In the Journals

Chronic total occlusion PCI in Latin America often successful despite limited resources

Chronic total occlusion PCI performed in Latin America is primarily done for angina relief, had a success rate of more than 80% and conferred low incidence of MACE, despite resources that are limited compared with other regions, according to an analysis published in Catheterization and Cardiovascular Interventions.

Researchers also found that factors including moderate to severe calcification (OR = 1.52; 95% CI, 1.08-2.15), a blunt proximal cap (OR = 2.59; 95% CI, 1.8-3.73) and previous attempt at CTO PCI (OR = 1.77; 95% CI, 1.15-2.73) were independent predictors for unsuccessful interventions.

“In this study, we report for the first time comprehensive data of CTO PCI performed in Latin America, including clinical, angiographic, procedural characteristics, outcomes and predictors of unsuccessful procedures,” Alexandre Quadros, MD, PhD, of the Instituto de Cardiologia do Rio Grande do Sul, and the Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista, Brazil, and colleagues wrote. “CTO PCI procedures data from North America, Western Europe and Japan have been extensively reported, but there is a paucity of real-world data from other regions.”

According to the study, of the 1,040 CTO PCIs completed in Argentina, Brazil, Chile, Colombia, Ecuador, Mexico and Puerto Rico between January 2015 and February 2019, 81% we performed for angina control while 30% were for the treatment of a large ischemic area.

Researchers found that the success rate of CTO PCI in Latin America was 82.5%. Among the successful procedures, 81% were achieved with antegrade wire escalation, 8% with antegrade dissection/reentry and 11% with retrograde techniques, Quadros and colleagues wrote.

Moreover, in-hospital MACE, defined as all-cause death, MI or stroke, occurred in 3.1% of procedures, death in 1% and cardiac tamponade in 0.9%, according to the study.

“The present analysis is relevant because equipment and resources are generally more limited in Latin America, mainly due to financial restraints and fragmented regulatory issues (Ybarra LF, et al. Arq Bras Cardiol. 2018;doi:10.5935/abc.20180077),” the researchers wrote. “Registry data from very experienced CTO centers report success rates of approximately 90%, higher than found in our report.”

Using an international multicenter registry to collect patient data (mean age, 64 years; 78% men; 17% smoking; 37% with diabetes), investigators performed a multivariable analysis to assess clinical and angiographic characteristics, outcomes and predictors of unsuccessful procedures in patients who underwent CTO PCI in Latin America.

“We aimed at showing a picture of clinical practice in CTO PCI in Latin America, and every center willing to participate was included,” the researchers wrote. “Our results may, therefore, be more generalizable and represent the global reality of most interventional cardiology services with CTO interest.” – by Scott Buzby

Disclosures: Quadros reports he received educational support from Asahi, Boston Scientific, Biotronik and Terumo; research grants from Boston Scientific and Terumo; and was a speaker for Boston Scientific.

Chronic total occlusion PCI performed in Latin America is primarily done for angina relief, had a success rate of more than 80% and conferred low incidence of MACE, despite resources that are limited compared with other regions, according to an analysis published in Catheterization and Cardiovascular Interventions.

Researchers also found that factors including moderate to severe calcification (OR = 1.52; 95% CI, 1.08-2.15), a blunt proximal cap (OR = 2.59; 95% CI, 1.8-3.73) and previous attempt at CTO PCI (OR = 1.77; 95% CI, 1.15-2.73) were independent predictors for unsuccessful interventions.

“In this study, we report for the first time comprehensive data of CTO PCI performed in Latin America, including clinical, angiographic, procedural characteristics, outcomes and predictors of unsuccessful procedures,” Alexandre Quadros, MD, PhD, of the Instituto de Cardiologia do Rio Grande do Sul, and the Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista, Brazil, and colleagues wrote. “CTO PCI procedures data from North America, Western Europe and Japan have been extensively reported, but there is a paucity of real-world data from other regions.”

According to the study, of the 1,040 CTO PCIs completed in Argentina, Brazil, Chile, Colombia, Ecuador, Mexico and Puerto Rico between January 2015 and February 2019, 81% we performed for angina control while 30% were for the treatment of a large ischemic area.

Researchers found that the success rate of CTO PCI in Latin America was 82.5%. Among the successful procedures, 81% were achieved with antegrade wire escalation, 8% with antegrade dissection/reentry and 11% with retrograde techniques, Quadros and colleagues wrote.

Moreover, in-hospital MACE, defined as all-cause death, MI or stroke, occurred in 3.1% of procedures, death in 1% and cardiac tamponade in 0.9%, according to the study.

“The present analysis is relevant because equipment and resources are generally more limited in Latin America, mainly due to financial restraints and fragmented regulatory issues (Ybarra LF, et al. Arq Bras Cardiol. 2018;doi:10.5935/abc.20180077),” the researchers wrote. “Registry data from very experienced CTO centers report success rates of approximately 90%, higher than found in our report.”

Using an international multicenter registry to collect patient data (mean age, 64 years; 78% men; 17% smoking; 37% with diabetes), investigators performed a multivariable analysis to assess clinical and angiographic characteristics, outcomes and predictors of unsuccessful procedures in patients who underwent CTO PCI in Latin America.

“We aimed at showing a picture of clinical practice in CTO PCI in Latin America, and every center willing to participate was included,” the researchers wrote. “Our results may, therefore, be more generalizable and represent the global reality of most interventional cardiology services with CTO interest.” – by Scott Buzby

Disclosures: Quadros reports he received educational support from Asahi, Boston Scientific, Biotronik and Terumo; research grants from Boston Scientific and Terumo; and was a speaker for Boston Scientific.