Author + information
- Joren Maeremans1,
- Alexandre Avran2,
- Simon Walsh3,
- Paul Knaapen4,
- Benjamin Faurie5,
- Pierfrancesco Agostoni6,
- Erwan Bressollette7,
- Dave Smith8,
- Margaret McEntegart9,
- William Smith10,
- Alun Harcombe10,
- John Irving11,
- James Spratt12 and
- Joseph Dens13
- 1Universiteit Hasselt, Genk, Belgium
- 2Arnault Tzanck Institut, Saint Laurent du Var, France
- 3Belfast Health & Social Care Trust, Belfast, United Kingdom
- 4VU University Medical Center, Amsterdam, Netherlands
- 5Ctr Hosp Mutualiste de Grenoble, Grenoble, France
- 6Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
- 7Nouvelles Cliniques Nantaises, Nantes, United States
- 8Morriston Hospital, Swansea, United Kingdom
- 9Golden Jubilee National Hospital, Glasgow, Scotland, United Kingdom
- 10Nottingham University Hospitals, Nottingham, United Kingdom
- 11Nhs, Dundee, United Kingdom
- 12St George's University Hospital, London, United Kingdom
- 13Ziekenhuis Oost Limburg, Genk, Belgium
Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) has historically been associated with higher event rates during follow-up (FU). The hybrid algorithm and contemporary antegrade and retrograde wiring and dissection re-entry (DR) techniques have the potential to further improve the long-term outcomes after CTO-PCI. The REgistry of CrossBoss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE) aims to assess the long-term clinical outcomes of the hybrid practice, when applied by operators with varying experience levels.
Between January 2014 and October 2015, 1165 patients were prospectively included by 17 centers. We examined the one-year clinical events according to technical outcome and final technique. The primary endpoint was major adverse cardiac events (MACE).
≥90% complete FU data up to 12 months of 1067 patients (92%; n=1067/1165) was provided by 13 centers. Mean FU duration was 362.8±0.9 days. One-year MACE-free survival was 91.3% (n=974/1067). MACE included death (1.9%; n=20), myocardial infarction (1.4%; n=15), target vessel failure (TVF) (5.9%; n=63), and target vessel revascularization (TVR) (5.5%; n=59). In two patients, TVF led to a myocardial infarction. In five patients, TVF was caused by an in-stent occlusion. Non-TVR was performed in 6.7% (n=71). Non-TVR via PCI was performed for the treatment of a second CTO lesion in 27% (n=19/71). The composite MACE endpoint was significantly in favor of successful CTO-PCI (8.0% vs. 13%; p=0.035), even after adjusting for baseline differences (adjusted hazard ratio=0.59; 95%CI 0.36-0.98; p=0.041). No differences in MACE or MACE components were observed according to technical outcome and final applied technique (DR vs. non-DR techniques).
The use of the hybrid algorithm and contemporary techniques by moderate to highly experienced operators for CTO treatment is safe and is associated with a low one-year event rate. Successful procedures are associated with better a MACE rate. DR techniques can be used as first-line strategies alongside intimal wiring techniques.
CORONARY: PCI Outcomes