Procedural characteristics and outcomes following chronic total occlusion coronary intervention: pooled analysis from 5 registries

ABSTRACT

Background

Recent improvements in clinical skills, technology, and hardware have resulted in improved success rates with chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We performed a study level pooled analysis from the five largest registries of percutaneous coronary intervention (PCI) of CTO.

Research design and methods

We conducted pooled analysis of 9500 patients in registries and data on procedural characteristics, technical success, and MACCE was collected.

Results

A total of 9500 patients were included in the analysis. Mean age was 65.4 years with previous CABG in 24.8%, reattempt procedure in 24.8% and mean JCTO score was 2.2. Final wiring strategy in hybrid algorithm-based registries was AWE in 40.8–58%, Retrograde in 24–35%, ADR in 16–25% and in Expert JCTO and EURO CTO was AWE in 72–75% and retrograde in 25–28%. Technical success was achieved in 87.8%. In hospital MACCE was 2.5% (95% CI: 1.8– 3.4%), mortality 0.44% (95% CI: 0.23–0.84%), stroke 0.2% (95% CI: 0.1–0.3%); myocardial infraction 1.6% (95% CI: 1.1–2.2%); and cardiac tamponade 0.8% (95% CI: 0.5 to 1.3%).

Conclusion

CTO PCI is currently performed with high technical success rates and low complication rates in experienced hands utilizing various techniques.

KEYWORDS:

• Coronary chronic total occlusion
• outcomes
• procedural success
• MACCE
• cardiac tamponade

Declaration of interest

M Brilakis reports consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, CSI, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support from Regeneron; owner, Hippocrates LLC; shareholder: MHI Ventures, Cleerly Health.

K Mashayekhi reports consulting/speaker/proctoring honoraria from Abbott Vascular, Ashai Intecc, AstraZeneca, Biotronik, Boston Scientific, Cardinal Health, Daiichi Sankyo, Medtronic, Teleflex, Terumo

A Grantham reports speaking fees, honoraria, and travel expense reimbursement from BSCI, Asahi, Corindus a Siemens Healthineers Company, and Abbott, and advisory board and consulting fees from Corindus a Siemen’ Healthineers company and BSCI, Institutional grants BSCI

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.