Abstract 15646: Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery

Abstract

Background: The long-term outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in patients with prior coronary artery bypass graft surgery (CABG) have received limited study. Methods: We examined the baseline characteristics and outcomes of CTO PCIs performed at 47 US and non-US centers between 2012 and 2023. Results: Of the 12,164 patients who underwent CTO PCI during the study period, 3,475 (29%) had prior CABG. Prior CABG patients were older, more likely to be men, with higher incidence of comorbidities and lower left ventricular ejection fraction and eGFR. Their CTOs were more likely to have moderate/severe calcification and proximal tortuosity, proximal cap ambiguity, longer lesion length and higher J-CTO scores. The first and final successful crossing strategy was more likely to be the retrograde approach. They had lower technical (82.1% vs 88.2%, p<0.001) and procedural (80.8% vs 86.8%, p<0.001) success, but similar incidence of in-hospital major complications. The incidence of in-hospital death (0.8% vs 0.3%, p<0.001), acute myocardial infarction (0.9% vs 0.5%, p=0.007) and perforation (7.0% vs 4.2%, p<0.001) was higher in prior CABG patients, while pericardial tamponade was less common (0.1% vs 1.3%, p<0.001). At 2-year follow-up, the incidence of major adverse cardiac events, repeat PCI and acute coronary syndromes was significantly higher in prior CABG patients, while all-cause mortality was similar. Conclusions: Prior CABG patients undergoing CTO PCI have more complex clinical and angiographic characteristics and lower success rate, but similar incidence of in-hospital major complications, and had higher incidence of MACE but similar all-cause mortality during long-term follow-up. Abbreviations: eGFR= estimated glomerular filtration rate