Percutaneous coronary intervention of chronic total occlusion in patients with prior coronary artery bypass graft: the current situation.

Objectives: The equipment and strategies used for percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) have been improved. However, CTO-PCI for patients with prior coronary artery bypass graft (CABG) remains challenging. This study aimed to compare the strategies and initial success rates of CTO-PCI in patients with and without prior CABG.

Methods: The authors extracted data from the Japanese CTO-PCI expert registry for this study. They enrolled 11 605 patients who underwent CTO-PCI by Japanese operators from 2014 to 2022. The cohort was divided into 2 groups: post-CABG (n = 830) and no-CABG patients (n = 10775).

Results: The post-CABG patients were older than the no-CABG patients (70.3 ± 9.2 vs 67.5 ± 11.1 years, P less than .01). The post-CABG group exhibited more prevalent long, tortuous, and calcified lesions, as well as higher Japanese Multicenter CTO Registry scores than the no-CABG group (1.8 ± 1.1 vs 1.4 ± 1.1, P less than .01). The post-CABG patients opted for the primary and rescue retrograde approaches more frequently than the no-CABG patients (52.4% vs 40.7%, P less than .02), and the post-CABG patients exhibited a lower success rate than the no-CABG patients (82.2% vs 90.2%, P less than .01). However, an improvement in success rates was observed in the post-CABG patients compared with that of Japanese data from 1999 to 2011 (71%-82.2%). Additionally, the procedure time decreased from 210 to 191 minutes.

Conclusions: Compared with no-CABG patients, the initial success rate of CTO-PCI for post-CABG patients remains low, and the retrograde approach is more commonly chosen. However, the success rate has improved over previous data.