Temporal Trends in Chronic Total Occlusion Interventions in Europe

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Medical Device Technology

Background:

• Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is a complex procedure.
• Understanding the evolution of CTO PCI practices and outcomes is crucial for improving patient care.
• The European Registry of Chronic Total Occlusion provides valuable data on CTO PCI trends.

Purpose of the Study:

• To analyze the changes in practice, procedural outcomes, and in-hospital complications of CTO PCI in Europe.
• To assess the impact of increasing lesion complexity on CTO PCI success and safety.
• To evaluate the trends in utilization of different CTO PCI techniques, such as retrograde approach.

Main Methods:

• Analysis of data from 17,626 CTO PCI procedures from the European Registry of Chronic Total Occlusion (2008-2015).
• Assessment of procedural success rates, in-hospital complications, and mortality.
• Evaluation of patient demographics, comorbidities, and lesion complexity using the J-CTO score.
• Tracking the utilization of retrograde and antegrade dissection reentry techniques.

Main Results:

• Procedural success for CTO PCI increased significantly from 79.7% to 89.3% between 2008 and 2015.
• Patient comorbidities and lesion complexity, indicated by the J-CTO score, increased over the study period.
• Retrograde approach utilization rose from 10.1% to 29.9%, while antegrade dissection reentry remained low (≤5.5%).
• In-hospital mortality decreased from 0.4% to 0.1%, but complication rates remained stable (4.4%-5.2%).

Conclusions:

• CTO PCI has demonstrated a consistent rise in procedural success over time.
• Despite increasing lesion complexity, complication rates have remained unchanged, highlighting procedural advancements.
• The J-CTO score showed limited predictive value for procedural success, especially with the retrograde approach.