A Retrospective Analysis of CTO PCI Performed at Waikato Hospital: Characteristics, Outcomes and Predictors of Procedural Success (2018–2019)

Abstract

Although current evidence does not suggest a mortality benefit with Chronic Total Occlusion Percutaneous Coronary Intervention (CTO PCI), there is established symptomatic benefit. We sought to evaluate the characteristics, outcomes, and predictors of procedural success in our local cohort of patients who have received CTO PCI. The ANZACS-QI database was used to extract all PCIs performed by 3 CTO operators at Waikato Hospital between 1 January 2018 to 31 December 2019- (n=700). 47 CTO PCIs were identified for further analysis. Statistical analyses were performed with Stats.Blue. CTO PCI made up 6.7% (47/700) of PCIs performed by 3 operators in 24 months. The cohort was predominantly male (83.0%; 39/47), NZ European (91.5%; 43/47) with a mean age of 65 years. Success rates for CTO PCI were: overall=72.3% (34/47); dedicated operator=81.8% (27/33); and, non-dedicated operator=50.0% (7/14). At 1 year, major adverse cardiovascular events (MACE) (3-point) was 2.1% and 12.8% required repeat revascularisation. Predictors for successful CTO PCI included a dedicated CTO operator (χ2 4.974; p=0.026), non-diabetic patient (χ2 8.465; p=0.004) and lower J-CTO score (r, -0.307; p=0.036). With respect to symptomatic relief, in successful CTO PCIs, there was a mean CCS Score reduction of 1.72, compared to a mean reduction of 0.67 in the failed CTO PCI group (t=3.193; p=0.003). Waikato Hospital has comparable procedural success rates to other tertiary centres. The degree of symptom improvement and the significance of dedicated CTO operators, presence of diabetes and lesion complexity (by J-CTO score) is in keeping with contemporary CTO literature.