title: Increase in J-CTO lesion complexity score explains the disparity between recanalisation success and evolution of chronic total occlusion strategies: insights from a single-centre 10-year experience.
abstract: OBJECTIVE
  To investigate whether treatment of lesions of greater complexity is now undertaken and to assess the rates of procedural success per class of lesion complexity.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Despite impressive progress in treatment strategies and equipment, the success rate of percutaneous coronary intervention for chronic total occlusion (CTO) has remained relatively stable.
  
  
  METHODS
  483 patients consecutively treated with CTO from 2003 to 2012.
  
  
  METHODS
  The Multicenter CTO Registry of Japan (J-CTO) score was used to classify lesion complexity. The study population was subdivided into an early (period 1, n=288) and a late (period 2, n=195) period according to the routine implementation of novel techniques and advanced equipment.
  
  
  RESULTS
  Period 2 was marked by more 'difficult' and 'very difficult' lesions (J-CTO grades 2 and 3) being attempted, with procedural success increasing from 68.4% to 88.1% (p<0.001) and from 42.0% to 78.9% (p<0.001), respectively. 'Easy' and 'intermediate' lesions (J-CTO grades 0 and 1) were less common, but with similarly high success rates (89.1% vs 96.6% (p=0.45) for easy, and 86.3% vs 86.1% (p=0.99) for intermediate). Period 2 was characterised by a trend for more successful procedures overall (by 6.1%, p=0.09). Procedural complications were similarly low in both periods. J-CTO score and technical era were identified as independent correlates of success in the total population by logistic regression analysis.
  
  
  CONCLUSIONS
  Advanced CTO techniques and equipment have resulted in an increase in the successful treatment of highly complex lesions. Total success rate did not substantially improve, as it was counterbalanced by the increased rate at which complex lesions were attempted.
authors: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
authors: Dimitrios
authors: D
authors: Syrseloudis
authors: Gioel Gabrio
authors: GG
authors: Secco
authors: Eduardo Alegria
authors: EA
authors: Barrero
authors: Alistair C
authors: AC
authors: Lindsay
authors: Matteo
authors: M
authors: Ghione
authors: Kadriye
authors: K
authors: Kilickesmez
authors: Nicolas
authors: N
authors: Foin
authors: Ramon
authors: R
authors: Martos
authors: Carlo
authors: C
authors: Di Mario
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008131:London; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000639:trends; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome