1. INITIAL SUCCESS RATE ANDINITIAL SUCCESS RATE AND
PREDICTORS OF PROCEDURALPREDICTORS OF PROCEDURAL
FAILURE IN PERCUTANEOUSFAILURE IN PERCUTANEOUS
CORONARY INTERVENTION ONCORONARY INTERVENTION ON
CHRONIC TOTAL OCCULUSION(CHRONIC TOTAL OCCULUSION( CTOCTO))
LESIONSLESIONS
Shahriyari Afshar M.Shahriyari Afshar M.
Arefi HArefi H..
Nadi S.Nadi S.
Shariati Hospital, Cardiovascular DepartmentShariati Hospital, Cardiovascular Department
Tehran University of Medical Sciences,2006Tehran University of Medical Sciences,2006

2. ObjectiveObjective
 The aim of this study wasThe aim of this study was
investigation ofinvestigation of initial success rateinitial success rate
and theand the early clinical outcomeearly clinical outcome andand
predicators of procedural failurepredicators of procedural failure inin
percutaneous coronary interventionpercutaneous coronary intervention
on Chronic Total Occlusion withon Chronic Total Occlusion with
conventional angioplasty wires atconventional angioplasty wires at
Shariati hospital, April 2005-2006.Shariati hospital, April 2005-2006.

3. MethodsMethods
 Forty six patients,Forty six patients, 37 men37 men andand
9 women9 women, 28-81 years old, with, 28-81 years old, with ChronicChronic
Total OcclusionTotal Occlusion enrolled in this study.enrolled in this study.
 Forty eightForty eight Chronic Total OcclusionsChronic Total Occlusions werewere
confirmed in 46 patients with angiography.confirmed in 46 patients with angiography.
 The end points wereThe end points were technical andtechnical and
procedural successprocedural success, and, and in hospital majorin hospital major
adverse cardiac eventsadverse cardiac events occurrence andoccurrence and
predictors of procedural failurepredictors of procedural failure..

6. ResultsResults
 Relative frequency of risk factorsRelative frequency of risk factors
 Diabetes mellitusDiabetes mellitus 1313 %%
 HypertensionHypertension 2828 %%
 DyslipidemiaDyslipidemia 4747 %%
 Cigarette smokingCigarette smoking 4545 %%
 Positive family historyPositive family history 6.56.5 %%
 No risk factorNo risk factor 1313 %%

7. ResultsResults Cont,Cont,
 84 %84 % had history ofhad history of myocardialmyocardial
infarctioninfarction
 Mean durationMean duration of MI to procedure wasof MI to procedure was
73 days73 days..

8. ResultsResults Cont,Cont,
 Location of CTOLocation of CTO
 RCARCA 5050 %%
 LADLAD 31.131.1 %%
 LCXLCX 18.818.8 %%
 Portion of CTOPortion of CTO
 Proximal partProximal part 47.947.9 %%
 Mid part of vesselsMid part of vessels 52.152.1 %%

9. ResultsResults Cont,Cont,
 Length of OcclusionLength of Occlusion
 < 1< 1 cmcm 6.76.7 %%
 1 ~ 31 ~ 3 cmcm 5656 %%
 > 3> 3 cmcm 33.333.3 %%
 Collateral flowCollateral flow
 SeenSeen 89.689.6 %%
 Not seenNot seen 10.410.4 %%
 TIMI flowTIMI flow
 SeenSeen 56.256.2 %%
 Not seenNot seen 43.843.8 %%

10. ResultsResults Cont,Cont,
 Taper StumpTaper Stump
 SeenSeen 79.279.2 %%
 Not seenNot seen 20.820.8 %%
 Coronary CalcificationCoronary Calcification
 SeenSeen 10.410.4 %%
 Not seenNot seen 89.689.6 %%

11. ResultsResults Cont,Cont,
 Other lesion in Culprit VesselOther lesion in Culprit Vessel
 SeenSeen 3535 %%
 Not seenNot seen 6565 %%
 Lesion in other VesselsLesion in other Vessels
 SeenSeen 52.252.2 %%
 Not seenNot seen 47.847.8 %%

12. ResultsResults Cont,Cont,
 The most common type of guide wire wasThe most common type of guide wire was
BMW, 0.014”BMW, 0.014”
Type of GWType of GW FrequencyFrequency PercentagePercentage
BMWBMW 3434 70.870.8
BHWBHW 66 12.512.5
CougarCougar 66 12.512.5
AsahiAsahi
FIELDERFIELDER
11 2.12.1
choISEchoISE
FloppyFloppy
11 2.12.1

13. Guide wire passage:
Successful 81.3 %
Unsuccessful 8.7 %
Results Cont,

14. ResultsResults Cont,Cont,
 Predilation pressurePredilation pressure
 > 10 atm> 10 atm 6262 %%
 < 10 atm< 10 atm 3838 %%
 In one case onlyIn one case only balloonballoon was notwas not
passedpassed

15. ResultsResults Cont,Cont,
 Type of StentType of Stent
 Bare Metal Stent (BMS)Bare Metal Stent (BMS) 8080 %%
 Drug Eluting Stent (DES)Drug Eluting Stent (DES) 2020 %%
 In all casesIn all cases TIMI 3TIMI 3 andand residualresidual
stenosis < 30 %stenosis < 30 % were achievedwere achieved
 No Major Adverse Cardiac EventsNo Major Adverse Cardiac Events
(MACE)(MACE) in hospital was notedin hospital was noted

16. ResultsResults Cont,Cont,
 TechnicalTechnical andand proceduralprocedural
successsuccess was obtained inwas obtained in 79.2 %79.2 %
ofof Chronic Total OcclusionsChronic Total Occlusions..

17. ResultsResults Cont,Cont,
 Univariate and multivariate analysis ofUnivariate and multivariate analysis of
predictors of PCI failurepredictors of PCI failure
 AgeAge
 SexSex
 History of InfarctionHistory of Infarction
 Location of InfarctionLocation of Infarction
 Duration of InfarctionDuration of Infarction
 SmokingSmoking was a significant predictors ofwas a significant predictors of
Percutaneous Coronary Intervention failure.Percutaneous Coronary Intervention failure.
Smoke Odds ratio = 0.16, P value = 0.034Smoke Odds ratio = 0.16, P value = 0.034
 DiabetesDiabetes
 DyslipidemiaDyslipidemia
 HypertensionHypertension
 Family History of IHDFamily History of IHD
 SmokingSmoking

18. PredictorsPredictors P ValueP Value Odd Ratio (95% CI)Odd Ratio (95% CI)
AgeAge 0.080.08 0.940.94 (0.89 - 1.00)(0.89 - 1.00)
SexSex 0.440.44 2.42.4 (0.26 - 21.84)(0.26 - 21.84)
MI HistoryMI History 0.750.75 1.331.33 (0.22 - 0.89)(0.22 - 0.89)
MI LocationMI Location 0.780.78 0.920.92 (0.53 - 1.61)(0.53 - 1.61)
MI DurationMI Duration 0.210.21 0.990.99 (0.98 - 1.00)(0.98 - 1.00)
DMDM 0.790.79 1.361.36 (0.14 - 13.20)(0.14 - 13.20)
DLPDLP 0.770.77 0.810.81 (0.20 - 3.27)(0.20 - 3.27)
HTNHTN 0.160.16 0.360.36 (0.08 - 1.50)(0.08 - 1.50)
CigaretteCigarette
SmokingSmoking
0.0340.034 0.160.16 (0.03 - 0.87)(0.03 - 0.87)
FHFH 0.160.16 0.220.22 (0.03 - 1.82)(0.03 - 1.82)
ResultsResults Cont,Cont,

19. ConclusionsConclusions
 UsingUsing conventional angioplasty wiresconventional angioplasty wires
inin CTOCTO
 High percentage of SuccessfulHigh percentage of Successful
Percutaneous Coronary InterventionPercutaneous Coronary Intervention
was achievedwas achieved
 Low incidence of complicationsLow incidence of complications waswas
seenseen
 SmokingSmoking was a significant predictorwas a significant predictor
of procedural failureof procedural failure

20.  Smoking was a significant predictor
of procedural failure