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Intravascular ultrasound analysis of intraplaque versus subintimal tracking in percutaneous intervention for coronary chronic total occlusions: One year outcomes
Author(s) -
Finn Matthew T.,
Doshi Darshan,
Cleman Jacob,
Song Lei,
Maehara Akiko,
Hatem Raja,
Redfors Björn,
Kalra Sanjog,
Fried Justin A.,
Liao Ming,
Batres Candido,
Moses Jeffery W.,
Parikh Manish A.,
Collins Michael B.,
Nazif Tamim M.,
Fall Khady N.,
Green Phillip,
Kirtane Ajay J.,
Ali Ziad A.,
Leon Martin B.,
Mintz Gary S.,
Karmpaliotis Dimitri
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27958
Subject(s) - medicine , conventional pci , intravascular ultrasound , percutaneous coronary intervention , cardiology , revascularization , myocardial infarction , artery , radiology , concomitant
Objectives We sought to determine the 1‐year outcomes of patients receiving successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures comparing subintimal versus intraplaque wire tracking patterns. Background CTO PCI utilizes both intraluminal and subintimal wire tracking to achieve successful percutaneous revascularization. Intravascular ultrasound (IVUS) can be used to precisely determine the path of wire tracking. Methods From 2014 to 2016, data from patients undergoing CTO PCI were collected in a single‐center database. The primary composite endpoint was target vessel failure (TVF) defined as cardiovascular death, target vessel myocardial infarction (MI), or target vessel revascularization (TVR). Results In total 157 patients with successful CTO PCI and concomitant IVUS imaging completed 1‐year follow‐up. Subintimal tracking was detected in 53.5% of cases and those patients had a higher incidence of prior PCI, prior coronary artery bypass grafting, and higher J‐CTO score. At 1‐year, the unadjusted rate of TVF in the subintimal tracking group was higher than the intraplaque group (17.9 vs. 6.9%, HR 2.74, 95% CI 1.00–7.54, P = 0.04), driven by numerically higher rates of TVR and peri‐procedural MI. After multivariable adjustment, no significant differences in the rates of the TVF between subintimal vs. intraplaque groups were present at 1‐year (TVF: HR 1.51, 95% CI 0.38–6.00, P = 0.55). Landmark analysis excluding in‐hospital events showed no significant differences in TVF to 1‐year. Conclusions IVUS‐detected subintimal tracking was observed in over half of successful CTO PCI cases and correlated with baseline and angiographic factors that contributed to the overall rate of TVF at 1‐year.