What do Polish interventional cardiologists know about indications and qualification for recanalisation of chronic total coronary artery occlusions?

Abstract

A b s t r a c tBackground: Chronic total occlusions (CTO) are diagnosed in about 20% of patients with significant coronary artery disease. A disproportion between the high prevalence of CTOs and low rate of invasive treatment still exists. Technical difficulties, clinical uncertainties whether patients benefit from recanalisation, and a lack of knowledge of CTO may be responsible for this fact. Aim:To assess the knowledge of coronary arteries CTO among Polish interventional cardiologists. Methods:A self-designed questionnaire was used during two major Polish invasive cardiology workshops held in 2014. Results:The study included 113 physicians, mostly cardiologists certified as independent operators. Average self-declared efficacy of CTO recanalisation was 63.5%. Most of the respondents agreed that the operator involved in the CTO recanalisation program should perform at least 30-50 procedures per year. Only 67% stated that before CTO revascularisation the evaluation of myocardial viability should be performed with dobutamine stress echocardiography as a preferred test. One third of the physicians agreed that CTO percutaneous coronary intervention (PCI) should not be performed directly after diagnostic angiography, and 51.5% believed that in patients with multi-vessel coronary artery disease PCI of CTO should be performed first. Multi-slice spiral computed tomography during the qualification and planning of the CTO revascularisation, in the opinion of 91% of the responders, should not be used before each procedure but could be useful in selected cases. Conclusions:Polish interventional cardiologists remains in compliance with current opinions about recanalisation of chronic coronary artery occlusions and the consensus of the EuroCTO Club, but there is still an unceasing need for further education and promotion of knowledge about CTOs.

Predictors of successful percutaneous coronary intervention in chronic total coronary occlusions

“…In several previous studies, the procedural success rates were reported between 58.9% and 75.2% [ 4 , 17 ]. Recently, the reported success rate of CTO-PCI has reached > 80% owing to the use of new sophisticated techniques and development of specialized devices [ 18 , 19 ]. The overall technical success rate of the present study is 83.2% and is similar to those reported in recent large United States and European CTO PCI registries (85.5% to 87.5%) [ 20 ].…”

Knowledge of chronic total occlusion among Polish interventional cardiologists

“…The estimated success rate of percutaneous coronary intervention (PCI) in CTO procedures in the whole studied group was 63.5%. Detailed characteristics of the studied group are presented in another article [ 13 ].…”

Which parameters are important before attempting chronic total occlusions recanalization?

“…Thus, the risk of failure and complications is very dependent on technical skills of the operator and vary from study to study. There are also some controversies, fortunately year by year less frequent, mainly due to the sharing of knowledge in the cardiology community, creating appropriate indications for CTO revascularization [ 1 , 2 ]. Finally, there are still some uncertainties regarding benefits of the CTO procedure, but the growing number of studies reporting good procedural, functional and, most importantly, a positive effect on long-term outcome, shifts the balance toward benefits.…”