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 journalArticle

    7 Citations (Scopus)

    Abstract

    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
    Volume30
    Issue number2
    Early online date15 Nov 2017
    Publication statusPublished - Feb 2018

    Keywords

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

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  • Cite this

    Maeremans, J., Avran, A., Walsh, S., Knaapen, P., Hanratty, C. G., Faurie, B., Agostoni, P., Bressollette, E., Kayaert, P., Smith, D., Chase, A., Mcentegart, M. B., Smith, W. H. T., Harcombe, A., Irving, J., Ladwiniec, A., Spratt, J. C., Dens, J., & RECHARGE Investigators (2018). One-Year Clinical Outcomes of the Hybrid CTO Revascularization Strategy After Hospital Discharge: A Subanalysis of the Multicenter RECHARGE Registry. Journal of Invasive Cardiology, 30(2), 62-70. https://www.invasivecardiology.com/articles/one-year-clinical-outcomes-hybrid-cto-revascularization-strategy-after-hospital-discharge