title: Impact of crossing strategy on midterm outcomes following percutaneous revascularisation of coronary chronic total occlusions.
abstract: OBJECTIVE
  The aim of the present study was to compare the midterm clinical outcomes of patients undergoing successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) according to the crossing technique used, in a large multicentre registry.
  
  
  RESULTS
  We compiled a multicentre registry of consecutive patients undergoing successful CTO PCI. Patients were divided into three groups: true-to-true (TTT) approach, modern dissection/re-entry (DR) techniques (CrossBoss/Stingray, reverse CART), and old DR techniques (LAST, STAR, CART). Cox regression was used to identify independent predictors of major adverse cardiac events (MACE: cardiac death, myocardial infarction and target vessel revascularisation). We included 924 patients (TTT, n=571; modern DR, n=258; old DR, n=95). Patients in both DR groups had a higher prevalence of comorbidities, angiographic and procedural complexity. The 12-month MACE rate was higher in old DR (22.1%) than in modern DR (8.9%) and TTT (9.1%, p<0.001). Old (hazard ratio [HR] 2.02, 95% confidence interval [CI]: 1.12 to 3.61, p=0.02) but not modern (HR 0.98, 95% CI: 0.54 to 1.79, p=0.96) DR techniques were associated with a higher adjusted risk of MACE compared to TTT.
  
  
  CONCLUSIONS
  The use of old but not modern DR techniques was associated with a higher risk of MACE. Therefore, CrossBoss/Stingray and reverse CART might be considered as first-line strategies for antegrade and retrograde DR-based CTO PCI, respectively.
authors.affiliation: Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Azzalini
authors.forename: Rustem
authors.initials: R
authors.lastname: Dautov
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Soledad
authors.initials: S
authors.lastname: Ojeda
authors.forename: Susanna
authors.initials: S
authors.lastname: Benincasa
authors.forename: Barbara
authors.initials: B
authors.lastname: Bellini
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.forename: Jorge
authors.initials: J
authors.lastname: Chavarría
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.forename: Manuel
authors.initials: M
authors.lastname: Pan
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Stéphane
authors.initials: S
authors.lastname: Rinfret
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome