Chronic total occlusion percutaneous coronary intervention in everyday clinical practice – an expert opinion of the Association of Cardiovascular Interventions of the Polish Cardiac Society

Bryniarski, Leszek; Opolski, Maksymilian P.; Wójcik, Jarosław; Lesiak, Maciej; Pawłowski, Tomasz; Drozd, Jakub; Wojakowski, Wojciech; Surowiec, Sławomir; Dąbrowski, M; Witkowski, Adam; Dudek, Dariusz; Grygier, Marek; Bartuś, Stanisław

doi:10.5114/aic.2021.104763

Cited by 2 publications

(1 citation statement)

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“…Such events are more pronounced in high-risk, complex procedures [18,[23][24][25][26]. Hence, the current European Consensus and National Societies guidelines regarding CTO-PCIs established requirements regarding certification for a well-experienced specialist to perform 300 CTO-PCIs in total and maintain more than 50 CTO-PCIs per year [27,28].…”

Section: Discussionmentioning

confidence: 99%

Single versus Dual-Operator Approaches for Percutaneous Coronary Interventions within Chronic Total Occlusion—An Analysis of 27,788 Patients

Januszek,

De Luca,

Siłka

et al. 2023

JCM

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(1) Background: Since the treatment of chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) is associated with high procedural complexity, it has been suggested to use a multi-operator approach. This study was aimed at evaluating the procedural outcomes of single (SO) versus dual-operator (DO) CTO-PCI approaches. (2) Methods: This retrospective analysis included data from the Polish Registry of Invasive Cardiology Procedures (ORPKI), collected between January 2014 and December 2020. To compare the DO and SO approaches, propensity score matching was introduced with equalized baseline features. (3) Results: The DO approach was applied in 3604 (13%) out of 27,788 CTO-PCI cases. Patients undergoing DO CTO-PCI experienced puncture-site bleeding less often than the SO group (0.1% vs. 0.3%, p = 0.03). No differences were found in the technical success rate (successful revascularization with thrombolysis in myocardial infarction flow grade 2/3) of the SO (72.4%) versus the DO approach (71.2%). Moreover, the presence of either multi-vessel (MVD) or left main coronary artery disease (LMCA) (odds ratio (OR), 1.67 (95% confidence interval (CI), 1.20–2.32); p = 0.002), as well as lower annual and total operator volumes of PCI and CTO-PCI, could be noted as factors linked with the DO approach. (4) Conclusions: Due to the retrospective character, the findings of this study have to be considered only as hypothesis-generating. DO CTO-PCI was infrequent and was performed on patients who were more likely to have LMCA lesions or MVD. Operators collaboratively performing CTO-PCIs were more likely to have less experience. Puncture-site bleeding occurred less often in the dual-operator group; however, second-operator involvement had no impact on the technical success of the intervention.

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