Ward Eertmans1,2, Peter Kayaert3, Johan Bennett4, Claudiu Ungureanu5, Yoann Bataille6,7, Georges Saad6, Steven Haine8,9, Patrick Coussement10, Bruno Pereira11, Pierfrancesco Agostoni12, Luc Janssens13, Bert Vandeloo14, Patrick Maréchal15, Kristoff Cornelis16, Quentin de Hemptinne17, Adel Aminian18, Francis Stammen19, Stéphane Carlier20, Patrick Timmermans21, Steven Vercauteren22, Jeroen Sonck14,23, Frédéric De Vroey24, Benny Drieghe2, Keir McCutcheon3, Benjamin Scott12, Laurent Davin15, Chadi Gafari20, Jo Dens1,2. 1. Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. 2. Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium. 3. Department of Cardiology, UZ Gent, Gent, Belgium. 4. Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium. 5. Department of Cardiology, Hôpital de Jolimont, La Louvière, Belgium. 6. Department of Cardiology, CHR de la Citadelle, Liège, Belgium. 7. Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium. 8. Department of Cardiology, Antwerp University Hospital, Edegem, Belgium. 9. Department of Cardiovascular Diseases, University of Antwerp, Wilrijk, Belgium. 10. Department of Cardiology, AZ Sint-Jan Brugge, Brugge, Belgium. 11. Department of Cardiology, INCCI Haerz Center, Luxembourg, Luxembourg. 12. HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA), Middelheim Hospital, Antwerp, Belgium. 13. Department of Cardiology, Imelda Ziekenhuis, Bonheiden, Belgium. 14. Department of Cardiology, Centrum voor Hart- en Vaatziekten, UZ Brussel, Jette, Belgium. 15. Department of Cardiology, CHU Liège, Liège, Belgium. 16. Department of Cardiology, AZ Maria Middelares, Gent, Belgium. 17. Department of Cardiology, CHU Saint-Pierre Université Libre de Bruxelles, Brussel, Belgium. 18. Department of Cardiology, CHU Charleroi, Charleroi, Belgium. 19. Department of Cardiology, AZ Delta, Roeselare, Belgium. 20. Department of Cardiology, CHU Ambroise Paré, Mons, Belgium. 21. Department of Cardiology, Clinique Saint-Luc Bouge, Namur, Belgium. 22. Department of Cardiology, Kliniek Sint-Jan, Brussel, Belgium. 23. Department of Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium. 24. Department of Cardiology, Grand Hôpital de Charleroi, Charleroi, Belgium.
Abstract
BACKGROUND: To chart the evolution of the CTO-PCI landscape in Belgium and Luxembourg, the Belgian Working Group on Chronic Total Occlusions (BWGCTO) was established in 2016. METHODS: Between May 2016 and December 2019, patients undergoing a CTO-PCI treatment were prospectively and consecutively enrolled. Twenty-one centres in Belgium and one in Luxembourg participated. Individual operators had mixed levels of expertise in treating CTO lesions. Demographic, angiographic, procedural parameters and incidence of major adverse cardiac and cerebrovascular events (MACCE) were systematically registered. RESULTS: Over a four-year enrolment period, 1832 procedures were performed in 1733 patients achieving technical success in 1474 cases (80%), with an in-hospital MACCE rate of 2.3%. Fifty-nine (3%) cases were re-attempt procedures of which 41 (69%) were successful. High-volume centres treated more complex lesions (mean J-CTO score: 2.15 ± 1.21) as compared to intermediate (mean J-CTO score: 1.72 ± 1.23; p < 0.001) and low-volume centres (mean J-CTO score: 0.99 ± 1.21; p = 0.002). Despite this, success rates did not differ between centres (p = 0.461). Overall success rates did not differ over time (p = 0.810). High-volume centres progressively tackled more complex CTOs while keeping success rates stable. In all centres, the most applied strategy was antegrade wire escalation (83%). High-volume centres more often successfully applied antegrade dissection and re-entry and retrograde techniques in lesions with higher complexity. CONCLUSION: With variable experience levels, operators treated CTOs with high success and relatively few complications. Although AWE remains the most used technique, it is paramount for operators to be skilled in all contemporary techniques in order to be successful in more complex CTOs.
BACKGROUND: To chart the evolution of the CTO-PCI landscape in Belgium and Luxembourg, the Belgian Working Group on Chronic Total Occlusions (BWGCTO) was established in 2016. METHODS: Between May 2016 and December 2019, patients undergoing a CTO-PCI treatment were prospectively and consecutively enrolled. Twenty-one centres in Belgium and one in Luxembourg participated. Individual operators had mixed levels of expertise in treating CTO lesions. Demographic, angiographic, procedural parameters and incidence of major adverse cardiac and cerebrovascular events (MACCE) were systematically registered. RESULTS: Over a four-year enrolment period, 1832 procedures were performed in 1733 patients achieving technical success in 1474 cases (80%), with an in-hospital MACCE rate of 2.3%. Fifty-nine (3%) cases were re-attempt procedures of which 41 (69%) were successful. High-volume centres treated more complex lesions (mean J-CTO score: 2.15 ± 1.21) as compared to intermediate (mean J-CTO score: 1.72 ± 1.23; p < 0.001) and low-volume centres (mean J-CTO score: 0.99 ± 1.21; p = 0.002). Despite this, success rates did not differ between centres (p = 0.461). Overall success rates did not differ over time (p = 0.810). High-volume centres progressively tackled more complex CTOs while keeping success rates stable. In all centres, the most applied strategy was antegrade wire escalation (83%). High-volume centres more often successfully applied antegrade dissection and re-entry and retrograde techniques in lesions with higher complexity. CONCLUSION: With variable experience levels, operators treated CTOs with high success and relatively few complications. Although AWE remains the most used technique, it is paramount for operators to be skilled in all contemporary techniques in order to be successful in more complex CTOs.
Entities:
Keywords:
Coronary total occlusion; in-hospital outcomes; percutaneous coronary intervention