One-Year Clinical Outcomes of the Hybrid CTO Revascularization Strategy After Hospital Discharge: a Subanalysis of the Multicenter RECHARGE Registry
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.
Journal of Invasive Cardiology 30(2): 62-70
2018
ISSN/ISBN: 1557-2501 PMID: 29138365 Document Number: 695517
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. 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. 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). 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.