Contemporary perspectives on coronary chronic total occlusion: Data from a Large French Registry (CARDIO-ARSIF)

Abstract

The aim of this study was to provide contemporary data on chronic total occlusion (CTO) prevalence and management in a large unselected population in the greater Paris area, and to compare percutaneous coronary intervention (PCI) features in patients with and without CTO. Contemporary data on the prevalence, clinical characteristics and management of CTO in a large unselected population are scarce. Between 2012 and 2015, 258,526 elective coronary procedures were performed in the greater Paris area and registered in the CARDIO-ARSIF (Agence régionale de santé Île de France) registry. Patients with acute coronary syndrome or previous coronary artery bypass grafting were excluded. Coronary CTO features were assessed and PCIs with and without CTO were compared. Among 128,739 included patients, 10,468 (8.1%) had at least one CTO. Cardiovascular risk-factor burden was higher in the CTO group, which had more patients with multivessel disease (73.8% vs. 23.5%) and with referral for interventional management (59% vs. 33%). In the CTO-PCI group, 86.6% of patients had documented ischemia. Of all PCIs during the study period, 5.7% involved a CTO; this proportion increased significantly over the study period. PCI success rate was 75.9% in the CTO group. CTO-PCI volume per center did not correlate with CTO-PCI success rate ( Table 1 ). CTO is common in patients undergoing scheduled coronary angiography. Invasive management is done more often in patients with than without CTO. The success rate of PCI in CTO is not associated with case volume per center.