DOI: 10.1161/circ.148.suppl_1.12054 ISSN: 0009-7322

Abstract 12054: Activated Clotting Time and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry

Bahadir Simsek, Athanasios Rempakos, Spyridon Kostantinis, Michaella Alexandrou, sevket gorgulu, Khaldoon Alaswad, Jarrod D Frizzell, Ufuk Yildirim, Paul Poommipanit, Nazif Aygul, Nidal Abi Rafeh, MD, FACC, Rodrigo Bagur, Rhian Davies, OMER GOKTEKIN, James W Choi, Niranjan Reddy, Elias Haddad, Jimmy Kerrigan, Deniz Mutlu, Olga Mastrodemos, Bavana V Rangan, Judit Karacsonyi, Salman S Allana, Kathleen E Kearney, Yader Sandoval, M Nicholas Burke, Emmanouil S Brilakis, Lorenzo Azzalini
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: The optimal range of activated clotting time (ACT) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.

Methods: We examined the association between ACT and in-hospital ischemic and bleeding outcomes in patients who underwent CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436).

Results: ACT values were available for 4,377 patients who underwent CTO PCI between 2012 and 2023 at 29 centers. Mean ACT distribution was: <250 seconds (19%), 250-349 seconds (50%), and ≥350 seconds (31%). The incidence of ischemic events was 0.8%, bleeding events 3.0%, and net adverse cardiovascular events (NACE, composite of in-hospital all-cause mortality, myocardial infarction, stroke, urgent repeat revascularization, pericardiocentesis, and bleeding) 3.8%. In multiple logistic regression analysis, increasing nadir ACT was associated with decreasing ischemic events: adjusted odds ratio (aOR) per 50-second increments: 0.69 (95% confidence interval [CI] 0.50-0.94, p=0.017); and increasing peak ACT was associated with increasing bleeding events: aOR per 50-second increments 1.17 (95% CI 1.01-1.36, p=0.032). A U-shaped association was seen between mean ACT and NACE, where restricted cubic spline analysis demonstrated that patients with low (<200 seconds) or high (>400 seconds) ACT had increasing NACE risk, compared with ACT 200-400 seconds (aOR 2.06, 95% CI 1.18-3.62, p=0.012) (Figure).

Conclusions: Among patients who underwent CTO PCI, mean ACT had a U-shaped relationship with NACE, where patients with low (<200 seconds) ACT (driven by ischemic events) or high (>400 seconds) ACT (driven by bleeding) had higher NACE compared with ACT of 200-400 seconds.

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