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Article summary:
1. This study investigated the factors that predict success in reattempted chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures.
2. Subintimal plaque modification (SPM) with guidewire crossing, referral to high-volume operators, and a bidirectional approach were identified as positive independent predictors of technical success in the subsequent reattempt.
3. The time interval for reattempt was negatively correlated with the technical success of the reattempted procedures.
Article analysis:
This article is a retrospective analysis of 208 consecutive patients who underwent a failed CTO PCI attempt and received reattempted procedure at the same cardiac center. The overall technical success rate of reattempted CTO PCI procedures was 71.2%. The study identified independent predictors of success in reattempted CTO PCI procedures, including SPM with GW crossing achieved in the initial attempt, referral to high-volume operators, and a bidirectional approach. The time interval for reattempt was also found to be negatively correlated with the technical success of the reattempted procedures.
The article is generally reliable and trustworthy due to its use of data from consecutive angiographic and procedural records from an established cardiac interventional center, as well as its clear presentation of results and conclusions based on statistical analysis. However, there are some potential biases that should be noted when considering this article’s trustworthiness and reliability. First, since this is a retrospective study, it may be subject to selection bias due to its reliance on existing data rather than randomized controlled trials or prospective studies. Second, since only one center was used for both initial attempts and subsequent reattempts, it is possible that certain factors such as operator experience or equipment availability could have influenced outcomes without being accounted for in the analysis. Finally, while this article provides evidence for SPM as a predictor of successful CTO PCI outcomes, it does not explore any potential risks associated with this technique or other counterarguments that could be made against its use in clinical practice.