Urgent Use of Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the Progress-CTO Registry
Presenter
Judit Karacsonyi, MD, PhD, Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN
Judit Karacsonyi, MD, PhD1, Karen Deffenbacher, MD, PhD2, Keith H. Benzuly, M.D., FSCAI3, James D Flaherty, MD, FSCAI4, Khaldoon Alaswad, M.D., FSCAI5, Farouc A. Jaffer, M.D., Ph.D., FSCAI6, Paul Poommipanit, M.D., FSCAI7, Jaikirshan Khatri, M.D., FSCAI8, Mitul P. Patel, M.D., FSCAI9, Robert F. Riley, M.D., FSCAI10, Abdul M. Sheikh, MD11, Jason R. Wollmuth, MD, FSCAI12, Ethan C. Korngold, M.D., FSCAI13, Barry F. Uretsky, M.D., MSCAI14, Robert W. Yeh, M.D., FSCAI15, Raj H. Chandwaney, M.D., FSCAI16, R. Michael Wyman, M.D.17, Srini Potluri, M.D., FSCAI18, Anthony Doing, MD19, Ahmed Elguindy, MD20, Khalid Omar Tammam, M.D., FSCAI21, Nidal Abi Rafeh, MD22, Christian Schmidt, MS23, Evangelia Vemmou, MD1, Ilias Nikolakopoulos, M.D.1, Spyridon Kostantinis, MD24, Iosif Xenogiannis, MD25, Bavana V Rangan, BDS, MPH24, Imre Ungi26, Emmanouil S. Brilakis, MD, PhD, FSCAI1 and Daniel Schimmel, MD, FSCAI3, (1)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN, (2)McGaw Medical Center of Northwestern University, Chicago, IL, (3)Northwestern Memorial Hospital, Chicago, IL, (4)Northwestern University Feinberg School of Medicine, Chicago, IL, (5)Henry Ford Hospital, Detroit, MI, (6)Massachusetts General Hospital, Boston, MA, (7)University Hospitals Cleveland Medical Center, Beachwood, OH, (8)Cleveland Clinic Main Campus, Cleveland, OH, (9)Intermountain Healthcare, Salt Lake City, UT, (10)Overlake Medical Center, Sammamish, WA, (11)Wellstar Health System, Marietta, GA, (12)Providence Heart & Vascular, Portland, OR, (13)Providence St. Vincent Medical Center, Portland, OR, (14)University of Arkansas for Medical Sciences, Fort Smith, AR, (15)Beth Israel Deaconess Medical Center, Boston, MA, (16)Oklahoma Heart Institute, Tulsa, OK, (17)Torrance Memorial Medical Center, Torrance, CA, (18)Baylor Scott & White The Heart Hospital - Plano, Frisco, TX, (19)Medical Center of the Rockies, Loveland, CO, (20)Magdi Yacoub Hospital, Cairo, Egypt, (21)The International Medical Center, Jeddah, Saudi Arabia, (22)North Oaks Health System, Hammond, LA, (23)Minneapolis Heart Institute, Minneapolis, MN, (24)Minneapolis Heart Institute Foundation, Minneapolis, MN, (25)Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, (26)University of Szeged, Szeged, Csongrad, Hungary
Keywords: Chronic Total Occlusion (CTO), Complex and High-risk Coronary Intervention (CHIP), Coronary and Hemodynamic Support
Background
Mechanical circulatory support (MCS) in complex percutaneous coronary intervention (PCI) is the subject of ongoing investigation, but the role of urgent MCS in chronic total occlusion (CTO) PCI is not well studied.
Methods
We analyzed the patient and angiographic characteristics and procedural outcomes of 6,923 CTO PCIs performed between 2012 and June 2021 at 35 international centers.
Results
Mean patient age was 64±10 years, 81% of the patients were men, and mean left ventricular ejection fraction (LVEF) was 51 ± 13 %. Urgent MCS was used in 62 (0.90%) of all cases, as follows: intra-aortic balloon pump (48%), Impella CP (40%), Impella 2.5 (10%) and venoarterial extracorporeal membrane oxygenation (VA ECMO, 8%). Higher J-CTO scores (3.50 ± 0.90 vs. 2.39 ± 1.27, p<0.001), prior coronary artery bypass graft surgery (CABG) (45% vs. 29%, p=0.006), and peripheral arterial disease (PAD) (31% vs. 14%, p<0.001) were more common in patients requiring urgent MCS. Cases performed with urgent MCS had lower technical (67.7% vs. 85.6%; p<0.001) and procedural (38.7% vs. 85.6%, p<0.001) success rates and higher rates of periprocedural major cardiac adverse events (32.26% vs. 1.68%, p<0.001) compared with no MCS use. On multivariable analysis advanced age, lower LVEF, PAD, proximal vessel tortuosity and use of retrograde crossing were associated with urgent MCS use (Figure 1).
Conclusions
In a contemporary, multicenter registry urgent MCS was used in 0.90% of CTO PCI and was associated with lower success and higher major complication rates. Advanced age, lower LVEF, PAD, proximal vessel tortuosity and use of retrograde crossing were associated with urgent MCS use.
