One-Year Clinical Outcomes of the Hybrid CTO Revascularization Strategy After Hospital Discharge: A Subanalysis of the Multicenter RECHARGE Registry

Joren Maeremans, Alexandre Avran, Simon Walsh, Paul Knaapen, Colm G Hanratty, Benjamin Faurie, Pierfrancesco Agostoni, Erwan Bressollette, Peter Kayaert, Dave Smith, Alexander Chase, Margaret B Mcentegart, William H T Smith, Alun Harcombe, John Irving, Andrew Ladwiniec, James C Spratt, Jo Dens (Lead / Corresponding author), RECHARGE Investigators

    Research output: Contribution to journalArticlepeer-review

    20 Citations (Scopus)


    Objectives: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) has historically been associated with higher event rates during follow-up. The hybrid algorithm and contemporary wiring and dissection re-entry (DR) techniques can potentially improve long-term outcomes after CTO-PCI. This study assessed the long-term clinical outcomes of the hybrid CTO practice, when applied by operators with varying experience levels.

    Methods: We examined the 1-year clinical events after hospital discharge of the RECHARGE population, according to technical outcome and final technique. The primary endpoint was major adverse cardiac event (MACE) rate. Centers that provided ≥90% complete 12-month follow-up were included.

    Results: Follow-up data of 1067 out of 1165 patients (92%) were provided by 13 centers. Mean follow-up duration was 362.8 ± 0.9 days. One-year MACE-free survival rate was 91.3% (974/1067). MACE included death (1.9%; n = 20), myocardial infarction (1.4%; n = 15), target-vessel failure (5.9%; n = 63), and target-vessel revascularization (TVR) (5.5%; n = 59). Non-TVR was performed in 6.7% (n = 71). MACE was significantly in favor of successful CTO-PCI (8.0% vs 13%; P=.04), even after adjusting for baseline differences (adjusted hazard ratio, 0.59; 95% confidence interval, 0.36-0.98; P=.04). Other events, including individual MACE components, were comparable with respect to technical outcome and final technique (DR vs non-DR techniques).

    Conclusions: The use of the hybrid algorithm with contemporary techniques by moderate to highly experienced operators for CTO-PCI is safe and associated with a low 1-year event rate. Successful procedures are associated with a better MACE rate. DR techniques can be used as first-line strategies alongside intimal wiring techniques without compromising clinical outcomes.

    Original languageEnglish
    Pages (from-to)62-70
    Number of pages9
    JournalJournal of Invasive Cardiology
    Issue number2
    Early online date15 Nov 2017
    Publication statusPublished - Feb 2018


    • chronic total occlusion
    • follow-up
    • percutaneous coronary intervention

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine


    Dive into the research topics of 'One-Year Clinical Outcomes of the Hybrid CTO Revascularization Strategy After Hospital Discharge: A Subanalysis of the Multicenter RECHARGE Registry'. Together they form a unique fingerprint.

    Cite this