The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry

Peter Tajti; Dimitri Karmpaliotis; Khaldoon Alaswad; Farouc A. Jaffer; Robert W. Yeh; Mitul Patel; Ehtisham Mahmud; James W. Choi; M. Nicholas Burke; Anthony H. Doing; Phil Dattilo; Catalin Toma; A. J.Conrad Smith; Barry Uretsky; Elizabeth Holper; R. Michael Wyman; David E. Kandzari; Santiago Garcia; Oleg Krestyaninov; Dmitrii Khelimskii; Michalis Koutouzis; Ioannis Tsiafoutis; Jeffrey W. Moses; Nicholas J. Lembo; Manish Parikh; Ajay J. Kirtane; Ziad A. Ali; Darshan Doshi; Bavana V. Rangan; Imre Ungi; Subhash Banerjee; Emmanouil S. Brilakis

doi:10.1016/j.jcin.2018.02.036

The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry

Peter Tajti, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, James W. Choi, M. Nicholas Burke, Anthony H. Doing, Phil Dattilo, Catalin Toma, A. J.Conrad Smith, Barry Uretsky, Elizabeth Holper, R. Michael Wyman, David E. Kandzari, Santiago Garcia, Oleg Krestyaninov, Dmitrii KhelimskiiMichalis Koutouzis, Ioannis Tsiafoutis, Jeffrey W. Moses, Nicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Darshan Doshi, Bavana V. Rangan, Imre Ungi, Subhash Banerjee, Emmanouil S. Brilakis

Medicine - Veteran's Administration Medical Center

Research output: Contribution to journal › Article › peer-review

164 Scopus citations

Abstract

Objectives: The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents. Background: CTO PCI has been evolving with constant improvement of equipment and techniques. Methods: Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patients at 20 centers in the United States, Europe, and Russia. Results: The mean age was 65 ± 10 years, and 85% of the patients were men, with high prevalence of diabetes (43%), prior myocardial infarction (46%), prior coronary artery bypass graft surgery (33%), and prior PCI (65%). The CTO target vessels were the right coronary artery (55%), left anterior descending coronary artery (24%), and left circumflex coronary artery (20%). The mean J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores were 2.4 ± 1.3 and 1.3 ± 1.0, respectively. The overall technical and procedural success rate was 87% and 85%, respectively, and the rate of in-hospital major complications was 3.0%. The final successful crossing strategy was antegrade wire escalation in 52.0%, retrograde in 27.1%, and antegrade dissection re-entry in 20.9%; >1 crossing strategy was required in 40.9%. Median contrast volume, air kerma radiation dose, and procedure and fluoroscopy time were 270 ml (interquartile range: 200 to 360 ml), 2.9 Gy (interquartile range: 1.7 to 4.7 Gy), 123 min (interquartile range: 81 to 188 min) and 47 min (interquartile range: 29 to 77 min), respectively. Conclusions: CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the United States, Europe, and Russia.

Original language	English (US)
Pages (from-to)	1325-1335
Number of pages	11
Journal	JACC: Cardiovascular Interventions
Volume	11
Issue number	14
DOIs	https://doi.org/10.1016/j.jcin.2018.02.036
State	Published - Jul 23 2018

Bibliographical note

Funding Information:
The PROGRESS CTO registry has received support from the Abbott Northwestern Hospital Foundation. Dr. Karmpaliotis has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Dr. Alaswad has received consulting fees from Terumo and Boston Scientific and is a consultant (without financial remuneration) for Abbott Laboratories. Dr. Jaffer is a consultant for Abbott Vascular and Boston Scientific and has received research grants from Canon, Siemens, and the National Institutes of Health. Dr. Yeh has received a Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr. Patel is a member of the Speakers Bureau for AstraZeneca. Dr. Mahmud has received consulting fees from Medtronic and Corindus; speaking fees from Medtronic, Corindus, and Abbott Vascular; educational program fees from Abbott Vascular; and clinical events committee fees from St. Jude Medical. Dr. Burke has received consulting and speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Wyman has received honoraria and consulting and speaking fees from Boston Scientific, Abbott Vascular, and Asahi Intecc USA, Inc. Dr. Kandzari has received research and grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular and research and grant support from Abbott Vascular. Dr. Garcia has received consulting fees from Medtronic. Dr. Moses is a consultant to Boston Scientific and Abiomed. Dr. Lembo is a member of the Speakers Bureau for Medtronic and advisory boards for Abbott Vascular and Medtronic. Dr. Parikh is a member of the Speakers Bureaus for Abbot Vascular, Medtronic, Cardiovascular Systems Inc., Boston Scientific, and Trireme and advisory boards for Medtronic, Abbott Vascular, and Philips. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, GlaxoSmithKline, and Eli Lilly. Dr. Ali has received consulting fees and honoraria from St. Jude Medical and AstraZeneca Pharmaceuticals; has ownership interest, partnership, or principal interest in Shockwave Medical and VitaBx; and has received research grants from Medtronic and St. Jude Medical. Dr. Rangan has received research grants from InfraReDx and Spectranetics. Dr. Banerjee has received research grants from Gilead and The Medicines Company; has received consulting and speaking honoraria from Covidien and Medtronic; has ownership in MDCARE Global (spouse); and has intellectual property in HygeiaTel. Dr. Brilakis has received consulting and speaking honoraria from Abbott Vascular, ACIST Medical Systems, Amgen, Asahi Intecc USA, Inc., Cardiovascular Systems Inc., Elsevier, GE Healthcare, Medicure, Medtronic, and Nitiloop; has received research support from Boston Scientific and Osprey; is a member of the board of directors of Cardiovascular Innovations Foundation; and is a member of the board of trustees of the Society of Cardiovascular Angiography and Interventions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2018 American College of Cardiology Foundation

Keywords

chronic total occlusion
outcomes
percutaneous coronary intervention
techniques

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Tajti, P., Karmpaliotis, D., Alaswad, K., Jaffer, F. A., Yeh, R. W., Patel, M., Mahmud, E., Choi, J. W., Burke, M. N., Doing, A. H., Dattilo, P., Toma, C., Smith, A. J. C., Uretsky, B., Holper, E., Wyman, R. M., Kandzari, D. E., Garcia, S., Krestyaninov, O., ... Brilakis, E. S. (2018). The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry. JACC: Cardiovascular Interventions, 11(14), 1325-1335. https://doi.org/10.1016/j.jcin.2018.02.036

Tajti, P, Karmpaliotis, D, Alaswad, K, Jaffer, FA, Yeh, RW, Patel, M, Mahmud, E, Choi, JW, Burke, MN, Doing, AH, Dattilo, P, Toma, C, Smith, AJC, Uretsky, B, Holper, E, Wyman, RM, Kandzari, DE, Garcia, S, Krestyaninov, O, Khelimskii, D, Koutouzis, M, Tsiafoutis, I, Moses, JW, Lembo, NJ, Parikh, M, Kirtane, AJ, Ali, ZA, Doshi, D, Rangan, BV, Ungi, I, Banerjee, S & Brilakis, ES 2018, 'The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry', JACC: Cardiovascular Interventions, vol. 11, no. 14, pp. 1325-1335. https://doi.org/10.1016/j.jcin.2018.02.036

@article{eff57414b31a405fb206911eed373a90,

title = "The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry",

abstract = "Objectives: The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents. Background: CTO PCI has been evolving with constant improvement of equipment and techniques. Methods: Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patients at 20 centers in the United States, Europe, and Russia. Results: The mean age was 65 ± 10 years, and 85% of the patients were men, with high prevalence of diabetes (43%), prior myocardial infarction (46%), prior coronary artery bypass graft surgery (33%), and prior PCI (65%). The CTO target vessels were the right coronary artery (55%), left anterior descending coronary artery (24%), and left circumflex coronary artery (20%). The mean J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores were 2.4 ± 1.3 and 1.3 ± 1.0, respectively. The overall technical and procedural success rate was 87% and 85%, respectively, and the rate of in-hospital major complications was 3.0%. The final successful crossing strategy was antegrade wire escalation in 52.0%, retrograde in 27.1%, and antegrade dissection re-entry in 20.9%; >1 crossing strategy was required in 40.9%. Median contrast volume, air kerma radiation dose, and procedure and fluoroscopy time were 270 ml (interquartile range: 200 to 360 ml), 2.9 Gy (interquartile range: 1.7 to 4.7 Gy), 123 min (interquartile range: 81 to 188 min) and 47 min (interquartile range: 29 to 77 min), respectively. Conclusions: CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the United States, Europe, and Russia.",

keywords = "chronic total occlusion, outcomes, percutaneous coronary intervention, techniques",

author = "Peter Tajti and Dimitri Karmpaliotis and Khaldoon Alaswad and Jaffer, {Farouc A.} and Yeh, {Robert W.} and Mitul Patel and Ehtisham Mahmud and Choi, {James W.} and Burke, {M. Nicholas} and Doing, {Anthony H.} and Phil Dattilo and Catalin Toma and Smith, {A. J.Conrad} and Barry Uretsky and Elizabeth Holper and Wyman, {R. Michael} and Kandzari, {David E.} and Santiago Garcia and Oleg Krestyaninov and Dmitrii Khelimskii and Michalis Koutouzis and Ioannis Tsiafoutis and Moses, {Jeffrey W.} and Lembo, {Nicholas J.} and Manish Parikh and Kirtane, {Ajay J.} and Ali, {Ziad A.} and Darshan Doshi and Rangan, {Bavana V.} and Imre Ungi and Subhash Banerjee and Brilakis, {Emmanouil S.}",

note = "Funding Information: The PROGRESS CTO registry has received support from the Abbott Northwestern Hospital Foundation. Dr. Karmpaliotis has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Dr. Alaswad has received consulting fees from Terumo and Boston Scientific and is a consultant (without financial remuneration) for Abbott Laboratories. Dr. Jaffer is a consultant for Abbott Vascular and Boston Scientific and has received research grants from Canon, Siemens, and the National Institutes of Health. Dr. Yeh has received a Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr. Patel is a member of the Speakers Bureau for AstraZeneca. Dr. Mahmud has received consulting fees from Medtronic and Corindus; speaking fees from Medtronic, Corindus, and Abbott Vascular; educational program fees from Abbott Vascular; and clinical events committee fees from St. Jude Medical. Dr. Burke has received consulting and speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Wyman has received honoraria and consulting and speaking fees from Boston Scientific, Abbott Vascular, and Asahi Intecc USA, Inc. Dr. Kandzari has received research and grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular and research and grant support from Abbott Vascular. Dr. Garcia has received consulting fees from Medtronic. Dr. Moses is a consultant to Boston Scientific and Abiomed. Dr. Lembo is a member of the Speakers Bureau for Medtronic and advisory boards for Abbott Vascular and Medtronic. Dr. Parikh is a member of the Speakers Bureaus for Abbot Vascular, Medtronic, Cardiovascular Systems Inc., Boston Scientific, and Trireme and advisory boards for Medtronic, Abbott Vascular, and Philips. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, GlaxoSmithKline, and Eli Lilly. Dr. Ali has received consulting fees and honoraria from St. Jude Medical and AstraZeneca Pharmaceuticals; has ownership interest, partnership, or principal interest in Shockwave Medical and VitaBx; and has received research grants from Medtronic and St. Jude Medical. Dr. Rangan has received research grants from InfraReDx and Spectranetics. Dr. Banerjee has received research grants from Gilead and The Medicines Company; has received consulting and speaking honoraria from Covidien and Medtronic; has ownership in MDCARE Global (spouse); and has intellectual property in HygeiaTel. Dr. Brilakis has received consulting and speaking honoraria from Abbott Vascular, ACIST Medical Systems, Amgen, Asahi Intecc USA, Inc., Cardiovascular Systems Inc., Elsevier, GE Healthcare, Medicure, Medtronic, and Nitiloop; has received research support from Boston Scientific and Osprey; is a member of the board of directors of Cardiovascular Innovations Foundation; and is a member of the board of trustees of the Society of Cardiovascular Angiography and Interventions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2018 American College of Cardiology Foundation",

year = "2018",

month = jul,

day = "23",

doi = "10.1016/j.jcin.2018.02.036",

language = "English (US)",

volume = "11",

pages = "1325--1335",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "14",

}

TY - JOUR

T1 - The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention

T2 - Update From the PROGRESS CTO Registry

AU - Tajti, Peter

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Jaffer, Farouc A.

AU - Yeh, Robert W.

AU - Patel, Mitul

AU - Mahmud, Ehtisham

AU - Choi, James W.

AU - Burke, M. Nicholas

AU - Doing, Anthony H.

AU - Dattilo, Phil

AU - Toma, Catalin

AU - Smith, A. J.Conrad

AU - Uretsky, Barry

AU - Holper, Elizabeth

AU - Wyman, R. Michael

AU - Kandzari, David E.

AU - Garcia, Santiago

AU - Krestyaninov, Oleg

AU - Khelimskii, Dmitrii

AU - Koutouzis, Michalis

AU - Tsiafoutis, Ioannis

AU - Moses, Jeffrey W.

AU - Lembo, Nicholas J.

AU - Parikh, Manish

AU - Kirtane, Ajay J.

AU - Ali, Ziad A.

AU - Doshi, Darshan

AU - Rangan, Bavana V.

AU - Ungi, Imre

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

N1 - Funding Information: The PROGRESS CTO registry has received support from the Abbott Northwestern Hospital Foundation. Dr. Karmpaliotis has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Dr. Alaswad has received consulting fees from Terumo and Boston Scientific and is a consultant (without financial remuneration) for Abbott Laboratories. Dr. Jaffer is a consultant for Abbott Vascular and Boston Scientific and has received research grants from Canon, Siemens, and the National Institutes of Health. Dr. Yeh has received a Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr. Patel is a member of the Speakers Bureau for AstraZeneca. Dr. Mahmud has received consulting fees from Medtronic and Corindus; speaking fees from Medtronic, Corindus, and Abbott Vascular; educational program fees from Abbott Vascular; and clinical events committee fees from St. Jude Medical. Dr. Burke has received consulting and speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Wyman has received honoraria and consulting and speaking fees from Boston Scientific, Abbott Vascular, and Asahi Intecc USA, Inc. Dr. Kandzari has received research and grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular and research and grant support from Abbott Vascular. Dr. Garcia has received consulting fees from Medtronic. Dr. Moses is a consultant to Boston Scientific and Abiomed. Dr. Lembo is a member of the Speakers Bureau for Medtronic and advisory boards for Abbott Vascular and Medtronic. Dr. Parikh is a member of the Speakers Bureaus for Abbot Vascular, Medtronic, Cardiovascular Systems Inc., Boston Scientific, and Trireme and advisory boards for Medtronic, Abbott Vascular, and Philips. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, GlaxoSmithKline, and Eli Lilly. Dr. Ali has received consulting fees and honoraria from St. Jude Medical and AstraZeneca Pharmaceuticals; has ownership interest, partnership, or principal interest in Shockwave Medical and VitaBx; and has received research grants from Medtronic and St. Jude Medical. Dr. Rangan has received research grants from InfraReDx and Spectranetics. Dr. Banerjee has received research grants from Gilead and The Medicines Company; has received consulting and speaking honoraria from Covidien and Medtronic; has ownership in MDCARE Global (spouse); and has intellectual property in HygeiaTel. Dr. Brilakis has received consulting and speaking honoraria from Abbott Vascular, ACIST Medical Systems, Amgen, Asahi Intecc USA, Inc., Cardiovascular Systems Inc., Elsevier, GE Healthcare, Medicure, Medtronic, and Nitiloop; has received research support from Boston Scientific and Osprey; is a member of the board of directors of Cardiovascular Innovations Foundation; and is a member of the board of trustees of the Society of Cardiovascular Angiography and Interventions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2018 American College of Cardiology Foundation

PY - 2018/7/23

Y1 - 2018/7/23

N2 - Objectives: The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents. Background: CTO PCI has been evolving with constant improvement of equipment and techniques. Methods: Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patients at 20 centers in the United States, Europe, and Russia. Results: The mean age was 65 ± 10 years, and 85% of the patients were men, with high prevalence of diabetes (43%), prior myocardial infarction (46%), prior coronary artery bypass graft surgery (33%), and prior PCI (65%). The CTO target vessels were the right coronary artery (55%), left anterior descending coronary artery (24%), and left circumflex coronary artery (20%). The mean J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores were 2.4 ± 1.3 and 1.3 ± 1.0, respectively. The overall technical and procedural success rate was 87% and 85%, respectively, and the rate of in-hospital major complications was 3.0%. The final successful crossing strategy was antegrade wire escalation in 52.0%, retrograde in 27.1%, and antegrade dissection re-entry in 20.9%; >1 crossing strategy was required in 40.9%. Median contrast volume, air kerma radiation dose, and procedure and fluoroscopy time were 270 ml (interquartile range: 200 to 360 ml), 2.9 Gy (interquartile range: 1.7 to 4.7 Gy), 123 min (interquartile range: 81 to 188 min) and 47 min (interquartile range: 29 to 77 min), respectively. Conclusions: CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the United States, Europe, and Russia.

AB - Objectives: The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents. Background: CTO PCI has been evolving with constant improvement of equipment and techniques. Methods: Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patients at 20 centers in the United States, Europe, and Russia. Results: The mean age was 65 ± 10 years, and 85% of the patients were men, with high prevalence of diabetes (43%), prior myocardial infarction (46%), prior coronary artery bypass graft surgery (33%), and prior PCI (65%). The CTO target vessels were the right coronary artery (55%), left anterior descending coronary artery (24%), and left circumflex coronary artery (20%). The mean J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) scores were 2.4 ± 1.3 and 1.3 ± 1.0, respectively. The overall technical and procedural success rate was 87% and 85%, respectively, and the rate of in-hospital major complications was 3.0%. The final successful crossing strategy was antegrade wire escalation in 52.0%, retrograde in 27.1%, and antegrade dissection re-entry in 20.9%; >1 crossing strategy was required in 40.9%. Median contrast volume, air kerma radiation dose, and procedure and fluoroscopy time were 270 ml (interquartile range: 200 to 360 ml), 2.9 Gy (interquartile range: 1.7 to 4.7 Gy), 123 min (interquartile range: 81 to 188 min) and 47 min (interquartile range: 29 to 77 min), respectively. Conclusions: CTO PCI is currently being performed with high success and acceptable complication rates among various experienced centers in the United States, Europe, and Russia.

KW - chronic total occlusion

KW - outcomes

KW - percutaneous coronary intervention

KW - techniques

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The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry

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UN SDGs

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