Joren Maeremans1, Simon Walsh2, Paul Knaapen3, James C Spratt4, Alexandre Avran5, Colm G Hanratty2, Benjamin Faurie6, Pierfrancesco Agostoni7, Erwan Bressollette8, Peter Kayaert9, Alan J Bagnall10, Mohaned Egred10, Dave Smith11, Alexander Chase11, Margaret B McEntegart12, William H T Smith13, Alun Harcombe13, Paul Kelly14, John Irving15, Elliot J Smith16, Julian W Strange17, Joseph Dens18. 1. Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium. 2. Department of Cardiology, Belfast City Hospital, Belfast, United Kingdom. 3. Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands. 4. Department of Cardiology, Forth Valley Royal Hospital, Edinburgh, United Kingdom. 5. Department of Cardiology, Clinique de Marignane, Marignane, France. 6. Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France. 7. Department of Cardiology, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands; Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands. 8. Department of Cardiology, Nouvelles Cliniques Nantaises, Nantes, France. 9. Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium. 10. Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, United Kingdom. 11. Department of Cardiology, Morriston Hospital, Swansea, United Kingdom. 12. Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom. 13. Department of Cardiology, Nottingham University Hospital, Nottingham, United Kingdom. 14. Department of Cardiology, Essex Cardiothoracic Centre, Basildon Hospital, Essex, United Kingdom. 15. Department of Cardiology, Ninewells Hospital, Dundee, United Kingdom. 16. Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom. 17. Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom. 18. Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium. Electronic address: jo.dens@zol.be.
Abstract
BACKGROUND: The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking. OBJECTIVES: The RECHARGE (REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom) registry aims to report achievable results using the hybrid algorithm. METHODS: Between January 2014 and October 2015, consecutive patients undergoing hybrid CTO-PCI were prospectively enrolled in 17 centers. Procedural techniques, outcomes, and in-hospital complications were analyzed. RESULTS: A total of 1,253 CTO-PCIs were performed in 1,177 patients, of which 86% were men. Mean age was 66 ± 11 years. The average Japanese CTO score was 2.0 ± 1.0, and was higher in the failure group (2.6 ± 0.6 vs. 1.9 ± 1.0; p < 0.001). Overall procedure success was 86% and major in-hospital complications occurred in 2.6%. Antegrade wire escalation was the preferred primary strategy in 77%, followed by retrograde (17%) and antegrade dissection re-entry strategies (7%). Primary strategies were successful in 60%. Consecutive strategies were applied in 34% and were successful in 74%. Antegrade dissection re-entry and retrograde strategies were the most common bailout strategies and were successful in 67% and 62%, respectively. Median procedure and fluoroscopy time were 90 (interquartile range [IQR]: 60 to 120) min and 35 (IQR: 21 to 55) min, contrast volume was 250 (IQR: 180 to 340) ml, and radiation doses (air kerma and dose area product) were 1.6 (IQR: 1.0 to 2.7) Gy and 98 (IQR: 57 to 168) Gy·cm2, respectively. CONCLUSIONS: High procedure and patient success rates, combined with a low event rate and improved procedural characteristics, support further use of the hybrid algorithm for a broad community of appropriately trained CTO operators.
BACKGROUND: The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking. OBJECTIVES: The RECHARGE (REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom) registry aims to report achievable results using the hybrid algorithm. METHODS: Between January 2014 and October 2015, consecutive patients undergoing hybrid CTO-PCI were prospectively enrolled in 17 centers. Procedural techniques, outcomes, and in-hospital complications were analyzed. RESULTS: A total of 1,253 CTO-PCIs were performed in 1,177 patients, of which 86% were men. Mean age was 66 ± 11 years. The average Japanese CTO score was 2.0 ± 1.0, and was higher in the failure group (2.6 ± 0.6 vs. 1.9 ± 1.0; p < 0.001). Overall procedure success was 86% and major in-hospital complications occurred in 2.6%. Antegrade wire escalation was the preferred primary strategy in 77%, followed by retrograde (17%) and antegrade dissection re-entry strategies (7%). Primary strategies were successful in 60%. Consecutive strategies were applied in 34% and were successful in 74%. Antegrade dissection re-entry and retrograde strategies were the most common bailout strategies and were successful in 67% and 62%, respectively. Median procedure and fluoroscopy time were 90 (interquartile range [IQR]: 60 to 120) min and 35 (IQR: 21 to 55) min, contrast volume was 250 (IQR: 180 to 340) ml, and radiation doses (air kerma and dose area product) were 1.6 (IQR: 1.0 to 2.7) Gy and 98 (IQR: 57 to 168) Gy·cm2, respectively. CONCLUSIONS: High procedure and patient success rates, combined with a low event rate and improved procedural characteristics, support further use of the hybrid algorithm for a broad community of appropriately trained CTO operators.
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