Reclassification of CTO Crossing Strategies in the ERCTO Registry According to the CTO-ARC Consensus Recommendations

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2024-10-28 DOI:10.1016/j.jcin.2024.09.002

Giuseppe Vadalà MD , Kambis Mashayekhi MD, PhD , Marouane Boukhris MD , Michael Behnes MD, PhD , Stylianos Pyxaras MD, PhD , Evald Høj Christiansen MD, PhD , Juan Luis Gutiérrez-Chico MD, PhD , Laura Maniscalco PhD , Sinisa Stojkovic MD, PhD , Nenad Z. Bozinovic MD , Nicolaus Boudou MD , Roberto Garbo MD , Gerald S. Werner MD, PhD , Alexander Avran MD , Gabriele L. Gasparini MD , Eugenio La Scala MD , Andrew Ladwiniec MD , George Sianos MD , Omer Goktekin MD, PhD , Sevket Gorgulu MD , Alfredo R. Galassi MD

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引用次数: 0

Abstract

Background

The CTO-ARC (Chronic Total Occlusion Academic Research Consortium) recognized that a nonstandardized definition of chronic total occlusion (CTO) percutaneous coronary intervention approaches can bias the complications’ attribution to each crossing strategy.

Objectives

The study sought to describe the numbers, efficacy, and safety of each final CTO crossing strategy according to CTO-ARC recommendations.

Methods

In this cross-sectional study, data were retrieved from the European Registry of Chronic Total Occlusions between 2021 and 2022.

Results

Out of 8,673 patients, antegrade and retrograde approach were performed in 79.2% and 20.8% of cases, respectively. The antegrade approach included antegrade wiring and antegrade dissection and re-entry, both performed with or without retrograde contribution (antegrade wiring without retrograde contribution: n = 5,929 [68.4%]; antegrade wiring with retrograde contribution: n = 446 [5.1%]; antegrade dissection and re-entry without retrograde contribution: n = 353 [4.1%]; antegrade dissection and re-entry with retrograde contribution: n = 137 [1.6%]). The retrograde approach included retrograde wiring (n = 735 [8.4%]) and retrograde dissection and re-entry (n = 1,073 [12.4%]). Alternative antegrade crossing was associated with lower technical success (70% vs 86% vs 93.1%, respectively; P < 0.001) and higher complication rates (4.6% vs 2.9% vs 1%, respectively; P < 0.001) as compared with retrograde and true antegrade crossing. However, alternative antegrade crossing was applied mostly as a rescue strategy (96.1%).

Conclusions

The application of CTO-ARC definitions allowed the reclassification of 6.7% of procedures as alternative antegrade crossing with retrograde or antegrade contribution which showed higher MACCE and lower technical success rates, as compared with true antegrade and retrograde crossing.

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根据 CTO-ARC 共识建议对 ERCTO 注册表中的 CTO 交叉策略进行重新分类

背景CTO-ARC（慢性全闭塞学术研究联盟）认为，慢性全闭塞（CTO）经皮冠状动脉介入治疗方法的非标准化定义会使每种交叉策略的并发症归因出现偏差。该研究旨在根据 CTO-ARC 的建议，描述每种最终 CTO 交叉策略的数量、疗效和安全性。结果在 8673 例患者中，分别有 79.2% 和 20.8% 的病例采用了前向和逆行方法。前向方法包括前向布线和前向解剖与再入路，两者均在有或无逆行贡献的情况下进行（无逆行贡献的前向布线：n = 5929 [68.4%]；有逆行贡献的前向布线：n = 446 [5.1%]；无逆行贡献的前向解剖与再入路：n = 353 [4.1%]；有逆行贡献的前向解剖与再入路：n = 137 [1.6%]）。逆行方式包括逆行布线（n = 735 [8.4%]）和逆行解剖和再入（n = 1,073 [12.4%]）。与逆行和真正的逆行穿刺相比，替代性逆行穿刺的技术成功率较低（分别为 70% vs 86% vs 93.1%；P < 0.001），并发症发生率较高（分别为 4.6% vs 2.9% vs 1%；P < 0.001）。结论CTO-ARC定义的应用使得6.7%的手术被重新归类为逆行或逆行的替代性前向穿刺，与真正的前向和逆行穿刺相比，替代性前向穿刺显示出更高的MACCE和更低的技术成功率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.