Stenting and balloon angioplasty is performed infrequently on patients with a complete blockage of a coronary artery, according to a study published in JACC: Cardiovascular Interventions. When the procedure is performed by experienced operators, however, it is more successful, with the most experienced operators achieving a 75% success rate.
The study's lead author, Emmanouil S. Brilakis, MD, PhD, FACC, director of the cardiac catheterization laboratories at VA North Texas Healthcare System and an associate professor of medicine at University of Texas Southwestern Medical School, pointed out that complete blockages, also called chronic total occlusions (CTOs), "are encountered commonly in patients who undergo coronary angiography (present in one-in-five to one-in-three patients).” He went on to say that the procedure was underutilized, adding that "there was no clear benchmark and understanding of how frequently [the procedure] is being performed for CTO.” For this reason, Brilakis and his team conducted this study to determine success and complication rates in patients across the U.S.
Using data from the American College of Cardiology's CathPCI Registry, researchers looked at 594,510 angioplasty procedures between July 1, 2009 and March 31, 2013, to determine how often these procedures were performed, what the success rates were, and how often major adverse cardiac events occurred. They found that during the study period, angioplasty for patients with CTO represented only 3.8% (22,365 procedures) of the total number of angioplasties performed for stable cardiac disease, although its frequency has been increasing slightly over time (3.2% of procedures in 2009 vs. 4.8% in 2013).
Procedures performed on patients with total blockages were less successful than those without this condition, (59% vs. 96%), but there was marked variability across centers. The team also found a higher risk for complications before, during, or after the procedure among patients in the CTO group compared to those in the non-CTO group (1.6% vs. 0.8%). Finally, those patients who were younger, had lower rates of prior heart attack, diabetes, prior stroke or prior coronary artery bypass graft surgery had more successful outcomes than their less healthy counterparts.
In an accompanying editorial
, John A. Bittl, MD, FACC, an interventional cardiologist at Munroe Regional Medical Center in Ocala, Fla., noted that superior outcomes were seen for operators with higher annual volumes. He then concluded that "the skills required for successful CTO [procedure] are teachable. Familiarity with advanced techniques leads to improved outcomes."