Percutaneous coronary intervention in chronic total occlusions

Abstract

Introduction: Percutaneous treatment of chronic total occlusions remains a challenge for the interventional cardiologist. Despite numerous and important advances, the rate of successful re-channeling of chronic total occlusions remains low. For this reason they are considered as the "last frontier of coronary interventionism". Objectives: To identify clinical and angiographic predictors of failure in patients with chronic total occlusions treated by percutaneous coronary intervention. Method: Observational, analytical and cross-sectional study of patients diagnosed with chronic total occlusion treated by percutaneous coronary intervention in the 2013-2017 period. A total of 252 patients were included and sociodemographic, clinical and angiographic variables were collected as the location of the chronic total occlusion, presence of lesions in other coronary arteries and angiographic result of the intervention. The Chi square and t-student statistical tests were applied according to the type of variable and a logistic regression model to obtain the probability ratios. Results: The mean age of the series was 60.3 ± 9.8 years, the male gender predominated (71%). Fifty percent of the patients presented with chronic occlude in the right coronary artery. The location in the middle segment was the most attempted revascularization (44.8%). In 67% of the cases the result was successful and only 4.7% presented complications, where the coronary dissection was the most present. Diabetes Mellitus (OR-2.3), Dyslipidemia (OR-3.4), a history of myocardial infarction (OR-3.6) and the presence of other vessel disease (OR-2.8) significantly related to the failure of the opening of chronic total occlusion. Conclusions: The treatment of chronic total occlusions by percutaneous coronary intervention is a valid therapeutic option for patients with this type of injury, although the presence of coronary risk factors and significant lesions in other coronary arteries reduce the success rate of the procedure.