LB-4 | Contemporary In-Hospital Outcomes and Temporal Trends of Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the PROGRESS-CTO International Registry
Year: 2022
Type: article
Study design: Observational Study
Abstract: BackgroundChronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been rapidly evolving.MethodsWe examined the clinical and angiographic characteristics and procedural outcomes of 10,249 CTO PCIs performed in 10,019 patients at 40 US and non-US centers between 2012 and 2022.ResultsMean age was 64±10 years and 81% of the patients were men. The prevalence of prior PCI (62%), prior coronary artery bypass graft surgery (29%), and diabetes mellitus (43%) was high. The most common target vessel was the right coronary artery (53%), followed by the left anterior descending artery (26%) and left circumflex artery (19%). The target CTOs were highly complex with mean J-CTO score of 2.4 ±1.3 and PROGRESS-CTO score of 1.3 ±1.0. Technical success was high (86%) and increased over time, from 81.6% in 2016 to 88.1% in 2021 (p for trend<0.0001). The overall incidence of in-hospital major adverse cardiac events (MACE) was 2.1% without significant changes over time (p for trend =0.194). The final successful crossing strategy was antegrade wire escalation in 55%, retrograde in 19%, and antegrade dissection re-entry in 12%, with greater antegrade wire escalation success over time. Median contrast volume, air kerma radiation dose, and procedural and fluoroscopy duration decreased over time.ConclusionsThe success and efficiency of CTO PCI has been increasing in recent years without change in MACE.DisclosuresK. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and CSI: Consulting; D. Karmpaliotis: Abbott: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; Saranas: Ownership Interests: Stocks, Stock Options; Soundbite: Ownership Interests: Stocks, Stock Options; Traverse Vascular: Ownership Interests: Stocks, Stock Options; F. A. Jaffer: sponsored research support from Kowa, Canon, Siemens, Teleflex, Shockwave, and Amarin; consultant for Boston Scientific, Abbott Vascular, Siemens, Magenta Medical, Asahi Intecc and IMDS; has an equity interest in Intravascular Imaging, Inc. and DurVena, I: Consulting; J. Khatri: Medtronic, Abbott, Boston, Terumo, Asahi speaker/proctor.: Consulting; W. A. Jaber: consultant for Inari: Consulting; S. Rinfret: Prof Rinfret has been a consultant for Boston Scientific, Teleflex, Medtronic, Abbott, and Abiomed.: Consulting; W. J. Nicholson: Dr. Nicholson has served as proctor, consultant, and advisory board member for Abbott Vascular, Boston Scientific and Medtronic.: Consulting; M. P. Patel: Abbott: Consulting; Cardiovascular Systems, Inc.: Consulting; Medtronic: Consulting; E. Mahmud: Abbott: Principal Investigator for a Research Study; Abiomed: Consulting; Cardiovascular Systems, Inc.: Principal Investigator for a Research Study; Medtronic: Consulting; CSI: Principal Investigator for a Research Study; Microport: Principal Investigator for a Research Study; A. Elguindy: Honoraria: Medtronic, Boston Scientific, Asahi Intecc, Abbott Proctorship fees: Medtronic, Boston Scientific, Asahi Intecc, Terumo Educational grants: Medtronic: Consulting; B. Jefferson: honoraria/consulting/speaking fees from Abbott, Boston Scientific, CSI, Medtronic: Consulting; J. R. Wollmuth: reports serving as proctor/speaker/medical advisory board for Abbott Vascular, Boston Scientific and Abiomed, proctor for Asahi Intecc, and medical advisory board with Philips: Advisory Board/Board Member; R. F. Riley: Boston Scientific Corp.: Advisory Board/Board Member, Consulting and Speaker Bureau; R. E. Davies: Medtronic: Speaker Bureau; Asahi Intec: Speaker Bureau; Shockwave: Advisory Board/Board Member; Siemens healthineers/Corindus: Speaker Bureau; Boston Scientific Corp.: Speaker Bureau; D. Schimmel: Inari Medical: Consulting; Penumbra: Journal club funding, dinner, travel and meeting with R&D.; Boston Scientific Corp.: Site PI for study; M. N. Burke: MHI Ventures, stockholder. Egg Medical, stockholder: Consulting; E. S. Brilakis: Abbott: Consulting and Speaker Bureau; AMgen: Consulting and Speaker Bureau; Asahi Intecc: Speaker Bureau; Biotronik: Consulting and Speaker Bureau; Boston Scientific Corp.: Consulting, Principal Investigator for a Research Study and Speaker Bureau; ControlRad: Speaker Bureau; CSI: Consulting and Speaker Bureau; GE Healthcare: Consulting, Principal Investigator for a Research Study and Speaker Bureau; Hippocrates LLC: Ownership Interests: Stocks, Stock Options; MHI Ventures: Ownership Interests: Stocks, Stock Options; Cleerly Health: Ownership Interests: Stocks, Stock Options; Stallion Medical: Ownership Interests: Stocks, Stock Options; S. Kostantinis Nothing to disclose. B. Simsek Nothing to disclose. J. Karacsonyi Nothing to disclose. O. Krestyaninov Nothing to disclose. D. Khelimskii Nothing to disclose. P. Poommipanit Nothing to disclose. J. W. Choi Nothing to disclose. P. Dattilo Nothing to disclose. Ş. Görgülü Nothing to disclose. M. Koutouzis Nothing to disclose. I. Tsiafoutis Nothing to disclose. B. Elbarouni Nothing to disclose. A. M. Sheikh Nothing to disclose. B. F. Uretsky Nothing to disclose. T. Patel Nothing to disclose. S. M. Benton Jr. Nothing to disclose. R. H. Chandwaney Nothing to disclose. C. Toma Nothing to disclose. R. W. Yeh Nothing to disclose. N. Abi Rafeh Nothing to disclose. Ö. Göktekin Nothing to disclose. J. L. Kerrigan Nothing to disclose. O. C. Mastrodemos Nothing to disclose. B. V. Rangan Nothing to disclose. BackgroundChronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been rapidly evolving. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been rapidly evolving. MethodsWe examined the clinical and angiographic characteristics and procedural outcomes of 10,249 CTO PCIs performed in 10,019 patients at 40 US and non-US centers between 2012 and 2022. We examined the clinical and angiographic characteristics and procedural outcomes of 10,249 CTO PCIs performed in 10,019 patients at 40 US and non-US centers between 2012 and 2022. ResultsMean age was 64±10 years and 81% of the patients were men. The prevalence of prior PCI (62%), prior coronary artery bypass graft surgery (29%), and diabetes mellitus (43%) was high. The most common target vessel was the right coronary artery (53%), followed by the left anterior descending artery (26%) and left circumflex artery (19%). The target CTOs were highly complex with mean J-CTO score of 2.4 ±1.3 and PROGRESS-CTO score of 1.3 ±1.0. Technical success was high (86%) and increased over time, from 81.6% in 2016 to 88.1% in 2021 (p for trend<0.0001). The overall incidence of in-hospital major adverse cardiac events (MACE) was 2.1% without significant changes over time (p for trend =0.194). The final successful crossing strategy was antegrade wire escalation in 55%, retrograde in 19%, and antegrade dissection re-entry in 12%, with greater antegrade wire escalation success over time. Median contrast volume, air kerma radiation dose, and procedural and fluoroscopy duration decreased over time. Mean age was 64±10 years and 81% of the patients were men. The prevalence of prior PCI (62%), prior coronary artery bypass graft surgery (29%), and diabetes mellitus (43%) was high. The most common target vessel was the right coronary artery (53%), followed by the left anterior descending artery (26%) and left circumflex artery (19%). The target CTOs were highly complex with mean J-CTO score of 2.4 ±1.3 and PROGRESS-CTO score of 1.3 ±1.0. Technical success was high (86%) and increased over time, from 81.6% in 2016 to 88.1% in 2021 (p for trend<0.0001). The overall incidence of in-hospital major adverse cardiac events (MACE) was 2.1% without significant changes over time (p for trend =0.194). The final successful crossing strategy was antegrade wire escalation in 55%, retrograde in 19%, and antegrade dissection re-entry in 12%, with greater antegrade wire escalation success over time. Median contrast volume, air kerma radiation dose, and procedural and fluoroscopy duration decreased over time. ConclusionsThe success and efficiency of CTO PCI has been increasing in recent years without change in MACE. The success and efficiency of CTO PCI has been increasing in recent years without change in MACE.
Authors: Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Dimitrios Karmpaliotis, Farouc A. Jaffer, Jaikirshan Khatri, Paul Poommipanit, James W. Choi, Wissam A. Jaber, Stéphane Rinfret, William J. Nicholson, Mitul P. Patel, Ehtisham Mahmud, Philip Dattilo, Şevket Görgülü, Michail Koutouzis, Ioannis Tsiafoutis, Basem Elbarouni, Abdul M. Sheikh, Barry F. Uretsky, Ahmed Elguindy, Brian Jefferson, Taral Patel, Jason R. Wollmuth, Robert F. Riley, Stewart M. Benton, Rhian E. Davies, Raj H. Chandwaney, Catalin Toma, Robert W. Yeh, Daniel Schimmel, Nidal Abi Rafeh, Ömer Göktekin, Jimmy Lee Kerrigan, M. Nicholas Burke, Olga C. Mastrodemos, Bavana V. Rangan, Emmanouil S. Brilakis
Institutions: Abbott Northwestern Hospital, Henry Ford Health, Meshalkin National Medical Research Center, Morristown Medical Center, Atlantic Health System, Massachusetts General Hospital, Cleveland Clinic, University Hospitals Cleveland Medical Center, Emory University Hospital, Saint Joseph's Hospital, Emory Healthcare, UC San Diego Health System, University of California San Diego, University of Colorado Health, Hellenic Red Cross, Red Cross Hospital, St. Boniface Hospital, WellStar Health System, University of Arkansas for Medical Sciences, Magdi Yacoub Heart Foundation, Centennial Medical Center, Overlake Hospital Medical Center, WellSpan Health, WellSpan York Hospital, Oklahoma Heart Institute, University of Pittsburgh Medical Center, Beth Israel Deaconess Medical Center, Northwestern Memorial Hospital, North Oaks Health System, Minneapolis Heart Institute Foundation
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,400
OpenAlex ID: W4280608154