The Impact of Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention

Xenogiannis, Iosif

The Impact of Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Iosif Xenogiannis, M.D. , ACIST Medical Systems, Dallas, TX

Dimitrios Karmpaliotis, M.D. , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Khaldoon Alaswad, M.D., FSCAI , Henry Ford Health System, Detroit, MI

Farouc A. Jaffer, M.D., Ph.D., FSCAI , Massachusetts General Hospital, Boston, MA

Robert W. Yeh, M.D., FSCAI , Beth Israel Deaconess Medical Center, Boston, MA

Mitul P. Patel, M.D., FSCAI , UCSD Medical Center, San Diego, CA

Ehtisham Mahmud, M.D., FSCAI , University of California, San Diego Sulpizio Cardiovascular Center, San Diego, CA

James W. Choi, M.D., FSCAI , Cardiology Consultants of Texas, Dallas, TX

M. Nicholas Burke, M.D., FSCAI , Minneapolis Heart Institute, Minneapolis, MN

Anthony Doing, MD , Medical Center of the Rockies, Loveland, CO

Philip Dattilo, M.D., FSCAI , University of Colorado Health North, Fort Collins, CO

Catalin Toma, M.D. , University Of Pittsburgh Medical Center, Pittsburgh, PA

A.J. Conrad Smith, M.D., FSCAI , UPMC, Pittsburgh, PA

Barry F. Uretsky, M.D., MSCAI , University of Arkansas for Medical Sciences Program, Fort Smith, AR

Oleg Krestyaninov, M.D. , Meshalkin Novosibrisk Research Institute, Novosibirsk, Russian Federation

Dmitrii Khelimskii, M.D. , Meshalkin Novosibrisk Research Institute, Novosibirsk, Russian Federation

Elizabeth M. Holper, M.D., FSCAI , Private Practice, Dallas, TX

Srini Potluri, M.D. , The Heart Hospital Baylor Plano, Plano, TX

R. Michael Wyman, M.D. , Torrance Memorial Medical Center, Torrance, CA

David E. Kandzari, M.D., FSCAI , Piedmont Heart Institute, Atlanta, GA

Santiago Garcia, M.D., FSCAI , Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Edina, MN

Michail Koutouzis, M.D., Ph.D. , Hellenic Red Cross Hospital of Athens, Athens, Greece

Ioannis Tsiafoutis, M.D. , Hellenic Red Cross Hospital of Athens, Athens, Greece

Jaikirshan Khatri, M.D., FSCAI , Cardiovascular Medicine Associates, Inc., Cleveland, OH

Wissam Jaber, M.D. , Emory Heart & Vascular Center, Atlanta, GA

Habib Samady, M.D., FSCAI , Emory University School of Medicine, Atlanta, GA

Brian Jefferson, M.D. , Centennial Heart, LLC, Nashville, TN

Taral Patel, M.D. , Centennial Heart, LLC, Nashville, TN

Abdul M Sheikh, M.D. , none, Atlanta, GA

Bilal A. Malik, M.D., FSCAI , Maimonides Medical Center, Brooklyn, Brooklyn, NY

Jeffrey W. Moses, M.D., FSCAI , Columbia University Medical Center, New York, NY

Nicholas Joseph Lembo, M.D., FSCAI , Center for Interventional Vascular Therapy, Columbia University Medical Center, Alys Beach, FL

Manish A. Parikh, M.D., FSCAI , Columbia University/NY Presbyterian Hospital, New York, NY

Ajay J. Kirtane, M.D., FSCAI , Columbia University Medical Center, Demarest, NJ

Ziad A. Ali, M.D., Ph.D. , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Fotis Gkargkoulas, M.D. , Columbia University Medical Center, New York, NY

Peter Tajti, M.D. , Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN

Allison Barbara Hall, M.D. , Memorial University of Newfoundland, Portugal Cove-St. Philip's, NF, Canada

Evangelia Vemmou, M.D. , Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN

Ilias Nikolakopoulos, M.D. , Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN

Bavana Rangan, BDS, MPH , Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN

Shuaib Abdullah, M.D. , VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX

Subhash Banerjee, M.D., FSCAI , Dallas Veterans Affairs Medical Center, Dallas, TX

Emmanouil S. Brilakis, M.D., FSCAI , Minneapolis Heart Institute, Minneapolis, MN

Background:
Peripheral artery disease (PAD) is a common comorbidity in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods:
We reviewed 3,999 CTO PCIs performed in 3,914 patients between 2012 and 2018 at 25 sites in the US, Europe and Russia of whom 14% had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with prior history of PAD to those with no prior history of PAD.

Results:
Patients with PAD were older (67±9 vs 64±10 years, p<0.001) and had higher incidence of cardiovascular risk factors, such as diabetes (50% vs 41%, p<0.001), hypertension (95% vs 90%, p<0.001) and dyslipidemia (94% vs 88%, p<0.001). PAD patients had more complex lesions as illustrated by higher J-CTO score (2.7±1.2 vs 2.4±1.3, p<0.001). Antegrade wire escalation was a less successful crossing strategy for PAD patients compared to those without PAD (Figure 1).Technical success was similar between the two groups (84% vs 87%, p=0.127) while procedural success was higher for patients without PAD (81% vs 85%, p=0.015). In-hospital major cardiac event rates were higher for patients with PAD (3% vs 2%, p=0.046) driven by the higher percentage of tamponade needing pericardiocentesis (1.8% vs 0.7%, p=0.021). Median procedure time (124 [82, 200] vs 115 [73, 174] min, p=0.003) and patient air kerma radiation dose (3.0 [1.7, 4.8] vs 2.7 [1.5, 4.5] Gray, p=0.032) were both higher for patients diagnosed with PAD.

Conclusions:
Patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions and lower rates of procedural success as compared with patients without PAD.