Further validation of the hybrid algorithm for CTO PCI; difficult lesions, same success

Cardiovasc Revasc Med. Jul-Aug 2017;18(5):328-331. doi: 10.1016/j.carrev.2017.02.014. Epub 2017 Feb 22.

Abstract

Objectives: To evaluate the success rates and outcome of the hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) by a single operator in two different clinical settings.

Methods: We compared 279 consecutive CTO PCIs performed by a single, high-volume operator using the hybrid algorithm in two different clinical settings. Data were collected through the PROGRESS CTO Registry. We compared 145 interventions performed in a community program (cohort A) with 134 interventions performed in a referral center (cohort B).

Results: Patient in cohort B had more complex lesions with higher J-CTO (3.0 vs. 3.41; p<0.001) and Progress CTO (1.5 vs.1.8, P=0.003) scores, more moderate to severe tortuosity (38% vs. 64%; p<0.001), longer total occlusion length (25 vs. 40mm; p<0.001) and higher prevalence of prior failed CTO PCI attempts (15% vs. 35%; p=0.001). Both technical (95% vs. 91%; p=0.266) and procedural (94% vs. 88%; p=0.088) success rates were similar between the two cohorts despite significantly different lesion complexity. Overall major adverse cardiovascular events were higher in cohort B (1.4% vs. 7.8%; p=0.012) without any significant difference in mortality (0.7% vs. 2.3%, p=0.351).

Conclusions: In spite of higher lesion complexity in the setting of a quaternary-care referral center, use of the hybrid algorithm for CTO PCI enabled similarly high technical and procedural success rates as compared with those previously achieved by the same operator in a community-based program at the expense of a higher rate of MACE.

Keywords: Chronic Total occlusion; PCI.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms*
  • Chronic Disease / therapy
  • Cohort Studies
  • Coronary Angiography* / methods
  • Coronary Occlusion / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention* / methods
  • Registries
  • Risk Factors
  • Treatment Outcome