Percutaneous coronary intervention for chronic total occlusion lesions is technically difficult despite equipment advances. Changes in electrocardiographic patterns such as Q wave during total occlusion can provide information about procedural success and myocardial viability.
The aims of study are to investigate clinical, electrocardiographic and procedural characteristics of chronic total occlusion and the relation of these variables to the procedural success rate.
PATIENTS AND METHODS:
In this study, clinical, electrocardiographic and coronary angiographic data of (100) patients with chronic total occlusion lesions who underwent percutanous coronary intervention between May 2010 and March 2011 at the Iraqi center for heart diseases were analyzed. The clinical data were collected using the patients’ files and angiographic data by the observation of their films. Chronic total occlusion was diagnosed from clinical events including myocardial infarction or worsening of their symptoms or previous angiography.
There were 100 patients with chronic total occlusion. Successful recanalization with stent deployment was accomplished in 65 patients (65%), while unsuccessful recanalization was found in 35 patients (35%). No major cardiovascular events occurred among both groups. The success rate of PCI was significantly more in lesions shorter than 15 mm, presence of tapered stump, angulations less than 45 degree, duration less than 3 months and TIMI 1 flow grade (p values were significant). Presence of Q wave was associated with severe angina , decreased left ventricular ejection fraction, critical lesions other than chronic total occlusion, T wave inversion and more regional wall motion abnormalities ( p values were significant). The most common cause of procedural failure was inability of guide wire to cross through the totally occluded segment.
Percutaneous coronary intervention is a safe and useful procedure for revascularization of coronary chronic total occlusion lesion. The procedural success rate was related to certain features of the totally occluded lesions.