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JACC Cardiovasc Interv. 2018 Jul 23;11(14):1325-1335. doi: 10.1016/j.jcin.2018.02.036. Epub 2018 Apr 26.

The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry.

Author information

1
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
2
Columbia University, New York, New York.
3
Henry Ford Hospital, Detroit, Michigan.
4
Massachusetts General Hospital, Boston, Massachusetts.
5
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
6
VA San Diego Healthcare System and University of California, San Diego, La Jolla, California.
7
Baylor Heart and Vascular Hospital, Dallas, Texas.
8
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
9
Medical Center of the Rockies, Loveland, Colorado.
10
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
11
VA Central Arkansas Healthcare System, Little Rock, Arkansas.
12
The Heart Hospital Baylor Plano, Plano, Texas.
13
Torrance Memorial Medical Center, Torrance, California.
14
Piedmont Heart Institute, Atlanta, Georgia.
15
VA Minneapolis Healthcare System and University of Minnesota, Minneapolis, Minnesota.
16
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation.
17
Korgialeneio-Benakeio Hellenic Red Cross General Hospital of Athens, Athens, Greece.
18
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
19
University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
20
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: esbrilakis@gmail.com.

Abstract

OBJECTIVES:

The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents.

BACKGROUND:

CTO PCI has been evolving with constant improvement of equipment and techniques.

METHODS:

Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patients at 20 centers in the United States, Europe, and Russia.

RESULTS:

The mean age was 65 ± 10 years, and 85% of the patients were men, with high prevalence of diabetes (43%), prior myocardial infarction (46%), prior coronary artery bypass graft surgery (33%), and prior PCI (65%). The CTO target vessels were the right coronary artery (55%), left anterior descending coronary artery (24%), and left circumflex coronary artery (20%). The mean J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores were 2.4 ± 1.3 and 1.3 ± 1.0, respectively. The overall technical and procedural success rate was 87% and 85%, respectively, and the rate of in-hospital major complications was 3.0%. The final successful crossing strategy was antegrade wire escalation in 52.0%, retrograde in 27.1%, and antegrade dissection re-entry in 20.9%; >1 crossing strategy was required in 40.9%. Median contrast volume, air kerma radiation dose, and procedure and fluoroscopy time were 270 ml (interquartile range: 200 to 360 ml), 2.9 Gy (interquartile range: 1.7 to 4.7 Gy), 123 min (interquartile range: 81 to 188 min) and 47 min (interquartile range: 29 to 77 min), respectively.

CONCLUSIONS:

CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the United States, Europe, and Russia. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436).

KEYWORDS:

chronic total occlusion; outcomes; percutaneous coronary intervention; techniques

PMID:
29706508
DOI:
10.1016/j.jcin.2018.02.036
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