The biological cost of cto intervention: insight from a prospective study


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GopakumarK S., Mathew Iype., Sunitha Viswanathan and A. George Koshy

Objectives: Chronic Total Occlusion (CTO) intervention is a challenging area in interventional cardiology. Presently about 70% of CTO interventions are successful. This study aims to look at the biological costs of CTO interventions in the current era in a teaching hospital in South India
Materials and methods: It was a prospective study of a cohort of all patients undergoing Percutaneous coronary intervention (PCI) for CTO. Only antegrade CTO interventions were included.
Results: A total of 210 (8.9% of total PCI (2353) during the study period) CTO patients were followed up. The mean age of the patients was 56.54 +/- 8.9 %. In the cohort 32.9% (n=69) had chronic stable angina, 22.9 % (n= 48) had unstable angina (UA) or non ST elevation myocardial infarction (NSTEMI) and 44.2% (n= 93) had (ST Elevation Myocardial Infarction (STEMI). Immediate cardiac complications in the first attempt CTO PCI were peri- procedural myocardial infarction in 10 patients (4.8%) and Coronary perforations in 17 patients (8.1%) and heart failure in 3 patients (1.5). There was no in hospital death /stent thrombosis/ need for urgent revascularization. Majority of coronary perforations were seen in failed cases (15/17 cases of perforation). Contrast nephropathy was seen in 5.7 % of cases
Conclusions: Biological costs of CTO interventions were immediate complications like periprocedural MI, cardiac perforation, contrast induced nephropathy, TIMI major and minor bleed, and AF and radiation exposure. Failed CTO interventions significantly had more biological costs compared to successful ones

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