Temporal Trends in Chronic Total Occlusion Interventions in Europe

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.

Development and first results of a dedicated chronic total occlusion programme

“…Since the adoption of the hybrid approach and increased use of retrograde techniques, success rates have increased along with lesion complexity. Several studies have found current success rates between 70% and 85% [2,[12][13][14]. In accordance with these registry results, we found an excellent rate of in-hospital major adverse cardiac events of less than 1%.…”

Percutaneous Coronary Intervention for Chronic Total Occlusion

“…The introduction of the retrograde approach has led to a successful rate of revascularization of approximately 90%. 43 The first step in the retrograde approach is to pass the collaterals.…”

Komplexe Koronarinterventionen

“…Ähnliche Ergebnisse fanden sich im amerikanischen OPEN-CTO [23] und europäischem RECHARGE-Register [24], mit jeweils 86 % technischem Erfolg und sogar 89 %iger Erfolgsrate im Japanischem J-CTO-Register [25]. Die unlängst veröffentlichten Daten [26] des weltweit größten Register, des europäischen EuroCTO-Registers, mit über 17 000 behandelten CTO-Patienten, zeigen einen Anstieg der prozeduralen Erfolgsrate von 79,7 % im Jahr 2008 bis auf 89,3 % im Jahr 2015.…”