307 Percutaneous Coronary Intervention To Chronic Total Occlusions Can Be Safely And Effectively Performed In Standalone PCI Centres

Successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) has been shown to reduce angina symptoms, reduce the need for coronary bypass surgery and may improve survival. With the development of retrograde and contemporary anterograde approaches the success rates of CTO PCI continues to improve. There remains much debate whether CTO PCI can be performed safely and effectively in high volume stand alone PCI centres. The Royal Alexandra Hospital has been performing PCI without on site surgery over the last 30 years. We identified all patients undergoing CTO PCI between January 2010 and March 2012. Patient demographics, angiographic features, procedure details and clinical outcomes were collected from local medical records the APPROACH database. 170 patients (85.8% male; 63.15 years) underwent PCI to 172 CTO lesions. Clinical presentations of the patients were stable angina (91.78%), non ST elevation MI (7.05%) and left ventricular failure ((LVF) 1.17%). The overall PCI success rate was 74.41%.Success rates of ad hoc, elective first, and subsequent reattempts were 59.1%, 68% and 69.7% respectively. Retrograde approach was attempted in 15% of the cases. Arterial access used was radial only in 63.6%, femoral only in 21.2% and radial-femoral combination in 15.2%. Bilateral injections were used in 37.2% of cases. Mean procedure time was 75.2 minutes. Mean radiation dose was 3.4±0.2 Gy/cm2. Mean contrast volume used was 297±10 ml. Complications of coronary perforation and coronary dissection occurred in 2% and 3% respectively with no occurrence of cardiac tamponade. Periprocedural myocardial infarction occurred in 1%. There were no periprocedural deaths and no patients required emergency cardiac surgery. The mean hospital stay in patients presenting with the stable angina, NSTEMI and LVF were 1.5, 9 and 4 days respectively. At mean follow up of 285 days, target vessel revascularisation (TVR) was only 3.1%. After successful CTO PCI, patient's CCS angina class decreased significantly from 2.2 to 0.5 (p<0.0001). Successful CTO PCI significantly improves angina symptoms with overall low rates of periprocedural complications. Using contemporary anterograde and retrograde techniques, CTO PCI can be safely and effectively performed in experienced stand alone PCI centres.