Predictors of successful primary antegrade wiring in chronic total occlusion percutaneous coronary intervention.

ABSTRACT

BACKGROUND: Antegrade wiring is the most commonly used chronic total occlusion (CTO) crossing technique. METHODS: Using data from the PROGRESS CTO registry (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; Clinicaltrials.gov identifier NCT02061436), we examined the clinical and angiographic characteristics and procedural outcomes of CTO percutaneous coronary interventions (PCIs) performed using a primary antegrade wiring strategy. RESULTS: Of the 13 563 CTO PCIs performed at 46 centers between 2012 and 2023, a primary antegrade wiring strategy was used in 11 332 (83.6%). Upon multivariable logistic regression analysis, proximal cap ambiguity (odds ratio [OR] 0.52; 95% CI, 0.46-0.59), side branch at the proximal cap (OR 0.85; 95% CI, 0.77-0.95), blunt/no stump (OR 0.52; 95% CI 0.47-0.59), increasing lesion length (OR [per 10 mm increase] 0.79; 95% CI, 0.76-0.81), moderate to severe calcification (OR 0.73; 95% CI, 0.66-0.81), moderate to severe proximal tortuosity (OR 0.67; 95% CI, 0.59-0.75), bifurcation at the distal cap (OR 0.66; 95% CI, 0.59-0.73), left anterior descending artery CTO (OR [vs right coronary artery] 1.44; 95% CI, 1.28-1.62) and left circumflex CTO (OR [vs right coronary artery] 1.22; 95% CI, 1.07-1.40), non-in-stent restenosis lesion (OR 0.56; 95% CI, 0.49-0.65), and good distal landing zone (OR 1.18; 95% CI, 1.06-1.32) were independently associated with primary antegrade wiring crossing success. CONCLUSIONS: The use of antegrade wiring as the initial strategy was high (83.6%) in our registry. We identified several parameters associated with primary antegrade wiring success.