TY - JOUR
T1 - Incidence and outcomes of chronic total occlusion percutaneous coronary intervention in the Netherlands: data from a nationwide registry
AU - van Veelen, A.
AU - Claessen, B. E. P. M.
AU - Houterman, S.
AU - Hoebers, L. P. C.
AU - Elias, J.
AU - Henriques, J. P. S.
AU - the PCI Registration Committee of the Netherlands Heart Registration
AU - Knaapen, P.
N1 - Funding Information: On behalf of the PCI Registration Committee of the Netherlands Heart Registration, consisting of: G.?Amoroso, OLVG; E.K.?Arkenbout, Tergooi; S.?Aydin, VieCuri Medisch Centrum; J.?Brouwer, Medisch Centrum Leeuwarden; C.?Camaro, RadboudUMC; J.?Daemen, Erasmus Medisch Centrum; P. Danse, Rijnstate; S.F.?de la Fuente, Jeroen Bosch Ziekenhuis; M.?van der Ent, Maasstad Ziekenhuis; R.?Erdem, ZorgSaam; P.?den Heijer, Amphia; J.P.S.?Henriques, Amsterdam UMC, locatie AMC; A.W.J.?van ?t Hof, Zuyderland MC; A.W.J.?van ?t Hof, Academisch Ziekenhuis Maastricht; I.?Karalis, Leids Universitair Medisch Centrum; A.?Kraaijeveld, UMC Utrecht; J.P.?van Kuijk, Sint Antonius Ziekenhuis; E.?Lipsic, Universitair Medisch Centrum Groningen; M.?Magro, Elisabeth-TweeSteden Ziekenhuis; K.M.J.?Marques, Amsterdam UMC, locatie VUmc; T.?Oude Ophuis, Canisius Wilhelmina Ziekenhuis; J.?van Ramshorst, Noordwest Ziekenhuisgroep; V.?Roolvink, Isala; W.T.?Ruifrok, Treant Zorggroep; M.?Scholte, Albert Schweitzer Ziekenhuis; C.E.?Schotborgh, Haga Ziekenhuis; B.J.?Sorgdrager, Haaglanden Medisch Centrum; F.?Spano, Meander Medisch Centrum; M.G.?Stoel, Medisch Spectrum Twente; K.?Teeuwen, Catharina Ziekenhuis Publisher Copyright: © 2020, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Background: Patients with chronic total coronary occlusions (CTO) are at increased risk for poor clinical outcomes. We aimed to determine the incidence of CTO percutaneous coronary intervention (PCI) and to identify CTO patients at risk for cardiac events in the nationwide Netherlands Heart Registration (NHR). Methods: We included all PCI procedures with ≥1 CTO registered in the NHR from January 2015 to December 2018, excluding acute interventions. We used multivariable logistic regression of baseline characteristics to calculate the risk for events as odds ratios (OR) with 95% confidence intervals (CI). Results: Of the PCIs performed during the study period, 6.3% (8,343/133,042) were for CTOs, with the percentage increasing significantly over time from 5.9% in 2015 to 6.6% in 2018 (p < 0.001). Coronary artery bypass grafting <24 h was carried out in 0.3%, and the only significant predictor was diabetes mellitus (OR 2.97, 95% CI 1.04–8.49, p = 0.042). Myocardial infarction (MI) <30 days occurred in 0.5%, and renal insufficiency (i.e. estimated glomerular filtration rate <30 ml/min per 1.73 m2) was identified as an independent predictor (OR 4.70, 95% CI 1.07–20.61, p = 0.040). Among patients undergoing CTO-PCI, 1‑year mortality was 3.7%, and independent predictors included renal insufficiency (OR 5.59, 95% CI 3.25–9.59, p < 0.001), left ventricular ejection fraction <30% (OR 3.43, 95% CI 2.00–5.90, p < 0.001), previous MI (OR 1.62, 95% CI 1.14–2.31, p = 0.007) and age (OR 1.06 per year increment, 95% CI 1.04–1.07, p < 0.001). Target-vessel revascularisation <1 year occurred in 11.3%. Conclusion: CTO-PCI is still infrequently performed in the Netherlands. The most important predictor of mortality after CTO-PCI was renal insufficiency. Identification of patients at risk may help improve the prognosis of CTO patients in the future.
AB - Background: Patients with chronic total coronary occlusions (CTO) are at increased risk for poor clinical outcomes. We aimed to determine the incidence of CTO percutaneous coronary intervention (PCI) and to identify CTO patients at risk for cardiac events in the nationwide Netherlands Heart Registration (NHR). Methods: We included all PCI procedures with ≥1 CTO registered in the NHR from January 2015 to December 2018, excluding acute interventions. We used multivariable logistic regression of baseline characteristics to calculate the risk for events as odds ratios (OR) with 95% confidence intervals (CI). Results: Of the PCIs performed during the study period, 6.3% (8,343/133,042) were for CTOs, with the percentage increasing significantly over time from 5.9% in 2015 to 6.6% in 2018 (p < 0.001). Coronary artery bypass grafting <24 h was carried out in 0.3%, and the only significant predictor was diabetes mellitus (OR 2.97, 95% CI 1.04–8.49, p = 0.042). Myocardial infarction (MI) <30 days occurred in 0.5%, and renal insufficiency (i.e. estimated glomerular filtration rate <30 ml/min per 1.73 m2) was identified as an independent predictor (OR 4.70, 95% CI 1.07–20.61, p = 0.040). Among patients undergoing CTO-PCI, 1‑year mortality was 3.7%, and independent predictors included renal insufficiency (OR 5.59, 95% CI 3.25–9.59, p < 0.001), left ventricular ejection fraction <30% (OR 3.43, 95% CI 2.00–5.90, p < 0.001), previous MI (OR 1.62, 95% CI 1.14–2.31, p = 0.007) and age (OR 1.06 per year increment, 95% CI 1.04–1.07, p < 0.001). Target-vessel revascularisation <1 year occurred in 11.3%. Conclusion: CTO-PCI is still infrequently performed in the Netherlands. The most important predictor of mortality after CTO-PCI was renal insufficiency. Identification of patients at risk may help improve the prognosis of CTO patients in the future.
KW - Chronic total occlusion
KW - Mortality
KW - Percutaneous coronary intervention
KW - Renal insufficiency
UR - http://www.scopus.com/inward/record.url?scp=85097027114&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s12471-020-01521-y
DO - https://doi.org/10.1007/s12471-020-01521-y
M3 - Article
C2 - 33263890
SN - 1568-5888
VL - 29
SP - 4
EP - 13
JO - Netherlands heart journal
JF - Netherlands heart journal
IS - 1
ER -