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. 1993 Aug;70(2):126–131. doi: 10.1136/hrt.70.2.126

Determinants of success of coronary angioplasty in patients with a chronic total occlusion: a multiple logistic regression model to improve selection of patients.

K H Tan 1, N Sulke 1, N A Taub 1, E Watts 1, S Karani 1, E Sowton 1
PMCID: PMC1025271  PMID: 8038021

Abstract

OBJECTIVE--To study the determinants of success of coronary angioplasty in patients with chronic total occlusions, and to formulate a multiple logistic regression model to improve selection of patients. DESIGN--A retrospective analysis of clinical and angiographic data on a consecutive series of patients. PATIENTS--312 patients (mean age 55, range 31 to 79 years, 86% men) who underwent coronary angioplasty procedure for a chronic total occlusion between 1981 and 1992. RESULTS--Procedural success was achieved in 191 lesions (61.2%). A major complication occurred in six patients (1.9%). Multiple stepwise logistic regression analysis identified the presence of bridging collaterals (p < 0.001), the absence of a tapered entry configuration (p < 0.001), estimated duration of occlusion of greater than three months (p = 0.001), and a vessel diameter of less than 3 mm (p = 0.003) as independent predictors of procedural failure. The logistic regression model was used to classify patients into groups of high, intermediate, and low probability of procedural success with cut off points of 70% and 30%. The predictive value for procedural success (probability > or = 70%) was 91% (95% confidence intervals (95% CI) 83% to 96%) and predictive value for procedural failure (probability < 30%) was 81% (95% CI 64% to 92%). CONCLUSIONS--Percutaneous transluminal coronary angioplasty of chronic total occlusions is associated with a low risk of acute complication. Procedural success is influenced by easily identifiable clinical and angiographic features and the multiple regression model described may help to improve selection of patients.

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Selected References

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  1. Barger A. C., Beeuwkes R., 3rd, Lainey L. L., Silverman K. J. Hypothesis: vasa vasorum and neovascularization of human coronary arteries. A possible role in the pathophysiology of atherosclerosis. N Engl J Med. 1984 Jan 19;310(3):175–177. doi: 10.1056/NEJM198401193100307. [DOI] [PubMed] [Google Scholar]
  2. Bell M. R., Bailey K. R., Reeder G. S., Lapeyre A. C., 3rd, Holmes D. R., Jr Percutaneous transluminal angioplasty in patients with multivessel coronary disease: how important is complete revascularization for cardiac event-free survival? J Am Coll Cardiol. 1990 Sep;16(3):553–562. doi: 10.1016/0735-1097(90)90342-m. [DOI] [PubMed] [Google Scholar]
  3. Bell M. R., Berger P. B., Bresnahan J. F., Reeder G. S., Bailey K. R., Holmes D. R., Jr Initial and long-term outcome of 354 patients after coronary balloon angioplasty of total coronary artery occlusions. Circulation. 1992 Mar;85(3):1003–1011. doi: 10.1161/01.cir.85.3.1003. [DOI] [PubMed] [Google Scholar]
  4. Campeau L. Letter: Grading of angina pectoris. Circulation. 1976 Sep;54(3):522–523. [PubMed] [Google Scholar]
  5. Deligonul U., Vandormael M. G., Kern M. J., Zelman R., Galan K., Chaitman B. R. Coronary angioplasty: a therapeutic option for symptomatic patients with two and three vessel coronary disease. J Am Coll Cardiol. 1988 Jun;11(6):1173–1179. doi: 10.1016/0735-1097(88)90278-1. [DOI] [PubMed] [Google Scholar]
  6. Detre K., Holubkov R., Kelsey S., Cowley M., Kent K., Williams D., Myler R., Faxon D., Holmes D., Jr, Bourassa M. Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977-1981. The National Heart, Lung, and Blood Institute Registry. N Engl J Med. 1988 Feb 4;318(5):265–270. doi: 10.1056/NEJM198802043180501. [DOI] [PubMed] [Google Scholar]
  7. DiSciascio G., Vetrovec G. W., Cowley M. J., Wolfgang T. C. Early and late outcome of percutaneous transluminal coronary angioplasty for subacute and chronic total coronary occlusion. Am Heart J. 1986 May;111(5):833–839. doi: 10.1016/0002-8703(86)90630-7. [DOI] [PubMed] [Google Scholar]
  8. Gruntzig A. Transluminal dilatation of coronary-artery stenosis. Lancet. 1978 Feb 4;1(8058):263–263. doi: 10.1016/s0140-6736(78)90500-7. [DOI] [PubMed] [Google Scholar]
  9. Hamm C. W., Kupper W., Kuck K. H., Hofmann D., Bleifeld W. Recanalization of chronic, totally occluded coronary arteries by new angioplasty systems. Am J Cardiol. 1990 Dec 15;66(20):1459–1463. doi: 10.1016/0002-9149(90)90534-8. [DOI] [PubMed] [Google Scholar]
  10. Ivanhoe R. J., Weintraub W. S., Douglas J. S., Jr, Lembo N. J., Furman M., Gershony G., Cohen C. L., King S. B., 3rd Percutaneous transluminal coronary angioplasty of chronic total occlusions. Primary success, restenosis, and long-term clinical follow-up. Circulation. 1992 Jan;85(1):106–115. doi: 10.1161/01.cir.85.1.106. [DOI] [PubMed] [Google Scholar]
  11. Kent K. M., Bentivoglio L. G., Block P. C., Cowley M. J., Dorros G., Gosselin A. J., Gruntzig A., Myler R. K., Simpson J., Stertzer S. H. Percutaneous transluminal coronary angioplasty: report from the Registry of the National Heart, Lung, and Blood Institute. Am J Cardiol. 1982 Jun;49(8):2011–2020. doi: 10.1016/0002-9149(82)90223-5. [DOI] [PubMed] [Google Scholar]
  12. Kereiakes D. J., Selmon M. R., McAuley B. J., McAuley D. B., Sheehan D. J., Simpson J. B. Angioplasty in total coronary artery occlusion: experience in 76 consecutive patients. J Am Coll Cardiol. 1985 Sep;6(3):526–533. doi: 10.1016/s0735-1097(85)80108-x. [DOI] [PubMed] [Google Scholar]
  13. LaVeau P. J., Remetz M. S., Cabin H. S., Hennecken J. F., McConnell S. H., Rosen R. E., Cleman M. W. Predictors of success in percutaneous transluminal coronary angioplasty of chronic total occlusions. Am J Cardiol. 1989 Dec 1;64(19):1264–1269. doi: 10.1016/0002-9149(89)90565-1. [DOI] [PubMed] [Google Scholar]
  14. Meier B., Carlier M., Finci L., Nukta E., Urban P., Niederhauser W., Favre J. Magnum wire for balloon recanalization of chronic total coronary occlusions. Am J Cardiol. 1989 Jul 15;64(3):148–154. doi: 10.1016/0002-9149(89)90448-7. [DOI] [PubMed] [Google Scholar]
  15. Melchior J. P., Doriot P. A., Chatelain P., Meier B., Urban P., Finci L., Rutishauser W. Improvement of left ventricular contraction and relaxation synchronism after recanalization of chronic total coronary occlusion by angioplasty. J Am Coll Cardiol. 1987 Apr;9(4):763–768. doi: 10.1016/s0735-1097(87)80230-9. [DOI] [PubMed] [Google Scholar]
  16. Melchior J. P., Meier B., Urban P., Finci L., Steffenino G., Noble J., Rutishauser W. Percutaneous transluminal coronary angioplasty for chronic total coronary arterial occlusion. Am J Cardiol. 1987 Mar 1;59(6):535–538. doi: 10.1016/0002-9149(87)91164-7. [DOI] [PubMed] [Google Scholar]
  17. Ruocco N. A., Jr, Ring M. E., Holubkov R., Jacobs A. K., Detre K. M., Faxon D. P. Results of coronary angioplasty of chronic total occlusions (the National Heart, Lung, and Blood Institute 1985-1986 Percutaneous Transluminal Angioplasty Registry). Am J Cardiol. 1992 Jan 1;69(1):69–76. doi: 10.1016/0002-9149(92)90678-r. [DOI] [PubMed] [Google Scholar]
  18. Serruys P. W., Umans V., Heyndrickx G. R., van den Brand M., de Feyter P. J., Wijns W., Jaski B., Hugenholtz P. G. Elective PTCA of totally occluded coronary arteries not associated with acute myocardial infarction; short-term and long-term results. Eur Heart J. 1985 Jan;6(1):2–12. doi: 10.1093/oxfordjournals.eurheartj.a061750. [DOI] [PubMed] [Google Scholar]
  19. Sowton E., Timmis A. D., Crick J. C., Griffin B., Yates A. K., Deverall P. Early results after percutaneous transluminal coronary angioplasty in 400 patients. Br Heart J. 1986 Aug;56(2):115–120. doi: 10.1136/hrt.56.2.115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Stone G. W., Rutherford B. D., McConahay D. R., Johnson W. L., Jr, Giorgi L. V., Ligon R. W., Hartzler G. O. Procedural outcome of angioplasty for total coronary artery occlusion: an analysis of 971 lesions in 905 patients. J Am Coll Cardiol. 1990 Mar 15;15(4):849–856. doi: 10.1016/0735-1097(90)90285-w. [DOI] [PubMed] [Google Scholar]

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