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October 1, 2018Circulation Cardiovascular Interventions

Temporal Trends in Chronic Total Occlusion Interventions in Europe

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Key result

Procedural success for chronic total occlusion percutaneous coronary intervention increased from 79.7% in 2008 to 89.3% in 2015, with in-hospital mortality decreasing from 0.4% to 0.1% (P<0.001).

Population

17,626 procedures for chronic total occlusion percutaneous coronary intervention enrolled in the European…

Design

Cohort

Follow-up

in-hospital

Authors

NKN. KonstantinidisGWGerald S. WernerSDSpyridon Deftereos

Discussion

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Overview

CTO PCI success rose over 7 years in this registry; supports technique evolution but leaves open causal factors and practice change.

Key Points

  • To evaluate temporal trends in procedural practice, procedural success rates, and in-hospital complications among patients undergoing chronic total occlusion percutaneous coronary intervention.
  • Analyzed prospective data from 17,626 chronic total occlusion percutaneous coronary intervention procedures enrolled in the European Registry of Chronic Total Occlusion between January 2008 and June 2015.
  • Tracked trends over time in lesion complexity (measured via the J-CTO score), revascularization strategies (antegrade vs. retrograde approaches), success rates, and adverse in-hospital events.
  • Procedural success significantly increased from 79.7% in 2008 to 89.3% in 2015, despite a concurrent rise in lesion complexity (mean J-CTO score increased from 1.76±1.03 to 2.17±0.91; P for trend < 0.001).
  • In-hospital mortality declined from 0.4% to 0.1% (P for trend < 0.001), while overall in-hospital complication rates remained stable between 4.4% and 5.2% (P for trend = 0.390).
  • Utilization of the retrograde approach grew from 10.1% to 29.9% (P for trend < 0.001), whereas the J-CTO score showed low predictive value overall and no predictive capacity for retrograde procedures.

Study Design

Type

Observational (n=17,626)

Multicenter

Yes

Structured PICO

P
Population
17,626 chronic total occlusion percutaneous coronary intervention procedures from a European registry between 2008 and 2015.
E
Exposure
Chronic total occlusion percutaneous coronary intervention (CTO PCI) between January 2008 and June 2015
O
Outcome
Procedural success, in-hospital mortality, and in-hospital complications

Main Result

Absolute Event Rate: 89.3% vs 79.7%

CTO PCI in Europe has shown increasing procedural success and decreasing in-hospital mortality over time despite increasing lesion complexity.

Cite This Study

Konstantinidis et al. (2018) conducted an observational in Chronic total occlusion (n=17,626). Chronic total occlusion percutaneous coronary intervention vs. Earlier time period (2008) was evaluated on Procedural success. Procedural success for chronic total occlusion percutaneous coronary intervention increased from 79.7% in 2008 to 89.3% in 2015, with in-hospital mortality decreasing from 0.4% to 0.1% (P<0.001).

synapsesocial.com/papers/6a937efbbda3c58f3b452a52https://doi.org/10.1161/circinterventions.117.006229
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Japanese multicenter registry evaluating the retrograde approach for chronic coronary total occlusion2013 · 103 citations
  2. 2Clinical Utility of the Japan–Chronic Total Occlusion Score in Coronary Chronic Total Occlusion Interventions2015 · 121 citations
  3. 3Current Perspectives on Coronary Chronic Total Occlusions2012 · 814 citations
  4. 4Clinical Impact of Intravascular Ultrasound–Guided Chronic Total Occlusion Intervention With Zotarolimus-Eluting Versus Biolimus-Eluting Stent Implantation2015 · 308 citations