PREDICTORS AND OUTCOMES OF FAILED RECANALIZATION OF CHRONIC TOTAL OCCLUSIONS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE AT A TERTIARY CARE CARDIAC CENTER
DOI:
https://doi.org/10.55519/JAMC-01-14375Abstract
Background: Chronic Total Occlusions (CTOs) are a challenging subset of coronary artery disease (CAD), often necessitating complex percutaneous coronary intervention (PCI). Despite advancements in tools and techniques, failure to recanalize CTOs remains a significant clinical concern, particularly in stable CAD patients. This study aimed to identify predictors and evaluate outcomes of failed CTO recanalization in a tertiary care cardiac center.Methods: A retrospective analysis was conducted on patients with stable CAD who underwent attempted CTO-PCI between January and July 2024. Clinical, angiographic, and procedural data were collected and analyzed. Primary outcome was CTO recanalization failure. Secondary outcomes included procedural complications, major adverse cardiac events (MACE), need for repeat revascularization, and mortality. Results: Among the studied cohort, key predictors of CTO-PCI failure included lesion length >20 mm (OR 3.2; 95% CI 2.2–4.6), severe calcification (OR 2.5; 95% CI 1.8–3.4), blunt stump morphology (OR 2.0; 95% CI 1.3–3.1), prior coronary artery bypass grafting (CABG) (OR 2.8; 95% CI 1.9–4.2), and proximal tortuosity (OR 1.7; 95% CI 1.2–2.7). Failed recanalization was associated with higher rates of perforation, MACE (66.7% vs. 13.3%), repeat revascularization, and mortality (8 vs. 4 cases) compared to successful recanalization. Conclusion: Specific anatomical and historical factors significantly predict CTO recanalization failure. These findings underscore the importance of comprehensive pre-procedural assessment and individualized procedural strategies. Failed CTO-PCI is associated with worse in-hospital and long-term outcomes, highlighting the need for continued refinement in techniques and patient selection to improve success rates and clinical prognosis
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