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Cardiovasc Revasc Med. 2017 Jul - Aug;18(5):328-331. doi: 10.1016/j.carrev.2017.02.014. Epub 2017 Feb 22.

Further validation of the hybrid algorithm for CTO PCI; difficult lesions, same success.

Author information

1
Henry Ford Hospital and Wayne State University, Detroit, MI.
2
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
3
Henry Ford Hospital and Wayne State University, Detroit, MI. Electronic address: kalaswa1@hfhs.org.

Abstract

OBJECTIVES:

To evaluate the success rates and outcome of the hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) by a single operator in two different clinical settings.

METHODS:

We compared 279 consecutive CTO PCIs performed by a single, high-volume operator using the hybrid algorithm in two different clinical settings. Data were collected through the PROGRESS CTO Registry. We compared 145 interventions performed in a community program (cohort A) with 134 interventions performed in a referral center (cohort B).

RESULTS:

Patient in cohort B had more complex lesions with higher J-CTO (3.0 vs. 3.41; p<0.001) and Progress CTO (1.5 vs.1.8, P=0.003) scores, more moderate to severe tortuosity (38% vs. 64%; p<0.001), longer total occlusion length (25 vs. 40mm; p<0.001) and higher prevalence of prior failed CTO PCI attempts (15% vs. 35%; p=0.001). Both technical (95% vs. 91%; p=0.266) and procedural (94% vs. 88%; p=0.088) success rates were similar between the two cohorts despite significantly different lesion complexity. Overall major adverse cardiovascular events were higher in cohort B (1.4% vs. 7.8%; p=0.012) without any significant difference in mortality (0.7% vs. 2.3%, p=0.351).

CONCLUSIONS:

In spite of higher lesion complexity in the setting of a quaternary-care referral center, use of the hybrid algorithm for CTO PCI enabled similarly high technical and procedural success rates as compared with those previously achieved by the same operator in a community-based program at the expense of a higher rate of MACE.

KEYWORDS:

Chronic Total occlusion; PCI

PMID:
28314674
DOI:
10.1016/j.carrev.2017.02.014
[Indexed for MEDLINE]

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