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Current Perspectives and Practices on Chronic Total Occlusion Percutaneous Coronary Interventions
Siddharth M Patel, Rohan V Menon, M Nicolas Burke
1Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA. esbrilakis@gmail.com.
Insights
Most cardiologists recognize the benefits of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), viewing it as beneficial for patient symptoms and survival. Interventional cardiologists generally hold a more positive outlook on CTO-PCI outcomes and success rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Interventions
Background:
- The frequency and success rates of chronic total occlusion percutaneous coronary intervention (CTO-PCI) have been increasing.
- CTO-PCI is a complex procedure addressing significant coronary artery disease.
Purpose of the Study:
- To examine current perspectives and practices regarding CTO-PCI among cardiologists.
- To understand the perceived benefits, success rates, and barriers associated with CTO-PCI.
Main Methods:
- An online questionnaire was distributed to cardiologists globally.
- 1149 responses were collected, with a majority from the United States.
- Respondents included interventional and non-interventional cardiologists with varying years of practice.
Main Results:
- A high percentage of cardiologists believe CTO-PCI improves patient symptoms, left ventricular function, and survival.
- Interventional cardiologists reported more favorable views on CTO-PCI benefits and success rates compared to non-interventionalists.
- Procedural success was estimated between 51%-85% by most respondents, with perforation, mortality, and tamponade as key concerns.
Conclusions:
- Cardiologists widely acknowledge the clinical benefits of CTO-PCI, anticipating moderate to high success rates.
- A disparity exists in perception, with interventional cardiologists showing a more optimistic view of CTO-PCI compared to their non-interventional colleagues.
- Procedural time and complexity are identified as primary obstacles to establishing CTO-PCI programs.
Objectives:
We sought to examine contemporary perspectives and practices on chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Background:
The frequency and success of CTO-PCI have been increasing in recent years.
Methods:
An online questionnaire was created and distributed to cardiologists within the United States and internationally.
Results:
A total of 1149 responses were obtained. The United States (n = 845; 73.5%), Asia (n = 98; 8.5%), Europe (n = 88; 7.7%), South America (n = 42; 3.7%), and Canada (n = 33; 2.9%) accounted for most responses. Mean practice duration of the respondents was 16.4 ± 11.5 years and 66.9% were interventional cardiologists. Most respondents agreed that CTO-PCI results in an improvement of patient symptoms (90.7%), left ventricular function (79.3%), arrhythmia risk (69.2%), and overall survival (63.1%). Interventional cardiologists had a more favorable view of the benefits of CTO-PCI as compared with non-interventional cardiologists (P<.001). Most respondents estimated the procedural success rates of contemporary CTO-PCI to be between 51%-75% (34.2%) and 76%-85% (30.2%), with interventional cardiologists estimating higher success rates than non-interventionalists (P<.001). Perforation, mortality, and tamponade were the three most concerning complications. Time and procedure complexity were reported to be the most significant barriers to the development of a CTO-PCI program.
Conclusions:
Most cardiologists believe that CTO-PCI can provide significant clinical benefits and can be accomplished with moderate to high success rates. Interventional cardiologists have a more favorable view of CTO-PCI as compared with non-invasive cardiologists.