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Impact of adherence to the hybrid algorithm for initial crossing strategy selection in chronic total occlusion
Iosif Xenogiannis1, Khaldoon Alaswad2, Oleg Krestyaninov3
1Coronary Artery Disease Science Center, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States.
Insights
Adhering to the hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary interventions (PCI) improves initial crossing strategy success. This adherence leads to better overall technical success without increasing adverse events in CTO PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- The hybrid algorithm guides strategy selection for chronic total occlusion (CTO) percutaneous coronary interventions (PCIs).
- Limited data exists on the success rates of initial strategies chosen based on the hybrid algorithm.
Purpose of the Study:
- To evaluate the impact of adherence to the hybrid algorithm's initial crossing strategy recommendation on CTO PCI outcomes.
- To assess the relationship between hybrid algorithm adherence and technical success, as well as major adverse cardiac events.
Main Methods:
- A multicenter registry analysis of 4178 CTO PCIs was performed.
- The study compared outcomes between interventions where the initial crossing strategy adhered to the hybrid algorithm versus those that did not.
- Multivariable analysis adjusted for key patient and procedural characteristics.
Main Results:
- Only 44% of CTO PCIs adhered to the hybrid algorithm's initial strategy recommendation.
- Adherence was associated with a lower J-CTO score and significantly higher technical success for both the first crossing strategy (68% vs. 48%) and overall (88% vs. 83%).
- Nonadherence was independently linked to lower initial crossing success (OR, 0.55; P < .01), with no significant difference in in-hospital major adverse events.
Conclusions:
- Adherence to the hybrid algorithm for initial crossing strategy selection in CTO PCI is associated with improved technical success.
- The hybrid algorithm's guidance for initial strategy selection does not appear to increase the risk of in-hospital major adverse cardiac events.
Introduction And Objectives:
The hybrid algorithm was designed to assist with initial and subsequent crossing strategy selection in chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). However, the success of the initially selected strategy has received limited study.
Methods:
We examined the impact of adherence to the hybrid algorithm recommendation for initial CTO crossing technique selection in 4178 CTO PCIs from a large multicenter registry.
Results:
The initial crossing strategy was concordant with the hybrid algorithm recommendation in 1833 interventions (44%). Patients in the concordant group had a similar age to those in the discordant group but a lower mean J-CTO score (2.0 ± 1.4 vs 2.8 ± 1.1; P < .01). The concordant group showed higher technical success with the first crossing strategy (68% vs 48%; P < .01) and higher overall technical success (88% vs 83%; P < .01) with no difference in the incidence of in-hospital major adverse events (1.8% vs 2.3%; P = .26). In multivariable analysis, after adjustment for age, prior myocardial infarction, prior PCI, prior coronary artery bypass grafting, J-CTO score, and scheduled CTO PCI, nonadherence to the hybrid algorithm was independently associated with lower technical success of the initial crossing strategy (odds ratio, 0.55; 95% confidence interval, 0.48-0.64; P < .01).
Conclusions:
Adherence to the hybrid algorithm for initial crossing strategy selection is associated with higher CTO PCI success but similar in-hospital major adverse cardiac events.
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