Procedural And Short-Term Outcomes Of Percutaneous Coronary Interventions For Chronic Total Occlusion In An Egyptian Tertiary Care Center

Abstract

Background: Chronic total occlusion (CTO) of coronary arteries presents a significant challenge for interventional cardiologists due to technical complexities and resource requirements. Egypt lacks comprehensive data on CTO percutaneous coronary intervention (CTO-PCI).

Aim: Is to document the procedural details, success rates, and short-term outcomes of CTO-PCI performed at the National Heart Institute,as an Egyptian tertiary care center between 1st of April 2019 till 31st March 2020.

Methods: This prospective observational study included patients with CTO undergoing PCI over one year. Data were collected on demographics, lesion characteristics, procedural techniques, and short-term outcomes, including major adverse cardiac and cerebrovascular events (MACCE).

Results: The study included a predominantly male cohort (80%) with a high prevalence of cardiovascular risk factors, including hypertension (96%), diabetes (40%), hyperlipidemia (68%), and smoking (62%). Prior myocardial infarction was documented in 60.9% of patients, while previous PCI and CABG were noted in 25% and 9.4%, respectively. Ischemic ECG changes were found in 85% of cases, and regional wall motion abnormalities were detected in 81.2% of patients.

Risk stratification using the SYNTAX score indicated that 61% of patients had no significant difference in four-year mortality between PCI and CABG, whereas 31% had scores favoring CABG and 7.8% had scores supporting PCI.

Angiographic assessment revealed that 57.8% of CTO-PCI procedures targeted the LAD, 46.9% the RCA, and 10.9% the CX, with complex lesions characterized by high calcification burden (89.1%), severe tortuosity (12.5%), and blunt proximal caps (60.9%).

The procedural success rate was 89.06%, with antegrade techniques used in 81.3% of cases and retrograde approaches in 18.7%. IVUS guidance was employed in 9 cases, and microcatheter use was documented in 70.3% of procedures. No cases of MACCE were observed. Coronary perforation occurred in 9 cases, all managed conservatively. The study found no significant correlation between lesion complexity and procedural success (p = 0.78), whereas different technical approaches significantly influenced success and guidewire passage failure rates (p = 0.01).

Conclusion: CTO-PCI in Egypt demonstrates promising success rates despite resource limitations. Enhanced training and advanced equipment are critical to improving outcomes further.