Registry for the Safety and Success of Percutaneous Coronary Intervention of Chronic Total Occlusion in Ain Shams University Hospitals

Abstract

Abstract Aim and Objectives The aim of this registry was to develop an electronic registry for all patients who had Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) at Ain Shams University Hospitals (ASUHs) over a period of eight months. To collect data on treatment strategies and the outcomes of the procedure and analyze it to determine the frequency of CTO PCI performed, examine the procedural strategies utilized, determine patients „comorbidities, risk factors, the predictors of in-hospital mortality and the outcomes regarding technical and procedural success during the hospital stay. Patients and Methods This study is an electronic Registry implementation study on all patients who had Coronary Angiography that shows viable CTO vessel and underwent CTO PCI at Ain shams University Hospitals during eight months of activity since the first of July 2020 till the end of February 2021. Results Our registry was conducted on 62 patients. overall procedural success was achieved in 57 lesions (91.9%). The rate of success among re-attempts following a previous failure was slightly lower and not significant (28.1%) (p = 0.573). An ante-grade approach was undertaken in 42 lesions (67.7%), while a retrograde approach was used in 20 lesions (32.2%); the switch of the initial approach strategy in the same procedure was observed in 4 cases (6.4%): in one case (1.6%), retrograde was switched with antegrade, while in the remaining 3 procedures (4.8%) antegrade was changed into the retrograde approach. Procedural success according to the approaches were (88.1%) for anterograde and (100%) for retrograde with no statically significant relation with (p < 0.108). In-hospital adverse event rates were very low (death 1.6% and stroke 1.6%). Potential disadvantages of these procedures, including a large amount of a contrast volume (median 400 ml) and long fluoroscopic time (median 55 min), were not associated with serious clinical sequelae (contrast induced nephropathy 3.2%). Conclusion Most CTO lesions can be safely and successfully treated with PCI. Invasiveness and potential risks of these strategies, which have been the greatest concerns of CTO treatment, may be acceptable in the majority of cases considering the actual incidences of related major adverse cardiac events and the procedural success rates. Such outcomes should become the standard of care that all centers undertaking CTO PCI should aspire to.