The Outcome of Coronary Chronic Total Occlusion Patients Treated with Percutaneous Coronary Intervention
Results from the Registry of Israeli CTO Collaboration
2Department of Cardiology, Carmel Medical Center, Israel
3Department of Cardiology, Shaare Zedek Medical Center, Israel
4Department of Cardiology, Hadassa Medical Center, Israel
5Department of Cardiology, Meir Medical Center, Israel
6Department of Cardiology, Assuta Ashdod Medical Center, Israel
7Department of Cardiology, Rabin Medical Center, Israel
8Department of Cardiology, Rabin Medical Center Campus Golda Hasharon, Israel
9Department of Cardiology, Hillel Yaffe Medical Center, Israel
10Department of Cardiology, Rambam Medical Center, Israel
11Department of Cardiology, B Padeh Medical Center, Israel
12Department of Cardiology, Assaf-Harofeh Medical Center, Israel
Introduction
Coronary chronic total coronary occlusions (CTO) are common and mostly treated medically due to the traditionally low success rate and high risk of percutaneous intervention (PCI). The application of a hybrid algorithm enabled operators to gain experience and improve procedural success.
Materials and methods
Registry of Israeli CTO Collaboration currently includes 12 centers. Data was collected prospectively since 1/1/2021 while cases performed between 2018-2020 were entered as retrospective cases. Data collection includes demographic, clinical, technical, and follow-up data.
Results
Currently, 185 CTO procedures were reported in 172 patients. The mean age is 63.7±12.13 years and 89.2% are male, 49% had diabetes and 12% had renal dysfunction. Ischemic heart disease was prevalent with prior myocardial infarction in 62%, prior PCI 73%, and bypass surgery in 17%. The clinical presentation was most commonly chronic angina symptoms in 57%, mean ejection fraction was 47±12%. The average JCTO score was
2.25±1.22 and the most frequent location of CTO in RCA (69.2%).
The overall procedure success rate was 81.1%, with an anterograde approach was implemented in 73.6%; and retrograde in 25.9%. There were 2 (1.1%) cases of tamponade, requiring urgent pericardiocentesis, without procedural mortality.
Thirty-day follow-up was reported for 136 patients, 4 (2.1%) of whom died. There were 8 (5.9%) PCI at 30-days 5 (3.7%) of which were for target vessel failure (TVF) and an additional 9 interventions (9.9%) at 1-year follow-up among 91 patients, 4 (4.4%) of which were for TVF, and 2 patients were referred for surgery.
Symptomatic improvement was significant with 83% of patients suffering CCS-II/IV at baseline, while at 30 days the rate was reduced to 32% (p<0.001).
Conclusion
CTO PCI performed according to a hybrid algorithm is feasible and effective in alleviating angina with acceptable risk even in complex CTO anatomy. Further results from the registry will be reported.
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