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Long-term major adverse cardiac and cerebrovascular events (MACCE) rate

Comparison of retrograde and antegrade recanalization of chronic total coronary occlusions

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Summary

Background

The recanalization success rate of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be increased by the retrograde approach; however, the long-term outcome of patients undergoing retrograde procedures is unknown.

Aim

We aimed to evaluate the long-term major adverse cardiac and cerebrovascular event (MACCE) rate (e.g. death, myocardial infarction, coronary artery bypass surgery and stroke) in patients after retrograde versus antegrade CTO-PCI.

Methods and results

In a prospective single center study from January 2008 to June 2012, 396 consecutive patients with CTO (≥3 months old) were enrolled. The mean age was 63.4 ± 10.3 years and 86.4% were male. The success rate of the total patient cohort was 88.6%. The retrograde PCI, only attempted after a failed antegrade intervention, was performed in 18% (n = 71) of patients. Long-term MACCE rate (mean follow up 2.3 ± 1.6 years) was significantly higher in the unsuccessful compared to the successful CTO-PCI group (23.1% versus 9.4%, p = 0.01) and this was also the case in the subgroup of antegrade CTO-PCI. In the retrograde subgroup, however, procedural success had no impact on outcome. Patients with unsuccessful retrograde CTO-PCI had a significantly better collateral connection compared to patients with an unsuccessful antegrade approach. Independent predictors for MACCE were peripheral artery disease and an ejection fraction ≤30%.

Conclusion

The long-term MACCE rate after unsuccessful recanalization was significantly higher, which was driven by a higher MACCE rate after unsuccessful versus successful antegrade approaches. In contrast, procedural success in the retrograde group had no impact on outcome.

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Acknowledgements

The authors thank Anne Hartmuth for data collection.

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Authors and Affiliations

  1. Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Wördemannsweg 25–27, 22527, Hamburg, Germany

    Klaudija Bijuklic MD, Carsten Schwencke MD &  Joachim Schofer MD, PhD

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  1. Klaudija Bijuklic MD
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  2. Carsten Schwencke MD
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  3. Joachim Schofer MD, PhD
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Correspondence to Joachim Schofer MD, PhD.

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K. Bijuklic, C. Schwencke, and J. Schofer declare that they have no competing interests.

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Bijuklic, K., Schwencke, C. & Schofer, J. Long-term major adverse cardiac and cerebrovascular events (MACCE) rate. Wien Klin Wochenschr 129, 243–250 (2017). https://doi.org/10.1007/s00508-016-1148-9

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  • DOI: https://doi.org/10.1007/s00508-016-1148-9

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