Geographic diversity in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO registry
Recommended Citation
Alexandrou M, Rempakos A, Mutlu D, Al Ogaili A, Choi JW, Poommipanit P, Alaswad K, Basir MB, Davies R, Jaffer FA, Chandwaney RH, Azzalini L, Aygul N, ElGuindy AM, Jefferson BK, Gorgulu S, Khatri JJ, Krestyaninov O, Khelimskii D, Frizzell J, Elbarouni B, Goktekin O, McEntegart MB, Rangan BV, Mastrodemos OC, Burke MN, Sandoval Y, and Brilakis ES. Geographic diversity in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO registry. J Invasive Cardiol 2024.
Document Type
Article
Publication Date
9-1-2024
Publication Title
The Journal of invasive cardiology
Abstract
BACKGROUND: There is variability in clinical and lesion characteristics as well as techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
METHODS: We analyzed patient and lesion characteristics, techniques, and outcomes in 11 503 CTO-PCI procedures performed in North America (NA) and in the combined regions of Europe, Asia, and Africa from 2017 to 2023 as documented in the PROGRESS-CTO registry.
RESULTS: Eight thousand four hundred seventy-nine (74%) procedures were performed in NA. Compared with non-NA patients, NA patients were older, with higher body mass index and higher prevalence of diabetes, hypertension, dyslipidemia, family history of coronary artery disease, prior history of PCI, coronary artery bypass graft surgery and heart failure, cerebrovascular disease, and peripheral arterial disease. Their CTOs were more complex, with higher J-CTO (2.56 ± 1.22 vs 1.81 ± 1.24; P less than .001) and PROGRESS-CTO (1.29 ± 1.01 vs 1.07 ± 0.95; P less than .001) scores, longer length, and higher prevalence of proximal cap ambiguity, blunt/no stump, moderate to severe calcification, and proximal tortuosity. Retrograde (31.0% vs 22.1%; P less than .001) and antegrade dissection and re-entry (ADR) (21.2% vs 9.2%; P less than .001) were more commonly used in NA centers, along with intravascular ultrasound (69.0% vs 10.1%; P less than .001). Procedure and fluoroscopy times were longer in NA, while contrast volume and radiation dose were lower. Technical (86.7% vs 86.8%; P > .90) and procedural (85.4% vs 85.8%; P = .70) success and in-hospital major adverse cardiovascular events (MACE) (1.9% vs 1.7%; P = .40) were similar in NA and non-NA centers.
CONCLUSIONS: Compared with non-NA patients, NA patients undergoing CTO PCI have more comorbidities, higher CTO lesion complexity, are more likely to undergo treatment with retrograde and ADR, and have similar technical success and MACE.
Medical Subject Headings
Humans; Coronary Occlusion; Percutaneous Coronary Intervention; Registries; Male; Female; Chronic Disease; Aged; Middle Aged; Coronary Angiography; Treatment Outcome; Coronary Vessels; North America
PubMed ID
38776473
ePublication
ePub ahead of print
Volume
36
Issue
9
