Further validation of the hybrid algorithm for CTO PCI; difficult lesions, same success.
OBJECTIVE
To evaluate the success rates and outcome of the hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) by a single operator in two different clinical settings.


METHODS
We compared 279 consecutive CTO PCIs performed by a single, high-volume operator using the hybrid algorithm in two different clinical settings. Data were collected through the PROGRESS CTO Registry. We compared 145 interventions performed in a community program (cohort A) with 134 interventions performed in a referral center (cohort B).


RESULTS
Patient in cohort B had more complex lesions with higher J-CTO (3.0 vs. 3.41; p<0.001) and Progress CTO (1.5 vs.1.8, P=0.003) scores, more moderate to severe tortuosity (38% vs. 64%; p<0.001), longer total occlusion length (25 vs. 40mm; p<0.001) and higher prevalence of prior failed CTO PCI attempts (15% vs. 35%; p=0.001). Both technical (95% vs. 91%; p=0.266) and procedural (94% vs. 88%; p=0.088) success rates were similar between the two cohorts despite significantly different lesion complexity. Overall major adverse cardiovascular events were higher in cohort B (1.4% vs. 7.8%; p=0.012) without any significant difference in mortality (0.7% vs. 2.3%, p=0.351).


CONCLUSIONS
In spite of higher lesion complexity in the setting of a quaternary-care referral center, use of the hybrid algorithm for CTO PCI enabled similarly high technical and procedural success rates as compared with those previously achieved by the same operator in a community-based program at the expense of a higher rate of MACE.
Henry Ford Hospital and Wayne State University, Detroit, MI.
Mir B
MB
Basir
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
Aris
A
Karatasakis
Henry Ford Hospital and Wayne State University, Detroit, MI.
Mohammad
M
Alqarqaz
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
Barbara
B
Danek
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
Bavana V
BV
Rangan
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX.
Emmanouil S
ES
Brilakis
Henry Ford Hospital and Wayne State University, Detroit, MI.
Henry
H
Kim
Henry Ford Hospital and Wayne State University, Detroit, MI.
William W
WW
O'Neill
Henry Ford Hospital and Wayne State University, Detroit, MI. Electronic address: kalaswa1@hfhs.org.
Khaldoon
K
Alaswad
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002908:Chronic Disease / Q000628:therapy; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
Chronic Total occlusion; PCI