LB-4
Contemporary In-Hospital Outcomes and Temporal Trends of Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the PROGRESS-CTO International Registry
Presenter
Spyridon Kostantinis, MD, Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN
Spyridon Kostantinis, MD1, Bahadir Simsek, MD1, Judit Karacsonyi, MD, PhD1, Khaldoon Alaswad, M.D., FSCAI2, Oleg Krestyaninov, M.D.3, Dmitrii Khelimskii, M.D.4, Dimitrios Karmpaliotis, M.D., FSCAI5, Farouc A. Jaffer, M.D., Ph.D., FSCAI6, Jaikirshan Khatri, M.D., FSCAI7, Paul Poommipanit, M.D., FSCAI8, James W. Choi, M.D., FSCAI9, Wissam A Jaber, M.D., FSCAI10, Stéphane Rinfret, M.D., FSCAI11, William J. Nicholson, M.D.12, Mitul P. Patel, M.D., FSCAI13, Ehtisham Mahmud, M.D., MSCAI14, Philip Dattilo, M.D.15, Şevket Görgülü, MD16, Michail Koutouzis, M.D., Ph.D.17, Ioannis Tsiafoutis, M.D.17, Basem Elbarouni, M.B.B.S.18, Abdul M. Sheikh, MD19, Barry F. Uretsky, M.D., MSCAI20, Ahmed Elguindy, MD21, Brian Keith Jefferson, MD, FSCAI22, Taral Patel, M.D.23, Jason R. Wollmuth, MD, FSCAI24, Robert F. Riley, M.D., FSCAI25, Stewart M. Benton Jr., M.D.26, Rhian E. Davies, DO MS, FSCAI27, Raj H. Chandwaney, M.D., FSCAI28, Catalin Toma, M.D.29, Robert W. Yeh, M.D., FSCAI30, Daniel Schimmel, MD, FSCAI31, Nidal Abi Rafeh, MD32, Ömer Göktekin, MD33, Dr. Jimmy L Kerrigan, M.D., FACC, FSCAI34, M. Nicholas Burke, M.D.1, Olga C Mastrodemos, BA35, Bavana V Rangan, BDS, MPH35 and Emmanouil S. Brilakis, MD, PhD, FSCAI1, (1)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN, (2)Henry Ford Hospital, Detroit, MI, (3)Federal State Institution Academician E.N.Meshalkin, Novosibirsk, Novosibirskaya oblast, Russian Federation, (4)Meshalkin Novosibrisk Research Institute, Novosibirsk, Russian Federation, (5)Atlantic Health Morristown Medical Center, Morristown , NJ, (6)Massachusetts General Hospital, Boston, MA, (7)Cleveland Clinic Main Campus, Cleveland, OH, (8)University Hospitals Cleveland Medical Center, Beachwood, OH, (9)Texas Health Heart and Vascular Specialists: Presbyterian Hospital, Dallas, TX, (10)Emory University Hospital, Atlanta, GA, (11)Georgia Heart Institute, Atlanta, GA, (12)Emory HealthCare, York, PA, (13)Intermountain Healthcare, Salt Lake City, UT, (14)The University of California, San Diego, La Jolla, CA, (15)University of Colorado Health Harmony, Fort Collins, CO, (16)Department Cardiology, Acibadem Kocaeli Hospital, Kocaeli, Turkey, Kadıköy/İstanbul, Turkey, (17)Hellenic Red Cross Hospital of Athens, Athens, Greece, (18)St. Boniface General Hospital, Winnipeg, MB, Canada, (19)Wellstar Health System, Marietta, GA, (20)University of Arkansas for Medical Sciences, Fort Smith, AR, (21)Magdi Yacoub Hospital, Cairo, Egypt, (22)TriStar Centennial Medical Center, Nashville, TN, (23)Centennial Heart, LLC, Nashville, TN, (24)Providence Heart & Vascular, Portland, OR, (25)Overlake Medical Center, Sammamish, WA, (26)WellSpan Health, York, PA, (27)WellSpan Cardiology - York, York, PA, (28)Oklahoma Heart Institute, Tulsa, OK, (29)University of Pittsburgh Medical Center, Pittsburgh, PA, (30)Beth Israel Deaconess Medical Center, Boston, MA, (31)Northwestern Memorial Hospital, Chicago, IL, (32)North Oaks Health System, Hammond, LA, (33)Memorial Bahcelievler Hospital, Istanbul, Turkey, (34)Ascension Saint Thomas Heart, Nashville, TN, (35)Minneapolis Heart Institute Foundation, Minneapolis, MN
Keywords: Chronic Total Occlusion (CTO), Complex and High-risk Coronary Intervention (CHIP) and Coronary
Background
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been rapidly evolving.
Methods
We examined the clinical and angiographic characteristics and procedural outcomes of 10,249 CTO PCIs performed in 10,019 patients at 40 US and non-US centers between 2012 and 2022.
Results
Mean age was 64±10 years and 81% of the patients were men. The prevalence of prior PCI (62%), prior coronary artery bypass graft surgery (29%), and diabetes mellitus (43%) was high. The most common target vessel was the right coronary artery (53%), followed by the left anterior descending artery (26%) and left circumflex artery (19%). The target CTOs were highly complex with mean J-CTO score of 2.4 ±1.3 and PROGRESS-CTO score of 1.3 ±1.0. Technical success was high (86%) and increased over time, from 81.6% in 2016 to 88.1% in 2021 (p for trend<0.0001). The overall incidence of in-hospital major adverse cardiac events (MACE) was 2.1% without significant changes over time (p for trend =0.194). The final successful crossing strategy was antegrade wire escalation in 55%, retrograde in 19%, and antegrade dissection re-entry in 12%, with greater antegrade wire escalation success over time. Median contrast volume, air kerma radiation dose, and procedural and fluoroscopy duration decreased over time.
Conclusions
The success and efficiency of CTO PCI has been increasing in recent years without change in MACE. 