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Temporal trends in chronic total occlusion interventions in Europe: 17626 procedures from the European Registry of Chronic total occlusion

  • Autori: Konstantinidis N.V.; Werner G.S.; Deftereos S.; Di Mario C.; Galassi A.R.; Buettner J.H.; Avran A.; Reifart N.; Goktekin O.; Garbo R.; Bufe A.; Mashayekhi K.; Boudou N.; Meyer-Gessner M.; Lauer B.; Elhadad S.; Christiansen E.H.; Escaned J.; Hildick-Smith D.; Carlino M.; Louvard Y.; Lefevre T.; Angelis L.; Giannopoulos G.; Sianos G.
  • Anno di pubblicazione: 2018
  • Tipologia: Articolo in rivista
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BACKGROUND: The study focuses on the evolution of practice, procedural outcomes, and in-hospital complications of chronic total occlusion percutaneous coronary intervention in Europe. METHODS AND RESULTS: Data from 17 626 procedures enrolled in European Registry of Chronic Total Occlusion between January 2008 and June 2015 were assessed. The mean patient age was 63.9±10.9 years; 85% were men. Procedural success increased from 79.7% to 89.3% through the study period. Patients enrolled during the years had increasing comorbidities and lesion complexity (J-CTO score [Multicenter CTO Registry of Japan] increased from 1.76±1.03 in 2008 to 2.17±0.91 in 2015; P for trend, <0.001). Retrograde approach utilization steadily increased from 10.1% in 2008 to 29.9% in 2015 (P for trend, <0.001). Antegrade dissection reentry adoption was low, not exceeding 5.5%. In-hospital mortality decreased during the study period from 0.4% to 0.1% (P for trend, <0.001), whereas in-hospital complication rates remained essentially unchanged, in the range 4.4% to 5.2% (P for trend, 0.390). CONCLUSIONS: Chronic total occlusion percutaneous coronary intervention has shown a steady increase in procedural success rate over time, with unchanged complication rates, despite the increasing complexity of the lesions attempted. The J-CTO score predictive value for procedural success was low for the entire registry and had no predictive ability for the retrograde approach.