Nikolaos V Konstantinidis1, Gerald S Werner2, Spyridon Deftereos3, Carlo Di Mario4, Alfredo R Galassi5, Joachim H Buettner6, Alexandre Avran7, Nicolaus Reifart8, Omer Goktekin9, Roberto Garbo10, Alexander Bufe11, Kambis Mashayekhi12, Nicolas Boudou13, Markus Meyer-Geßner14, Bernward Lauer15, Simon Elhadad16, Evald H Christiansen17, Javier Escaned18, David Hildick-Smith19, Mauro Carlino20, Yves Louvard21, Thierry Lefèvre21, Lefteris Angelis22, Georgios Giannopoulos3, Georgios Sianos1. 1. First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (N.V.K., G.S.). 2. Medizinische Klinik I, Klinikum Darmstadt GmbH, Germany (G.S.W.). 3. Second Department of Cardiology, Attikon University Hospital, Athens, Greece (S.D., G.G.). 4. Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.). 5. Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Italy (A.R.G.). 6. Interventional Cardiology Department, University Heart Center Freiburg, Bad-Krozingen, Germany (J.H.B.). 7. Interventional Cardiology Department, Arnaud Tzanck Institut, Saint Laurent du Var, France (A.A.). 8. Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany (N.R.). 9. Department of Cardiology, Istanbul Memorial Hospital, Turkey (O.G.). 10. Interventional Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy (R.G.). 11. Medizinische Klinik I, HELIOS Klinikum, Wuppertal, Germany (A.B.). 12. Department of Cardiology and Angiology II, University Heart center Freiburg, Bad-Krozingen, Germany (K.M.). 13. Department of Cardiology, Rangueil University Hospital, Toulouse, France (N.B.). 14. Klinik Kardiologie Augusta Krankenhaus, Dusseldorf, Germany (M.M.-G.). 15. Division of Cardiology, Zentralklinik Bad Berka, Germany (B.L.). 16. Department of Cardiology, CH-de-Lagny, Lagny-sur-Marne, France (S.E.). 17. Department of Cardiology, Aarhus University Hospital, Denmark (E.H.C.). 18. Interventional Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain (J.E.). 19. Department of Cardiology, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S.). 20. Invasive Cardiology Unit, San Raffaele Hospital, Milan, Italy (M.C.). 21. Institut Hospitalier Jacques Cartier, Massy, France (Y.L., T.L.). 22. School of Informatics, Aristotle University of Thessaloniki, Greece (L.A.).
Abstract
BACKGROUND: The study focuses on the evolution of practice, procedural outcomes, and in-hospital complications of chronic total occlusion percutaneous coronary intervention in Europe. METHODS AND RESULTS: Data from 17 626 procedures enrolled in European Registry of Chronic Total Occlusion between January 2008 and June 2015 were assessed. The mean patient age was 63.9±10.9 years; 85% were men. Procedural success increased from 79.7% to 89.3% through the study period. Patients enrolled during the years had increasing comorbidities and lesion complexity (J-CTO score [Multicenter CTO Registry of Japan] increased from 1.76±1.03 in 2008 to 2.17±0.91 in 2015; P for trend, <0.001). Retrograde approach utilization steadily increased from 10.1% in 2008 to 29.9% in 2015 ( P for trend, <0.001). Antegrade dissection reentry adoption was low, not exceeding 5.5%. In-hospital mortality decreased during the study period from 0.4% to 0.1% ( P for trend, <0.001), whereas in-hospital complication rates remained essentially unchanged, in the range 4.4% to 5.2% ( P for trend, 0.390). CONCLUSIONS: Chronic total occlusion percutaneous coronary intervention has shown a steady increase in procedural success rate over time, with unchanged complication rates, despite the increasing complexity of the lesions attempted. The J-CTO score predictive value for procedural success was low for the entire registry and had no predictive ability for the retrograde approach.
BACKGROUND: The study focuses on the evolution of practice, procedural outcomes, and in-hospital complications of chronic total occlusion percutaneous coronary intervention in Europe. METHODS AND RESULTS: Data from 17 626 procedures enrolled in European Registry of Chronic Total Occlusion between January 2008 and June 2015 were assessed. The mean patient age was 63.9±10.9 years; 85% were men. Procedural success increased from 79.7% to 89.3% through the study period. Patients enrolled during the years had increasing comorbidities and lesion complexity (J-CTO score [Multicenter CTO Registry of Japan] increased from 1.76±1.03 in 2008 to 2.17±0.91 in 2015; P for trend, <0.001). Retrograde approach utilization steadily increased from 10.1% in 2008 to 29.9% in 2015 ( P for trend, <0.001). Antegrade dissection reentry adoption was low, not exceeding 5.5%. In-hospital mortality decreased during the study period from 0.4% to 0.1% ( P for trend, <0.001), whereas in-hospital complication rates remained essentially unchanged, in the range 4.4% to 5.2% ( P for trend, 0.390). CONCLUSIONS:Chronic total occlusion percutaneous coronary intervention has shown a steady increase in procedural success rate over time, with unchanged complication rates, despite the increasing complexity of the lesions attempted. The J-CTO score predictive value for procedural success was low for the entire registry and had no predictive ability for the retrograde approach.
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