Abstract 216: Outcomes Of Percutaneous Coronary Interventions In Patients With Chronic Total Occlusion (CTO): A Single Center Study Evaluating A New Dedicated CTO Program In Egypt

Background: Percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO) is underutilized. Initiation of a dedicated, cost-oriented, CTO PCI program is challenging. Objectives: We present our experience in establishing a limited resources dedicated multi-operator CTO PCI program in a major tertiary academic center in Egypt. Methods: We analyzed the clinical, angiographic, and procedural characteristics of patients who underwent CTO PCI during the first year of our program. Major outcome was successful recanalization. Other outcomes include in-hospital mortality, stroke, peri-procedural myocardial infarction (MI), coronary perforation, and urgent need of coronary artery bypass grafting (CABG). Results: Sixty-four patients underwent CTO PCI. The median J-CTO score was 2 (0-5). Successful recanalization was achieved in 47 patients (73%). The most common cause of failure was failure of re-entry (46.7%). The mean number of wires per patients was 2.69+/-1.32, and the most successful crossing strategy was antegrade wire escalation (56.3%). The mean procedural time was 123 +/- 48.8 min, mean contrast volume was 359.03 +/- 151.9 and mean radiation dose was 9.4 +/-4.2 Gy. There was no in-hospital mortality nor stroke. We had one case (1.6%) with peri-procedural MI, and one patient who needed an urgent CABG. The cost ranged from 6520 Egyptian Pounds (EP) ($415) to 63, 720 EP ($4058), with a mean of 26,213 EP ($1670) (Table 1). Conclusion: A dedicated limited resources CTO PCI program, in a low-income country as Egypt, can probably be established with a good success rate and a low complication rate. Proctored program allows rational equipment utilization and growth of the operators’ experiences and skills.