Single vs. multiple operators for chronic total occlusion percutaneous coronary interventions: From the PROGRESS-CTO...

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Limited data exists on the impact of multiple operators (MOs) on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) outcomes.
• CTO PCI is a complex procedure often requiring specialized techniques.

Purpose of the Study:

• To analyze the association between MOs and procedural outcomes in CTO PCI.
• To compare the complexity, procedural efficiency, and safety of CTO PCI performed by MOs versus single operators (SO).

Main Methods:

• Analysis of 9296 CTO PCIs performed between 2012 and 2021 across 37 centers.
• Comparison of procedural outcomes, including technical and procedural success rates, and major adverse complication events (MACE), between cases performed by SOs (85%) and MOs (15%).
• Assessment of procedural time, fluoroscopy time, radiation dose, and contrast volume.

Main Results:

• MO cases were associated with higher complexity scores (Japan-CTO and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention scores).
• MO cases had significantly longer procedural times, fluoroscopy times, and higher contrast volumes compared to SO cases.
• Despite increased complexity and procedural parameters, MOs and SOs demonstrated similar technical success (86%), procedural success (84% vs. 85%), and MACE rates (2.17% vs. 2.42%).

Conclusions:

• In a contemporary multicenter registry, 15% of CTO PCI cases involved MOs.
• CTO PCI performed by MOs, despite higher complexity, yielded similar technical and procedural success rates and complication risks compared to SOs.
• SO cases exhibited shorter procedural and fluoroscopy times than MO cases.