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Multicenter Study
. 2015 Jun 9;65(22):2388-400.
doi: 10.1016/j.jacc.2015.03.566.

Retrograde Recanalization of Chronic Total Occlusions in Europe: Procedural, In-Hospital, and Long-Term Outcomes From the Multicenter ERCTO Registry

Alfredo R Galassi  1 , Georgios Sianos  2 , Gerald S Werner  3 , Javier Escaned  4 , Salvatore D Tomasello  5 , Marouane Boukhris  6 , Marine Castaing  5 , Joachim H Büttner  7 , Alexander Bufe  8 , Artis Kalnins  9 , James C Spratt  10 , Roberto Garbo  11 , David Hildick-Smith  12 , Simon Elhadad  13 , Andrea Gagnor  14 , Bernward Lauer  15 , Leszek Bryniarski  16 , Evald H Christiansen  17 , Leif Thuesen  17 , Markus Meyer-Geßner  18 , Omer Goktekin  19 , Mauro Carlino  20 , Yves Louvard  21 , Thierry Lefèvre  21 , Aigars Lismanis  22 , Valery L Gelev  23 , Antonio Serra  24 , Francesco Marzà  5 , Carlo Di Mario  25 , Nicolaus Reifart  26 ; Euro CTO Club
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Free article
Multicenter Study

Retrograde Recanalization of Chronic Total Occlusions in Europe: Procedural, In-Hospital, and Long-Term Outcomes From the Multicenter ERCTO Registry

Alfredo R Galassi et al. J Am Coll Cardiol. .
Free article

Abstract

Background: A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs).

Objectives: The authors describe the European experience with and outcomes of retrograde PCI revascularization for coronary CTOs.

Methods: Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization.

Results: The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up.

Conclusions: The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.

Keywords: J-CTO score; chronic total occlusions; retrograde PCI revascularization.

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