In-hospital outcome of re-attempted percutaneous coronary interventions for chronic total occlusion.

BACKGROUND: With the advent of novel recanalization techniques and emerging devices, percutaneous coronary intervention (PCI) has become a promising leading treatment option for patients with chronic total occlusions (CTO). The present study aims to evaluate the acute outcomes of PCI in previously failed re-attempted vs. first-attempted CTO-lesions. METHODS: Between 2012 and 2019, 619 patients were included and treated with PCI of at least one CTO. 253 patients were re-attempted lesions, while 366 were initially attempted lesions. RESULTS: Re-attempted lesions were more complex, including higher Japanese-CTO (J-CTO) score and the need for a retrograde approach. The procedure time and fluoroscopy time were longer in this group. Nevertheless, overall success rates were comparable between both groups of patients. In-hospital events were rare and without significant differences. CONCLUSIONS: Re-attempted CTO lesions are more complex than first-attempt lesions and are associated with longer procedural times. However, they can be safely intervened by experienced operators with a similar success rate.

Influence of smoking habits on acute outcome of revascularization of chronic total occlusion.

OBJECTIVE: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains a major challenge in interventional cardiology. The exact toxic components of cigarette smoke and the mechanisms involved in smoking-related cardiovascular dysfunction are largely unknown, but it increases inflammation, thrombosis, and oxidation of low-density lipoprotein cholesterol. There is only insignificant knowledge reported in the literature about the influence of smoking habits on acute outcome in CTO PCI. METHODS: Between 2012 and 2017, a total of 559 patients were included in the study. The patients all underwent PCI for at least 1 CTO. Antegrade and retrograde CTO techniques were applied. The Shapiro-Wilk test was used to test for normality of distribution. Continuous variables were tested for differences with the Kruskal-Wallis test or the Mann-Whitney U test, as appropriate. Categorical variables were tested using Fisher's exact test. RESULTS: Non-smokers were older than smoking patients (65.3±10.3 years vs. 58.3±9.2 years; p<0.001). The mean age of the cohort was 62.1 years (±10.5). Smokers were more often male (85.7% vs. 79.7%; p=0.074), suffered from longer lesion length (36.1±17.5 mm vs. 39.1±17.2 mm; p=0.023) and therefore needed longer stents (64.2±26.5 mm vs. 69.0±28.0 mm; p=0.084). The success rate was comparable for smokers and non-smokers. In-hospital procedural complications were rare and demonstrated no statistically significant difference. CONCLUSION: The results of this retrospective study revealed no significant association between smoking and acute outcome in CTO PCI. Smokers did, however, have longer lesions and needed longer stents.