title: Retrograde Recanalization of Chronic Total Occlusions in Europe: Procedural, In-Hospital, and Long-Term Outcomes From the Multicenter ERCTO Registry.
abstract: BACKGROUND
  A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs).
  
  
  OBJECTIVE
  The authors describe the European experience with and outcomes of retrograde PCI revascularization for coronary CTOs.
  
  
  METHODS
  Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization.
  
  
  RESULTS
  The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up.
  
  
  CONCLUSIONS
  The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.
authors.affiliation: Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Italy. Electronic address: argalassi@gmail.com.
authors.forename: Alfredo R
authors.initials: AR
authors.lastname: Galassi
authors.affiliation: Department of Cardiology, American Hellenic Educational Progressive Association University Hospital, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sianos
authors.affiliation: Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Werner
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.affiliation: Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Salvatore D
authors.initials: SD
authors.lastname: Tomasello
authors.affiliation: Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Italy; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
authors.forename: Marouane
authors.initials: M
authors.lastname: Boukhris
authors.affiliation: Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Marine
authors.initials: M
authors.lastname: Castaing
authors.affiliation: Interventional Cardiology - Universitäts-Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Büttner
authors.affiliation: Helios Clinic Krefeld, Department of Cardiology, University Witten/Herdecke, Witten, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bufe
authors.affiliation: Department of Cardiology, Eastern Clinical University Hospital, Riga, Latvia.
authors.forename: Artis
authors.initials: A
authors.lastname: Kalnins
authors.affiliation: Department of Cardiology, Forth Valley Royal Hospital, Larbert, United Kingdom.
authors.forename: James C
authors.initials: JC
authors.lastname: Spratt
authors.affiliation: Policlinico San Giovanni Bosco, Turin, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Garbo
authors.affiliation: Department of Cardiology, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.affiliation: Department of Cardiology, CH de Lagny, Lagny-sur-Marne, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Elhadad
authors.affiliation: Department of Cardiology, Infermi Hospital, Rivoli, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gagnor
authors.affiliation: Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia; Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany.
authors.forename: Bernward
authors.initials: B
authors.lastname: Lauer
authors.affiliation: Department of Interventional Cardiology, Jagiellonian University Medical Hospital, Krakow, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Bryniarski
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
authors.forename: Evald H
authors.initials: EH
authors.lastname: Christiansen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.affiliation: Augusta-Krankenhaus Klinik Kardiologie, Dusseldorf, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Meyer-Geßner
authors.affiliation: Faculty of Medicine, Department of Cardiology, BezmiÂlem Foundation University, Istanbul, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Goktekin
authors.affiliation: Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia; Invasive Cardiology Unit, San Raffaele Hospital, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.affiliation: Institut Hospitalier Jacques Cartier, Massy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Louvard
authors.affiliation: Institut Hospitalier Jacques Cartier, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: Latvian Center of Cardiology-Pauls Stradins Clinical University Hospital, Riga, Latvia.
authors.forename: Aigars
authors.initials: A
authors.lastname: Lismanis
authors.affiliation: Hospital N.I.Pirogov, Sofia, Bulgaria.
authors.forename: Valery L
authors.initials: VL
authors.lastname: Gelev
authors.affiliation: Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.affiliation: Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marzà
authors.affiliation: NIHR Cardiovascular BRU Royal Brompton Hospital & National Heart and Lung Institute, Imperial College London, London, United Kingdom.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.affiliation: Department of Cardiology, Main Taunus Hospitals, Bad Soden University of Frankfurt, Frankfurt, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Reifart
mesh_terms: D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
keywords: J-CTO score; chronic total occlusions; retrograde PCI revascularization