Temporal Trends in Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the PROGRESS-CTO Registry
Xenogiannis I, Vemmou E, Gkargkoulas F, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh R, Patel M, Mahmud E, Megaly M, Nikolakopoulos I, Morley P, Choi J, Garcia S, Doing A, Toma C, Uretsky B, Krestyaninov O, Khelimskii D, Moses JW, Lembo N, Parikh M, Kirtane AJ, Ali Z, Russo J, Karatasakis A, Danek B, Rangan B, Abdullah S, Banerjee S, and Brilakis E. Temporal Trends in Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the PROGRESS-CTO Registry. J Am Coll Cardiol 2019; 74(13):B219.
J Am Coll Cardiol
Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly evolved in recent years. Methods: We compared the clinical, angiographic, and technical characteristics and procedural outcomes of CTO PCI in a multicenter registry between the “early era” (2012 to 2016, 1,986 CTO PCIs) and the “current era” (2017 to 2019, 1,675 CTO PCIs). Results: As compared with “early era” patients, “current era” patients more often had class III or IV angina (71% vs. 66%; p = 0.029) and were less likely to undergo ad hoc CTO PCI (13% vs. 16%; p = 0.035). The J-CTO score was slightly higher in the “early era” (2.3 ± 1.4 vs. 2.5 ± 1.3; p = 0.035). Use of antegrade wire escalation was higher in the current era (92% vs. 83%; p < 0.001), whereas use of retrograde crossing (29% vs. 39%; p < 0.001) and antegrade/dissection re-entry (23% vs. 32%; p < 0.001) was lower. Technical (85% vs. 86%, p = 0.687) and procedural (83% vs. 85%, p = 0.151) success rates were similar, whereas the incidence of in-hospital major cardiovascular events (MACE) was lower in the “current era” (2% vs. 3%; p = 0.037) (Figure). Procedure time (105 min [67, 164 min] vs. 136 min [91, 203 min]; p < 0.001), contrast volume (225 ml [164, 300 ml] vs. 280 ml [200, 370 ml]; p < 0.001), and air kerma radiation dose (2.4 Gy [1.3, 4.1 Gy] vs. 2.8 Gy [1.7, 4.5 Gy]; p < 0.001) were lower during the “current era” (Figure). [Figure presented] Conclusion: During recent years, the complexity of CTO PCI attempted lesions decreased and ad hoc CTO PCI decreased, along with lower use of retrograde crossing and antegrade dissection and re-entry. Technical and procedural success rates remained stable, whereas the incidence of in-hospital MACE decreased. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)