Michaella Alexandrou, Athanasios Rempakos, Deniz Mutlu, Ahmed Al Ogaili, James W Choi, Paul Poommipanit, Khaldoon Alaswad, Mir Babar Basir, Rhian Davies, Farouc A Jaffer, Raj H Chandwaney, Lorenzo Azzalini, Nazif Aygul, Ahmed M ElGuindy, Brian K Jefferson, Sevket Gorgulu, Jaikirshan J Khatri, Oleg Krestyaninov, Dmitrii Khelimskii, Jarrod Frizzell, Basem Elbarouni, Omer Goktekin, Margaret B McEntegart, Bavana V Rangan, Olga C Mastrodemos, M Nicholas Burke, Yader Sandoval, Emmanouil S Brilakis
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Compared with non-NA patients, NA patients were older, with higher body mass index and higher prevalence of diabetes, hypertension, dyslipidemia, family history of coronary artery disease, prior history of PCI, coronary artery bypass graft surgery and heart failure, cerebrovascular disease, and peripheral arterial disease. Their CTOs were more complex, with higher J-CTO (2.56 ± 1.22 vs 1.81 ± 1.24; P less than .001) and PROGRESS-CTO (1.29 ± 1.01 vs 1.07 ± 0.95; P less than .001) scores, longer length, and higher prevalence of proximal cap ambiguity, blunt/no stump, moderate to severe calcification, and proximal tortuosity. Retrograde (31.0% vs 22.1%; P less than .001) and antegrade dissection and re-entry (ADR) (21.2% vs 9.2%; P less than .001) were more commonly used in NA centers, along with intravascular ultrasound (69.0% vs 10.1%; P less than .001). Procedure and fluoroscopy times were longer in NA, while contrast volume and radiation dose were lower. Technical (86.7% vs 86.8%; P > .90) and procedural (85.4% vs 85.8%; P = .70) success and in-hospital major adverse cardiovascular events (MACE) (1.9% vs 1.7%; P = .40) were similar in NA and non-NA centers.</p><p><strong>Conclusions: </strong>Compared with non-NA patients, NA patients undergoing CTO PCI have more comorbidities, higher CTO lesion complexity, are more likely to undergo treatment with retrograde and ADR, and have similar technical success and MACE.</p>","PeriodicalId":49261,"journal":{"name":"Journal of Invasive Cardiology","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Geographic diversity in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO registry.\",\"authors\":\"Michaella Alexandrou, Athanasios Rempakos, Deniz Mutlu, Ahmed Al Ogaili, James W Choi, Paul Poommipanit, Khaldoon Alaswad, Mir Babar Basir, Rhian Davies, Farouc A Jaffer, Raj H Chandwaney, Lorenzo Azzalini, Nazif Aygul, Ahmed M ElGuindy, Brian K Jefferson, Sevket Gorgulu, Jaikirshan J Khatri, Oleg Krestyaninov, Dmitrii Khelimskii, Jarrod Frizzell, Basem Elbarouni, Omer Goktekin, Margaret B McEntegart, Bavana V Rangan, Olga C Mastrodemos, M Nicholas Burke, Yader Sandoval, Emmanouil S Brilakis\",\"doi\":\"10.25270/jic/24.00056\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is variability in clinical and lesion characteristics as well as techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>We analyzed patient and lesion characteristics, techniques, and outcomes in 11 503 CTO-PCI procedures performed in North America (NA) and in the combined regions of Europe, Asia, and Africa from 2017 to 2023 as documented in the PROGRESS-CTO registry.</p><p><strong>Results: </strong>Eight thousand four hundred seventy-nine (74%) procedures were performed in NA. Compared with non-NA patients, NA patients were older, with higher body mass index and higher prevalence of diabetes, hypertension, dyslipidemia, family history of coronary artery disease, prior history of PCI, coronary artery bypass graft surgery and heart failure, cerebrovascular disease, and peripheral arterial disease. Their CTOs were more complex, with higher J-CTO (2.56 ± 1.22 vs 1.81 ± 1.24; P less than .001) and PROGRESS-CTO (1.29 ± 1.01 vs 1.07 ± 0.95; P less than .001) scores, longer length, and higher prevalence of proximal cap ambiguity, blunt/no stump, moderate to severe calcification, and proximal tortuosity. Retrograde (31.0% vs 22.1%; P less than .001) and antegrade dissection and re-entry (ADR) (21.2% vs 9.2%; P less than .001) were more commonly used in NA centers, along with intravascular ultrasound (69.0% vs 10.1%; P less than .001). Procedure and fluoroscopy times were longer in NA, while contrast volume and radiation dose were lower. Technical (86.7% vs 86.8%; P > .90) and procedural (85.4% vs 85.8%; P = .70) success and in-hospital major adverse cardiovascular events (MACE) (1.9% vs 1.7%; P = .40) were similar in NA and non-NA centers.</p><p><strong>Conclusions: </strong>Compared with non-NA patients, NA patients undergoing CTO PCI have more comorbidities, higher CTO lesion complexity, are more likely to undergo treatment with retrograde and ADR, and have similar technical success and MACE.</p>\",\"PeriodicalId\":49261,\"journal\":{\"name\":\"Journal of Invasive Cardiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Invasive Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.25270/jic/24.00056\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Invasive Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.25270/jic/24.00056","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：慢性全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的临床和病变特征以及技术存在差异：慢性全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的临床和病变特征以及技术存在差异：我们分析了 PROGRESS-CTO 注册表中记录的 2017 年至 2023 年在北美（NA）以及欧洲、亚洲和非洲联合地区进行的 11 503 例 CTO-PCI 手术的患者和病变特征、技术和结果：8479例（74%）手术在北美进行。与非NA患者相比，NA患者年龄更大，体重指数更高，糖尿病、高血压、血脂异常、冠心病家族史、PCI既往史、冠状动脉旁路移植手术和心衰、脑血管疾病和外周动脉疾病的发病率更高。他们的CTO更复杂，J-CTO（2.56 ± 1.22 vs 1.81 ± 1.24；P小于0.001）和PROGRESS-CTO（1.29 ± 1.01 vs 1.07 ± 0.95；P小于0.001）评分更高，长度更长，近端冠状动脉帽模糊、钝化/无残端、中度至重度钙化和近端迂曲的发生率更高。逆行（31.0% vs 22.1%；P小于0.001）和前向夹层和再入路（ADR）（21.2% vs 9.2%；P小于0.001）以及血管内超声（69.0% vs 10.1%；P小于0.001）在NA中心更常用。非北美中心的手术和透视时间更长，而造影剂用量和辐射剂量更低。NA和非NA中心的技术成功率（86.7% vs 86.8%；P > .90）和程序成功率（85.4% vs 85.8%；P = .70）以及院内主要不良心血管事件（MACE）（1.9% vs 1.7%；P = .40）相似：与非NA患者相比，接受CTO PCI的NA患者合并症更多，CTO病变复杂程度更高，更有可能接受逆行和ADR治疗，但技术成功率和MACE相似。
Geographic diversity in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO registry.
Background: There is variability in clinical and lesion characteristics as well as techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: We analyzed patient and lesion characteristics, techniques, and outcomes in 11 503 CTO-PCI procedures performed in North America (NA) and in the combined regions of Europe, Asia, and Africa from 2017 to 2023 as documented in the PROGRESS-CTO registry.
Results: Eight thousand four hundred seventy-nine (74%) procedures were performed in NA. Compared with non-NA patients, NA patients were older, with higher body mass index and higher prevalence of diabetes, hypertension, dyslipidemia, family history of coronary artery disease, prior history of PCI, coronary artery bypass graft surgery and heart failure, cerebrovascular disease, and peripheral arterial disease. Their CTOs were more complex, with higher J-CTO (2.56 ± 1.22 vs 1.81 ± 1.24; P less than .001) and PROGRESS-CTO (1.29 ± 1.01 vs 1.07 ± 0.95; P less than .001) scores, longer length, and higher prevalence of proximal cap ambiguity, blunt/no stump, moderate to severe calcification, and proximal tortuosity. Retrograde (31.0% vs 22.1%; P less than .001) and antegrade dissection and re-entry (ADR) (21.2% vs 9.2%; P less than .001) were more commonly used in NA centers, along with intravascular ultrasound (69.0% vs 10.1%; P less than .001). Procedure and fluoroscopy times were longer in NA, while contrast volume and radiation dose were lower. Technical (86.7% vs 86.8%; P > .90) and procedural (85.4% vs 85.8%; P = .70) success and in-hospital major adverse cardiovascular events (MACE) (1.9% vs 1.7%; P = .40) were similar in NA and non-NA centers.
Conclusions: Compared with non-NA patients, NA patients undergoing CTO PCI have more comorbidities, higher CTO lesion complexity, are more likely to undergo treatment with retrograde and ADR, and have similar technical success and MACE.
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