Long-term major adverse cardiac and cerebrovascular events (MACCE) rate : Comparison of retrograde and antegrade recanalization of chronic total coronary occlusions.

Abstract

The recanalization success rate of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be increased by the retrograde approach; however, the long-term outcome of patients undergoing retrograde procedures is unknown. We aimed to evaluate the long-term major adverse cardiac and cerebrovascular event (MACCE) rate (e.g. death, myocardial infarction, coronary artery bypass surgery and stroke) in patients after retrograde versus antegrade CTO-PCI. In aprospective single center study from January 2008 to June 2012, 396 consecutive patients with CTO (≥3months old) were enrolled. The mean age was 63.4± 10.3 years and 86.4% were male. The success rate of the total patient cohort was 88.6%. The retrograde PCI, only attempted after afailed antegrade intervention, was performed in 18% (n= 71) of patients. Long-term MACCE rate (mean follow up 2.3± 1.6 years) was significantly higher in the unsuccessful compared to the successful CTO-PCI group (23.1% versus 9.4%, p= 0.01) and this was also the case in the subgroup of antegrade CTO-PCI. In the retrograde subgroup, however, procedural success had no impact on outcome. Patients with unsuccessful retrograde CTO-PCI had asignificantly better collateral connection compared to patients with an unsuccessful antegrade approach. Independent predictors for MACCE were peripheral artery disease and an ejection fraction ≤30%. The long-term MACCE rate after unsuccessful recanalization was significantly higher, which was driven by ahigher MACCE rate after unsuccessful versus successful antegrade approaches. In contrast, procedural success in the retrograde group had no impact on outcome.