Utilization of the hybrid approach for percutaneous coronary interventions for chronic total occlusions: Update from a multicenter global registry
Tajti P, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh R, Patel M, Mahmud E, Choi J, Burke N, Doing A, Toma C, Uretsky B, Holper E, Wyman RM, Lombardi W, Kandzari D, Lembo N, Garcia S, Krestyaninov O, Khelimskii D, Koutouzis M, Tsiafoutis I, Moses J, Kirtane AJ, Parikh M, Ali Z, Hatem R, Karatasakis A, Karacsonyi J, Danek BA, Rangan B, Brilakis E. Utilization of the hybrid approach for percutaneous coronary interventions for chronic total occlusions: Update from a multicenter global registry. J Am Coll Cardiol. 2017;70(18):B207.
J Am Coll Cardiol
BACKGROUND We sought to examine thecontemporary outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCI). METHODS We examined the clinical, angiographic and procedural characteristics of 2,733 CTO interventions of 2677 patients that were performed in 18 centers from the United States and Europe. RESULTS Mean age was 65±10 years and 85% of thepatients were men. There was a high prevalence ofdiabetes (44%), prior myocardial infarction (46%), prior coronary artery bypass surgery (33%), and prior PCI (66%). The most common target vessels were theright coronary artery (55%), left anterior descending artery (24%), and left circumflex artery (20%). Themean J-CTO and PROGRESS-CTO score was 2.5±1.3 and 1.4±1.0, respectively. The overall technical and procedural success rate was 88% and 86% respectively and the rate of in-hospital major complications was 2.9%. The initial crossing strategy was successful in 55% (Figure). The final successful crossing strategy was antegrade wire escalation in 50%, retrograde in 28%, and antegrade dissection reentry in 22%. Median contrast volume, air kerma radiation dose, procedure and fluoroscopy time were 270 (200-365) ml, 2.9 (1.7-4.8) Gray, 125 (82-191) and 46 (29-76) minutes, respectively. CONCLUSION Application of the hybrid approach for CTO PCI is associated with high technical success and low major adverse complication rates among various operators and patient populations. (Figure presented).