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Chronic Total Occlusion
Real World Scenario of Coronary Chronic Total Occlusion in Developing Nation: Prevalence, Management Strategies and Outcome of Percutaneous Intervention - Data from a Tertiary Referral Center of North India
Krishnasantosh Vemuri1, Yashpaul Sharma1, Bhupendra Kumar Sihag1, Parag Barwad1
Post Graduate Institute of Medical Education & Research, India1
There was limited data on the prevalence, clinical and angiographic characteristics and outcomes percutaneous management of coronary chronic total occlusions from India.
Data was collected form all coronary angiographies and interventions performed at our centre since January 2018 till August 2019. Coronary angiographies were retrospectively reviewed independently by 3 different interventional cardiologists. Data on demographic characteristics, angiographic findings, CTO characteristics, revascularisation strategy adopted, outcome of percutaneous intervention and complications of procedure were collected and analysed for the outcome measures.
A total of 12022 angiographies were performed during the above-mentioned period. Out of which normal coronaries were 32.6% (3921/12022). Single vessel, double vessel and triple vessel disease accounts for 34.4%, 25.8%, and 7% respectively. Prevalence of CTO in any of the three arterial distribution was found to be16.4%(1968/12022). However, the prevalence was 24.29% (1968/8102) in patient with diseased coronaries. LAD, RCA, LCX CTO accounts for 38.1%, 42.1%, and 19.8% respectively. Amongst all patients with CTO, Percutaneous coronary intervention (PCI) was attempted in only 456/1968 patients (23.17%). This was based on clinical manifestations, myocardial viability in the CTO segment and patient willingness to undergo PCI. PCI was successful in 340/456 (74.5%) and unsuccessful in 116/456 (25.5%) patients. All the CTO were attempted by antegrade approach only, with femoral access (94.3%) being used predominantly. Amongst the predictors of outcome of PCI in CTO, increasing age, high J-CTO score, CTO in LCX territory was significantly associated with procedural failure. Overall peri procedural mortality was <1% (0.87%). Peri procedural major and minor complication were 6.5%. 
Chronic total occlusions is a common finding in coronary angiography. Majority of patients with CTO either undergo, medical management or are sent for surgery. For those who underwent percutaneous management of CTO, the success rate is fair and comparable to real world registry data, except compared to high volume dedicated CTO centre. Prospective detailed studies are required in developing countries to ascertain the benefits of treatment of CTO which are reasonably common nowadays.
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