Association of Proximal Vessel Tortuosity with Technical Success and Clinical Outcomes: Analysis From the Progress‐CTO Registry
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Proximal vessel tortuosity can hinder wiring and equipment delivery during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). AIMS: We sought to examine the association of proximal vessel tortuosity with the short and long-term outcomes of patients undergoing CTO PCI. METHODS: We examined the association of proximal vessel tortuosity with clinical outcomes in patients who underwent CTO PCI at 50 US and non-US centers between 2012 and 2024. RESULTS: Of 14,141 patients, 3,974 (28.1%) had moderate or severe proximal vessel tortuosity. Patients with moderate or severe proximal vessel tortuosity had more comorbidities and more complex angiographic characteristics, such as longer lesion length and higher prevalence of side branch at the proximal cap. Lesions with moderate or severe proximal tortuosity required greater procedure and fluoroscopy time. On unadjusted analyses, moderate/severe proximal vessel tortuosity was associated with lower technical success and higher incidence of major adverse cardiac events (MACE). In multivariable analysis, moderate/severe proximal vessel tortuosity was associated with lower technical success (odds ratio [OR]: 0.77; 95% confidence intervals [CI]: 0.67, 0.89) but similar MACE (OR: 1.26; 95% CI: 0.91, 1.73). Higher operator volume (≥ 30 CTO PCI cases per year) was associated with higher technical (85.2% vs. 75.6%, p < 0.001) and procedural success (83.6% vs. 74.5%, p < 0.001) but also higher risk of perforation (6.49% vs. 3.57%, p < 0.001) but not pericardiocentesis, in lesions with moderate/severe proximal vessel tortuosity. CONCLUSIONS: Moderate or severe proximal vessel tortuosity is independently associated with lower technical success in CTO PCI but not with MACE. High-volume operators are more likely to successfully perform CTO PCI in lesions with moderate/severe tortuosity at the cost of higher risk of perforation, without higher MACE.
DOI: 10.1002/ccd.31338
Authors: Dimitrios Strepkos, Athanasios Rempakos, Michaella Alexandrou, Deniz Mutlu, Pedro E. P. Carvalho, Ali Bahbah, Spyridon Kostantinis, James W. Choi, Sevket Gorgulu, Farouc A. Jaffer, Raj Chandwaney, Khaldoon Alaswad, Mir B. Basir, Lorenzo Azzalini, Ramazan Ozdemir, Mahmut Uluganyan, Jaikirshan Khatri, Laura Young, Paul Poommipanit, Nazif Aygul, Rhian Davies, Oleg Krestyaninov, Dmitrii Khelimskii, Omer Goktekin, Hasim Tuner, Nidal Abi Rafeh, Ahmed Elguindy, Bavana V. Rangan, Olga C. Mastrodemos, Konstantinos Voudris, Ahmed Al‐Ogaili, M. Nicholas Burke, Yader Sandoval, Emmanouil S. Brilakis
Institutions: Abbott Northwestern Hospital, Minneapolis Heart Institute Foundation, Yale New Haven Hospital, Texas Health Dallas, Biruni University, Massachusetts General Hospital, Oklahoma Heart Institute, Henry Ford Health, Henry Ford Hospital, University of Washington Medical Center, Bezmiâlem Vakıf Üniversitesi, Cleveland Clinic, University Hospitals of Cleveland, Case Western Reserve University, Selçuk University, WellSpan Health, Meshalkin National Medical Research Center, Van Yüzüncü Yıl Üniversitesi, North Oaks Health System, Magdi Yacoub Heart Foundation
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4405280899