December 1, 2018EuroIntervention
Impact of retrograde approach on long-term clinical outcomes of patients undergoing coronary chronic total occlusion interventions
Key result
Retrograde PCI for coronary chronic total occlusion was associated with similar long-term risk of all-cause death compared to antegrade PCI alone (adjusted HR 1.06; 95% CI 0.75-1.49; p=0.745).
Why the study?
The study was conducted to assess the long-term clinical outcomes of coronary chronic total occlusion lesions treated with retrograde PCI compared with antegrade PCI alone.
Does retrograde PCI compared to antegrade PCI alone affect long-term outcomes in patients with coronary chronic total occlusion?
Population
842 consecutive patients (928 CTO lesions) undergoing PCI
Comparison
Retrograde PCI for at least one CTO vs antegrade PCI alone
Design
Cohort study
Follow-up
Median 7.7 (interquartile range 5.6-8.7) years
Authors
Discussion
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Member takes
Implication
May warrant caution selecting retrograde CTO PCI in complex lesions; leaves open whether long-term outcomes differ from antegrade alone.
Study Design
Type
Cohort (n=842)
Structured PICO
Does retrograde PCI compared to antegrade PCI alone affect long-term outcomes in patients with coronary chronic total occlusion?
P
Population
842 consecutive patients undergoing PCI for coronary chronic total occlusion, followed for a median of 7.7 years.
E
Exposure
Retrograde PCI for at least one CTO (n=302)
C
Comparator
Antegrade PCI alone (n=540)
O
Outcome
Long-term outcomes including all-cause death, cardiac death, coronary artery bypass grafting, and non-target vessel revascularisation at median 7.7 years follow-uphard clinical
Main Result
Hazard Ratio: 1.06 (95% CI 0.75–1.49)
p-value: p=0.745
Retrograde CTO PCI does not lead to worse long-term outcomes compared to antegrade PCI alone, despite an increased risk of periprocedural myocardial infarction and coronary perforation.
Cite This Study
Tanaka et al. (2018) conducted a cohort in Coronary chronic total occlusion (n=842). Retrograde percutaneous coronary intervention vs. Antegrade PCI alone was evaluated on All-cause death (HR 1.06, 95% CI 0.75-1.49, p=0.745). Retrograde PCI for coronary chronic total occlusion was associated with similar long-term risk of all-cause death compared to antegrade PCI alone (adjusted HR 1.06; 95% CI 0.75-1.49; p=0.745).