Minimalistic Hybrid Approach for the Percutaneous Treatment of Coronary Chronic Total Occlusions: Midterm Follow-Up of an International Multicenter Cohort
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Published on: November 24, 2014
Gianluca Castaldi1, Mihajlo Kovacic2, Enrico Poletti3
1Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Universitair Ziekenhuis Leuven, Leuven, Belgium.
Insights
The minimalistic hybrid approach (MHA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) shows promising midterm results. This approach is a viable alternative for expert operators, demonstrating comparable outcomes to other CTO PCI strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- The minimalistic hybrid approach (MHA) is a novel algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- While MHA reduces invasiveness and maintains acute results, midterm outcomes data were previously lacking.
- This study addresses the need for midterm clinical outcome data for the MHA in CTO PCI.
Purpose of the Study:
- To evaluate the midterm clinical outcomes of CTO PCI performed using the MHA.
- To assess the safety and efficacy of the MHA in a multicenter international cohort.
- To compare MHA outcomes with contemporary CTO PCI algorithms.
Main Methods:
- Prospective data collection and retrospective analysis of 212 patients undergoing MHA for CTO PCI across 3 European centers (February 2019 - March 2022).
- Primary endpoint: Major Adverse Cardiac Event (MACE), a composite of all-cause death, myocardial infarction, and target vessel revascularization.
- Follow-up data analyzed for midterm clinical performance.
Main Results:
- High technical success (93.9%) and procedural success (91.9%) rates were achieved.
- At a median follow-up of 677 days, the cumulative MACE incidence was 11.5%.
- Specific MACE components included all-cause death (7.4%), myocardial infarction (4.3%), and target vessel revascularization (6.5%).
Conclusions:
- The MHA demonstrates favorable midterm clinical outcomes for CTO PCI.
- MHA results are comparable to contemporary CTO PCI algorithms, suggesting its validity as an alternative approach.
- Successful MHA implementation requires experienced interventionalists familiar with its specific techniques and definitions.
Abstract:
The minimalistic hybrid approach (MHA) is a recently proposed algorithm to perform chronic total occlusion (CTO) percutaneous coronary intervention (PCI), reducing the overall invasiveness of the procedure without impacting the acute results. However, data on midterm results are lacking. This study aimed to evaluate the midterm clinical outcomes of a multicenter international cohort of CTO PCI treated according to the MHA. Data from a consecutive series of patients with a CTO who underwent PCI according to the MHA between February 2019 and March 2022 were prospectively collected in 3 European centers and retrospectively analyzed. The main outcome was the first occurrence of a major adverse cardiac event (MACE), defined as a composite outcome of all-cause death, any myocardial infarction, and target vessel revascularization, at the last follow-up available. A total of 212 patients were included. The majority of the patients were symptomatic for angina (Canadian Cardiovascular Society class 2 or 3: 63.7%) at the time of the index procedure. The mean Japanese-CTO and CASTLE scores were 2.1 ± 1.2 and 2.0 ± 1.3, respectively. Technical success (CTO open with optimal flow) was achieved in 198 patients (93.9%) and procedural success (technical success without in-hospital MACEs) in 195 (91.9%). At the last follow-up available (median 677 days), the cumulative incidence rate of MACEs was 11.5%; in particular, all-cause death was 7.4%, any myocardial infarction was 4.3%, and unplanned target vessel revascularization was 6.5%. In conclusion, the midterm results of the MHA seem to be in line with contemporary results of other CTO PCI algorithms, thus potentially validating the MHA as a valuable alternative, provided that interventionalists are already expert CTO operators and accustomed to the definitions and peculiarities of MHA.
