Giuseppe Vadalà; Alfredo R. Galassi; Gerald S. Werner; George Sianos; Nicolaus Boudou; Roberto Garbo; Laura Maniscalco; Alexander Bufe; Alexander Avran; Gabriele L. Gasparini; Eugenio La Scala; Andrew Ladwiniec; Meruzhan Saghatelyan; Omer Goktekin; Sevket Gorgulu; Nicolaus Reifart; Pierfrancesco Agostoni; Sudhir Rathore; Mohamed Ayoub; Michael Behnes; Iskander Atmowihardjo; Mario Iannaccone; Roberto Diletti; Carlo Di Mario; Kambis Mashayekhi; on behalf of the EURO CTO investigators

doi:10.4244/EIJ-D-23-00490

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

The reference multimedia journal in interventional cardiology

Original Research

DOI: 10.4244/EIJ-D-23-00490

Contemporary outcomes of chronic total occlusion percutaneous coronary intervention in Europe: the ERCTO registry

Giuseppe Vadalà¹, MD; Alfredo R. Galassi², MD; Gerald S. Werner³, MD, PhD; George Sianos⁴, MD; Nicolaus Boudou⁵, MD; Roberto Garbo⁶, MD; Laura Maniscalco¹, PhD; Alexander Bufe⁷, MD; Alexander Avran⁸, MD; Gabriele L. Gasparini⁹, MD; Eugenio La Scala¹⁰, MD; Andrew Ladwiniec¹¹, MD; Meruzhan Saghatelyan¹², MD; Omer Goktekin¹³, MD, PhD; Sevket Gorgulu¹⁴, MD; Nicolaus Reifart¹⁵, MD, PhD; Pierfrancesco Agostoni¹⁶, MD; Sudhir Rathore¹⁷, MD; Mohamed Ayoub¹⁸, MD; Michael Behnes¹⁹, MD; Iskander Atmowihardjo²⁰, MD; Mario Iannaccone²¹, MD; Roberto Diletti²², MD; Carlo Di Mario²³, MD, PhD; Kambis Mashayekhi²⁴^,²⁵, MD, PhD; on behalf of the EURO CTO investigators

1. Division of Cardiology, University Hospital “P. Giaccone”, Palermo, Italy; 2. Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy; 3. Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany; 4. Al Qassimi Hospital, Sharjah, United Arab Emirates; 5. Clinique St Augustin, Bordeaux, France; 6. Maria Pia Hospital, GVM Care & Research, Turin, Italy; 7. Helios Klinikum Krefeld, University Witten/Herdecke, Witten, Germany; 8. Centre Hospitalier de Valenciennes, Valenciennes, France; 9. Humanitas Research Hospital, IRCSS, Rozzano, Italy; 10. Polyclinique Les Fleurs, Ollioules, France; 11. Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; 12. Erebouni Medical Center, Yerevan, Armenia and Nork-Marash Medical Center (NMMC), Yerevan, Armenia; 13. Memorial Bahçelievler Hospital, Istanbul, Turkey; 14. Department of Cardiology, Acibadem University Istanbul, Istanbul, Turkey; 15. Goethe-Universität Frankfurt, Frankfurt am Main, Germany; 16. Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; 17. Frimley Park Hospital, NHS Foundation Trust, Camberley, United Kingdom; 18. University Heart Center NRW, Bad Oeynhausen, Germany; 19. University Medical Centre Mannheim, Mannheim, Germany; 20. Department of Cardiology and Angiology, DRK Kliniken Berlin Köpenick, Berlin, Germany; 21. San Giovanni Bosco Hospital, ASL Città Torino, Turin, Italy; 22. Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands; 23. Department of Clinical & Experimental Medicine, Structural Interventional Cardiology Division, Careggi University Hospital, Florence, Italy; 24. Department of Cardiology and Angiology, University Heart Center, University Freiburg, Freiburg, Germany; 25. Department of Internal Medicine and Cardiology, Heart Center Lahr, Lahr, Germany

Abstract

BACKGROUND: Percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) have reached high procedural success rates thanks to dedicated equipment, evolving techniques, and worldwide adoption of state-of-the-art crossing algorithms.

AIMS: We report the contemporary results of CTO PCIs performed by a large European community of experienced interventionalists. Furthermore, we investigated the impact of different risk factors for procedural major adverse cardiac and cerebrovascular events (MACCE) and trends of employment of specific devices like dual lumen microcatheters, guiding catheter extensions, intravascular ultrasound and calcium-modifying tools.

METHODS: We evaluated data from 8,673 CTO PCIs included in the European Registry of Chronic Total Occlusion (ERCTO) between January 2021 and October 2022.

RESULTS: The overall technical success rate was 89.1% and was higher in antegrade as compared with retrograde cases (92.8% vs 79.3%; p<0.001). Compared with antegrade procedures, retrograde procedures had a higher complexity of attempted lesions (Japanese CTO [J-CTO] score: 3.0±1.0 vs 1.9±1.2; p<0.001), a higher procedural and in-hospital MACCE rate (3.1% vs 1.2%; p<0.018) and a higher perforation rate with and without tamponade (1.5% vs 0.4% and 8.3% vs 2.1%, respectively; p<0.001). As compared with mid-volume operators, high-volume operators had a higher technical success rate in antegrade and retrograde procedures (93.4% vs 91.2% and 81.5% vs 69.0%, respectively; p<0.001), and had a lower MACCE rate (1.47% vs 2.41%; p<0.001) despite a higher mean complexity of the attempted lesions (J-CTO score: 2.42±1.28 vs 2.15±1.27; p<0.001).

CONCLUSIONS: The adoption of different recanalisation techniques, operator experience and the use of specific devices have contributed to a high procedural success rate despite the high complexity of the lesions documented in the ERCTO.

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Volume 20 Number 3

Feb 5, 2024