Author + information
- Sudhir Rathore1,
- S.R.K. Seshasai2,
- Alfredo Galassi3,
- Marouane Boukhris4,
- Etsuo Tsuchikane5,
- Joseph Dens6,
- Kambis Mashayekhi7,
- J. Aaron Grantham8,
- Emmanouil Brilakis9 and
- Gerald Werner10
- 1Frimley Health NHS Foundation Trust, Camberley, United Kingdom
- 2St Georges, University of London, London, United Kingdom
- 3University of Catania, Catania, Catania, Italy
- 4Abderrahmen Mami Hospital, Ben Arous, Tunisia
- 5Toyohashi Heart Center, Toyohashi, Japan
- 6Ziekenhuis Oost Limburg, Genk, Belgium
- 7University Heartcenter Bad Krozingen, Bad Krozingen, Germany
- 8University of Missouri Kansas City and Mid America Heart Institute, Kansas City, Missouri, United States
- 9Minneapolis Heart Institute, UT Southwestern Medical Center/VA North Texas Health Care System, Minneapolis, Minnesota, United States
- 10Klinikum Darmstadt, Darmstadt, Germany
Recent improvement in clinical skills, technology and hardware has resulted in improved success rates with chronic total occlusion angioplasty. We sought to perform pooled analysis of procedural characteristics, procedural outcomes and complications following contemporary chronic toatal occlusion angioplasty.
We conducted pooled analysis of 9500 patients from around the world included in major registries performed by experienced operators. Data on procedural characteristics, procedural success, JCTO score, procedural time, contrast volume usage, in hospital mortality, myocardial infarction and cardiac tamponade was collected.
A total of 9500 patients were included from five large registries. Pooled estimates of the baseline and procedural characteristics were as follows: Age 65.4 years (95% confidence interval (CI): 62.9 to 67.8 years); previous CABG 24.8% (95% CI: 12.4 to 37.3 %); reattempt 24.8% (95% CI: 12.4 to 37.3%); JCTO score 2.2 (95% CI: 1.9 TO 2.3). Final wiring strategy in hybrid algorithm based registries RECHARGE, PROGRESS and OPEN CTO was AWE in 40.8-58%, Retrograde in 24-35%, ADR in 16-25% and in Expert JCTO and EURO CTO was AWE in 72-75% and Retrograde in 25-28%. Pooled estimates of the outcomes were: Procedural success 87.8% (95% CI: 85.5% to 89.9%); procedure time 133.1 minutes (95% CI: 109.8 to 156.3 minutes); contrast volume 256.8 ml (95% CI: 229.6 to 283.9 ml), In hospital MACE 2.6 % (95% CI: 1.1 to 4.2%), mortality 0.36% (95% CI: 0.09 to 0.62%), stroke 0.13% (95% CI: 0.04 to 0.21%); MI 1.62% (95% CI: 1.0 to 2.27%) ; Cardiac Tamponade 0.9% (95% CI: 0.50 t0 1.29 %).
Modern chronic total occlusion angioplasty could be performed with high procedural success rates and low complication rates in experienced hands utilizing various techniques.
CORONARY: PCI Outcomes