The following is a summary of “Activated Clotting Time and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry,” published in the November 2023 issue of cardiology by Simsek et al.

The optimal activated clotting time (ACT) range for chronic total occlusion(CTO) percutaneous coronary intervention (PCI) remains unclear due to limited research. Researchers aimed to investigate the correlation between ACT and in-hospital ischemic and bleeding outcomes in pts undergoing CTO PCI.

The study analyzed ACT values in 4,377 pts undergoing CTO PCI from 2012 to 2023 at 29 centers. Mean ACT distribution was as follows: <250 seconds (19%), 250-349 seconds (50%), and ≥350 seconds (31%). Incidence rates were ischemic events 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 logistic regression, higher nadir ACT was associated with lower ischemic events aOR per 50-second increments: 0.69, (95%CI 0.50-0.94, P=0.017). Elevated peak ACT correlated with increased bleeding events, and aOR per 50-second increments was 1.17 (95% CI 1.01-1.36, P=0.032). Mean ACT showed a U-shaped association with NACE, indicating that patients with low (<200 seconds) or high (>400 seconds) ACT had an elevated NACE risk compared to those with ACT 200-400 seconds (aOR 2.06, 95% CI 1.18-3.62, P=0.012).

The study found that in CTO PCI pts, ACT exhibited a U-shaped association with NACE, with higher NACE observed in those with ACT outside the 200-400 second range.

Source: abstractsonline.com/pp8/#!/10871/presentation/9341