）. Stump was the only predictor of recanalization success （HR 0.158, 95% Cl 0.041-0.612, P=0.008）, whereas procedural failure （OR 13.023, 95% CI 6.67-13.69, P=0.002）, incomplete revascularization （OR 9.71, 95% CI 2.93-5.59, P=0.005）, and total stent length （OR 6.02, 95% Cl 1.55-11.93, P=0.027） were three independent predictors of MACE. Conclusions PCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.