Assessment Of Clinical, Angiographic Features And Determinants Of Percutaeous Coronary Intervention In Patients With Coronary Artery Chronic Total Occlusion

Objective:The aim of our study was to assess the clinical and angiographic features and investigate influential factors of percutanenous coronary intervention (PCI) for coronary artery chronic total occlusion(CTO).Methods:Retrospectively analyzed the clinical and angiographic data from 638 patients with CTO who were examined by Coronary Angiography(CAG) between January 2004 and December 2008.The differences in categorical variables were analyzed using a chi-square analysis,and the differences in continuous variables were analyzed by the two-tailed unpaired t-test.Their relationships were determined by logistic stepwise regression analysis,and predict factors on successful procedure were sieved。Results:191 patients(538 male,100 female,mean age 64.1±11.0 yrs) were suggested to CABG or simply drug treatment,and the other 447 ones were treated by PCI.The success rate was 85.5%(382/447).Average number of stents planted was 1.92±0.75,and average length was 55.56±20.44mm.Reasons for procedural failure included inability to cross the lesion with a guidewire(73.8%,48/65), failure to cross the lesion with the balloon(3.1%,2/65) or dilate the lesion(12.3%, 8/65) and severe complications(10.8%,7/65).There were dissection in 17 cases and perforation in 10 cases during the procedure,and hem pericardium(1.3%, 6/447),acute thrombus formation(0.22%,1/447) and death for acute myocardial infarction(0.44%,2/447) in hospital after the operation.(1) Compared with patients treated by PCI,patients suggested to CABG or simply drug treatment was more aged(63.4±10.4 vs.65.7±12.0,P<0.05) and had a longer angina time(168.1±224.4w vs.280.8±291.0w,P<0.05),higher level of and LDL-C(2.3±1.0mmol/L vs.2.6±1.2mmol/L,P<0.01).And the angiographic revealed that stump missing(51.9%vs.78.0%,P<0.01),presence of calcification (42.1%vs.57.1%,P<0.01) and ostial occlusion(22.4%vs.32.5%,P<0.01), combined with multivessel disease(32.2%vs.63.4%,P<0.01),left main(0.9% vs.11.5%,P<0.01) or other occlusions(4.3%vs.19.9%,P<0.01) were more common.A multiple logistic regression analysis revealed that angina time more than 3 years(OR:0.998,95%CI:0.997-1.000,P<0.01),ostial occlusion(OR: 0.288,95%CI:0.172-0.482,P<0.01)and presence of mutilvessel disease(OR:0.288 95%CI:0.172-0.482,P<0.01) were independent predictors of not choosing PCI as a first treatment.(2) Compared with patients of successful recanalization,patients failure to recanalization were more aged(62.9±10.4yrs vs.65.9±9.9yrs,P<0.05) and the stump missing(47.1%vs.80.0%,P<0.01),presence of calcification(36.9%vs. 72.3%,P<0.01),excessive tortuosity(16.2%vs.38.5%,P<0.01) and angulated lesions(11.26%vs.38.46%,P<0.01) were more common.Usually not using the micro-catheter and tapered tip wires or hydrophilic wires.A multiple logistic regression analysis revealed that aged more than 65(P<0.05,OR:0.949, 95%C/:0.906-0.995),high level ofTG(OR:0.038,95%CI:0.148-0.949,P<0.05), presence of calcification(OR:253,95%CI:0.108-0.592,P<0.01),angulated lesion (OR:0.167,95%CI:0.062-0.451,P<0.001) and stump missing(OR:0.223, P<0.001,95%CI:0.089-0.561) were independent predictors for procedural failure.Conclusions:Percutanenous Coronary Intervention in patients with a Chronic Total Occlusion is relatively safe and effective,and success rates of our center have been proved to be around a high level(85.5%) without an accompanying increase in MACE rates during the past 5 years.A long angina time more than 3years,ostial occlusion and presence of mutilvessel disease were independent predictors of not choosing PCI as a first treatment and we should make the appropriate strategy on the basis of clinical features and characteristic of target lesions.Aged older than 65, high level of TG,presence of calcification,excessive tortuosity,angulated and stump missing were independent predictors for procedural failure.