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. 2023 Mar;31(3):117-123.
doi: 10.1007/s12471-022-01732-5. Epub 2022 Nov 29.

Improvement of angiographic and clinical outcomes of percutaneous coronary intervention for chronic total occlusion after implementation of a dedicated team: a single-centre experience

L Polimac  1 , M M C J van Leunen  1 , G J van Steenbergen  1 , J M Zelis  1 , R Eerdekens  1 , M van 't Veer  1 , D N Schulz  1 , I F Wijnbergen  1 , P J Vlaar  1 , K Teeuwen  2
Affiliations

Improvement of angiographic and clinical outcomes of percutaneous coronary intervention for chronic total occlusion after implementation of a dedicated team: a single-centre experience

L Polimac et al. Neth Heart J. 2023 Mar.

Abstract

Introduction: In a Dutch heart centre, a dedicated chronic total occlusion (CTO) team was implemented in June 2017. The aim of this study was to the evaluate treatment success and clinical outcomes before and after this implementation.

Methods: A total of 662 patients who underwent percutaneous coronary intervention (PCI) for a CTO between January 2013 and June 2020 were included and divided into pre- and post-CTO team groups. The primary endpoint was the angiographic success rate of CTO-PCI. Secondary endpoints included angiographic success stratified by complexity using the J‑CTO score and the following clinical outcomes: in-hospital complications and myocardial infarction, target vessel revascularisation, all-cause mortality, quality of life (QoL) and major adverse cardiac events (MACE) at 30-day and 1‑year follow-up.

Results: Compared with the pre-CTO team group, the success rate in the post-CTO team group was higher after the first attempt (81.4% vs 62.7%; p < 0.001) and final attempt (86.7% vs 73.8%; p = 0.001). This was mainly driven by higher success rates for difficult and very difficult CTO lesions according to the J‑CTO score. The MACE rate at 1 year was lower in the post-CTO team group than in the pre-CTO team group (6.4% vs 16.0%; p < 0.01), while it was comparable at 30-day follow-up (0.1% vs 1.7%; p = 0.74). Angina symptoms were significantly reduced at 30-day and 1‑year follow-up, and QoL scores were higher after 1 year.

Conclusion: This study demonstrated higher success rates of CTO-PCI and improved clinical outcomes and QoL at 1‑year follow-up after implementation of a dedicated CTO team using the hybrid algorithm.

Keywords: Chronic total occlusion; Hybrid algorithm; Percutaneous coronary intervention.

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Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion. a Seven patients were included in both groups. b One patient underwent two percutaneous coronary interventions (PCIs) for chronic total occlusion (CTO) procedures in the post–CTO team group for the same lesion
Fig. 2
Fig. 2
Angiographic success of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in pre–CTO team and post–CTO team groups. a Success rates after first and final attempts. b Success rates after first attempt stratified by Multicentre CTO Registry of Japan (J‑CTO) score. c Success rates after final attempt stratified by J‑CTO score. Values are percentages of total number of procedures performed. aindicates p ≤ 0.001
Fig. 3
Fig. 3
Major adverse cardiac event (MACE)–free survival after percutaneous coronary intervention (PCI) for chronic total occlusion in pre–CTO team and post–CTO team groups up to 1 year of follow-up
See this image and copyright information in PMC

References

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