Abstract
Background The field of CTO PCI is expanding, but successful and safe percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTO) requires a substantial resource and experience investment. We aimed to assess temporal trends in strategies and outcomes of 2 dedicated programs for CTO PCI. Methods Between 2011 and 2020, 920 CTO PCI procedures were prospectively included at 2 referral centres in Belgium. Temporal trends were assessed, and logistic regression models were built to identify predictors of outcome. Results Despite an increase in lesion complexity (the J-CTO score increased from 1.3 in year 1 to 1.7–2.0 in years 8-9, p < 0.001), technical success improved from 70.0% to 85.6% in year 9 (p value for trend <0.001). We observed the most significant improvement starting at years 3-4 (OR 2.3 in year 4 versus year 1, p=0.018). Together with an increase in success rates and lesions complexity, there was an increase in the use of dual injections, retrograde approaches, the number of balloons and stents, and the use of microcatheters. Conversely, there was a decrease in large bore access, an increase in radial approach, and a shift towards contemporary dissection/reentry techniques. This strategy resulted in a stable major complication rate of 4.7% (p value for trend 0.33). The rate of coronary procedure-related myocardial injury was high (71.0%) and was associated with the use of more intracoronary devices. Conclusions Three to four years after initiation of a dedicated CTO PCI program with 50 CTO PCIs per year, consistent high technical success and low complication rates are achieved using contemporary strategies.
Highlights
Chronic total occlusions (CTO) of the coronary arteries are identified in 15–25% of patients with coronary artery disease undergoing coronary angiography [1]
E majority of patients were male (85.2%) and presented with stable angina (62.4%). e CTO was located in the RCA in the majority of patients (56.1%), and 33.4% of patients had a J-CTO score of 3 or higher. e CTO lesion characteristics are shown in Supplementary Table 1
Technical success improved despite a significant increase in lesion complexity over time. e J-CTO score increased from 1.3 ± 1.1 to 2.0 ± 1.3 in year 8 and 1.7 ± 1.1 in year 9 (p value for trend 0.004, Figure 1(b)). is increase was associated with a change in Percutaneous coronary intervention (PCI) strategy, with an increased use of dissection/reentry techniques and retrograde approaches
Summary
Chronic total occlusions (CTO) of the coronary arteries are identified in 15–25% of patients with coronary artery disease undergoing coronary angiography [1]. Percutaneous coronary intervention (PCI) of CTOs has shown to reduce angina and ischemia burden in prospective clinical studies [2, 3]. CTO PCI currently has a class IIa (level of evidence B) indication in patients with stable angina despite optimal medical therapy and in patients with a large area of ischemia [4]. Two Belgian centres initiated a dedicated CTO PCI program during which patients were prospectively enrolled. E aim of the current study was to assess contemporary trends in the strategies, approach, and outcomes of CTO PCI in Belgium, including technical success and safety. E results from this study can guide other hospitals with or without on-site cardiac surgery to establish and optimize a dedicated CTO PCI program Two Belgian centres initiated a dedicated CTO PCI program during which patients were prospectively enrolled. e aim of the current study was to assess contemporary trends in the strategies, approach, and outcomes of CTO PCI in Belgium, including technical success and safety. e results from this study can guide other hospitals with or without on-site cardiac surgery to establish and optimize a dedicated CTO PCI program.
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