The use of mechanical circulatory support (MCS) in chronic total occlusion (CTO) percutaneous
coronary intervention (PCI) has received limited study. We analyzed the clinical and
angiographic characteristics, and procedural outcomes of 7,171 CTO PCIs performed
between 2012 and 2021 at 35 international centers. Mean age was 64.5 ± 10 years, mean
left ventricular ejection fraction was 50 ± 13%. MCS was used in 4.5%, prophylactically
in 78.7%, and urgently in 21.3%. The most common type of MCS overall was Impella CP
(Abiomed) (55.5%), followed by intra-aortic balloon pump (14.8%) and TandemHeart (LivaNova
Inc.) (10.0%). Prophylactic MCS patients were more likely to have diabetes mellitus
(55% vs 42%, p <0.001) and had more complex lesions compared with cases without prophylactic
MCS (Japan-CTO score: 2.80 ± 1.22 vs 2.39 ± 1.27, p <0.001). Cases with prophylactic
MCS had similar technical (86% vs 87%, p = 0.643) but lower procedural (80% vs 86%,
p = 0.028) success rates and higher rates of periprocedural major cardiac adverse
events compared with no prophylactic MCS use (6.55% vs 1.68%, p <0.001). Urgent MCS
use was associated with lower technical (68% vs 87%, p <0.001) and procedural (39%
vs 86%, p <0.001) success rates and higher major cardiac adverse events compared with
no-MCS use (32.26% vs 1.68%, p <0.001). The differences persisted in multivariable
analyses. In summary, in this contemporary multicenter registry, MCS was used in 4.5%
of CTO PCIs, mostly prophylactically (78.7%). Elective MCS cases had similar technical
success but a higher risk of complications. Urgent MCS cases had lower technical and
procedural success and higher periprocedural major complication rates.
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Article info
Publication history
Published online: December 10, 2022
Received in revised form:
October 3,
2022
Received:
May 17,
2022
Footnotes
Funding: The authors are grateful for the generosity of our many philanthropy partners, including our anonymous donors, Drs. Mary Ann and Donald A. Sens, Ms. Dianne and Dr. Cline Hickok, Ms. Charlotte and Mr. Jerry Golinvaux Family Fund, the Roehl Family Foundation, and the Joseph Durda Foundation, Mississippi. Wilma and Mr. Dale Johnson, for making this work possible at the Minneapolis Heart Institute Foundation's Science Center for Coronary Artery Disease.
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