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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

Wiener klinische Wochenschrift volume 129, pages 243–250 (2017)Cite this article

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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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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Conflict of interest

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

Keywords

  • Chronic total occlusion
  • Retrograde
  • Long term follow-up
  • Antegrade approach
  • MACCE