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Operator experience and clinical outcomes of percutaneous coronary intervention for chronic total occlusion: insights from a pooled analysis of the Japanese CTO PCI Expert Registry and the Retrograde Summit General Registry

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Abstract

There have not been enough studies to examine the association between difference in operator experience and technical success rate in contemporary percutaneous coronary intervention for chronic total occlusion (CTO-PCI). The present study sought to provide insights into the impact of operator experience on clinical outcomes of CTO-PCI through a comparison of two largest Japanese CTO-PCI registries consisting of operators with different CTO-PCI experience. After combining clinical data from the Japanese CTO-PCI Expert Registry (ER) 2014–2016 (N = 4316) including CTO-PCI performed by highly experienced operators and the Retrograde Summit General Registry (RSGR) 2014–2016 (N = 2230) including CTO-PCI performed by less experienced operators, a pooled analysis was performed to compare clinical outcomes of CTO-PCI in 2 registries. The overall technical success rate and the incidence of in-hospital major adverse events were comparable between ER and RSGR (90.1% vs 88.9%, p = 0.133, 1.7% vs 1.5%, p = 0.606, respectively). Technical success rate in ER was significantly higher among the patients treated with primary antegrade approach (91.8% vs 89.5%, p = 0.009), whereas there was no significant difference among the patients treated with the primary retrograde approach (85.7% vs 85.3%, p = 0.857). Multivariate analysis suggested ER operator could not be an independent predictor for technical success. CTO-PCI performed by less experienced but appropriately trained operators could achieve similarly high technical success rate with comparable safety compared with those performed by highly experienced specialists in contemporary Japanese context.

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References

  1. Prasad A, Rihal CS, Lennon RJ, Wiste HJ, Singh M, Holmes DR Jr. Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic. J Am Coll Cardiol. 2007;49:1611–8.

    Article  Google Scholar 

  2. Joyal D, Afilalo J, Rinfret S. Effectiveness of recanalization of chronic total occlusions: a systematic review and meta-analysis. Am Heart J. 2010;160:179–87.

    Article  Google Scholar 

  3. Surmely JF, Tsuchikane E, Katoh O, Nishida Y, Nakayama M, Nakamura S, et al. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. J Invasive Cardiol. 2006;18:334–8.

    PubMed  Google Scholar 

  4. Surmely JF, Katoh O, Tsuchikane E, Nasu K, Suzuki T. Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv. 2007;69:826–32.

    Article  Google Scholar 

  5. Rathore S, Katoh O, Matsuo H, Terashima M, Tanaka N, Kinoshita Y, et al. Retrograde percutaneous recanalization of chronic total occlusion of the coronary arteries: procedural outcomes and predictors of success in contemporary practice. Circ Cardiovasc Interv. 2009;2:124–32.

    Article  Google Scholar 

  6. Rathore S, Katoh O, Tuschikane E, Oida A, Suzuki T, Takase S. A novel modification of the retrograde approach for the recanalization of chronic total occlusion of the coronary arteries intravascular ultrasound-guided reverse controlled antegrade and retrograde tracking. JACC Cardiovasc Interv. 2010;3:155–64.

    Article  Google Scholar 

  7. Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4:213–21.

    Article  Google Scholar 

  8. Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis D, Wyman MR, et al. Development and validation of a novel scoring system for predicting technical success of chronic total occlusion percutaneous coronary interventions: the PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score. JACC Cardiovasc Interv. 2016;9:1–9.

    Article  Google Scholar 

  9. Maeremans J, Spratt JC, Knaapen P, Walsh S, Agostoni P, Wilson W, et al. Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: the RECHARGE score. Catheter Cardiovasc Interv. 2018;91:192–202.

    Article  Google Scholar 

  10. Szijgyarto Z, Rampat R, Werner GS, Ho C, Reifart N, Lefevre T, et al. Derivation and validation of a chronic total coronary occlusion intervention procedural success score from the 20,000-patient EuroCTO Registry: the EuroCTO (CASTLE) Score. JACC Cardiovasc Interv. 2019;12:335–42.

    Article  Google Scholar 

  11. Brilakis ES, Grantham JA, Rinfret S, Wyman RM, Burke MN, Karmpaliotis D, et al. A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Interv. 2012;5:367–79.

    Article  Google Scholar 

  12. Harding SA, Wu EB, Lo S, Lim ST, Ge L, Chen JY, et al. A new algorithm for crossing chronic total occlusions from the Asia Pacific Chronic Total Occlusion Club. JACC Cardiovasc Interv. 2017;10:2135–43.

    Article  Google Scholar 

  13. Sapontis J, Christopoulos G, Grantham JA, Wyman RM, Alaswad K, Karmpaliotis D, et al. Procedural failure of chronic total occlusion percutaneous coronary intervention: Insights from a multicenter US registry. Catheter Cardiovasc Interv. 2015;85:1115–22.

    Article  Google Scholar 

  14. Karmpaliotis D, Karatasakis A, Alaswad K, Jaffer FA, Yeh RW, Wyman RM, et al. Outcomes with the use of the retrograde approach for coronary chronic total occlusion interventions in a contemporary multicenter US Registry. Circ Cardiovasc Interv. 2016;67:9.

    Google Scholar 

  15. Galassi AR, Tomasello SD, Reifart N, Werner GS, Sianos G, Bonnier H, et al. In-hospital outcomes of percutaneous coronary intervention in patients with chronic total occlusion: insights from the ERCTO (European Registry of Chronic Total Occlusion) registry. EuroIntervention. 2011;7:472–9.

    Article  Google Scholar 

  16. Maeremans J, Walsh S, Knaapen P, Spratt JC, Avran A, Hanratty CG, et al. The hybrid algorithm for treating chronic total occlusions in Europe: the RECHARGE Registry. J Am Coll Cardiol. 2016;68:1958–70.

    Article  Google Scholar 

  17. Morino Y, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, et al. In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan). JACC Cardiovasc Interv. 2010;3:143–51.

    Article  Google Scholar 

  18. Habara M, Tsuchikane E, Muramatsu T, Kashima Y, Okamura A, Mutoh M, et al. Comparison of percutaneous coronary intervention for chronic total occlusion outcome according to operator experience from the Japanese retrograde summit registry. Catheter Cardiovasc Interv. 2016;87:1027–35.

    Article  Google Scholar 

  19. Chan CY, Wu EB, Yan BP, Tsuchikane E. Procedure failure of chronic total occlusion percutaneous coronary intervention in an algorithm driven contemporary Asia-Pacific Chronic Total Occlusion Club (APCTO Club) multicenter registry. Catheter Cardiovasc Interv. 2019;93:1033–8.

    Article  Google Scholar 

  20. Brilakis ES, Banerjee S, Karmpaliotis D, Lombardi WL, Tsai TT, Shunk KA, et al. Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv. 2015;8:245–53.

    Article  Google Scholar 

  21. Thompson CA, Jayne JE, Robb JF, Friedman BJ, Kaplan AV, Hettleman BD, et al. Retrograde techniques and the impact of operator volume on percutaneous intervention for coronary chronic total occlusions an early US experience. JACC Cardiovasc Interv. 2009;2:834–42.

    Article  Google Scholar 

  22. Galassi AR, Sianos G, Werner GS, Escaned J, Tomasello SD, Boukhris M, et al. Retrograde recanalization of chronic total occlusions in europe: procedural, in-hospital, and long-term outcomes from the multicenter ERCTO Registry. J Am Coll Cardiol. 2015;65:2388–400.

    Article  Google Scholar 

  23. Sharma V, Jadhav ST, Harcombe AA, Kelly PA, Mozid A, Bagnall A, et al. Impact of proctoring on success rates for percutaneous revascularisation of coronary chronic total occlusions. Open Heart. 2015;2:e000228.

    Article  Google Scholar 

  24. Yamamoto M, Tsuchikane E, Kagase A, Shimura T, Teramoto T, Kimura M, et al. Novel proctorship effectively teaches interventionists coronary artery chronic total occlusion lesions. Cardiovasc Revasc Med. 2018;19:407–12.

    Article  Google Scholar 

  25. Suzuki Y, Tsuchikane E, Katoh O, Muramatsu T, Muto M, Kishi K, et al. Outcomes of percutaneous coronary interventions for chronic total occlusion performed by highly experienced japanese specialists: the first report from the Japanese CTO-PCI Expert Registry. JACC Cardiovasc Interv. 2017;10:2144–54.

    Article  Google Scholar 

  26. Tsuchikane E, Yamane M, Mutoh M, Matsubara T, Fujita T, Nakamura S, et al. Japanese multicenter registry evaluating the retrograde approach for chronic coronary total occlusion. Catheter Cardiovasc Interv. 2013;82:E654–61.

    Article  Google Scholar 

  27. Suzuki Y, Muto M, Yamane M, Muramatsu T, Okamura A, Igarashi Y, et al. Independent predictors of retrograde failure in CTO-PCI after successful collateral channel crossing. Catheter Cardiovasc Interv. 2017;90:E11–8.

    Article  Google Scholar 

  28. Galassi AR, Werner GS, Boukhris M, Azzalini L, Mashayekhi K, Carlino M, et al. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EuroIntervention. 2019;15:198–208.

    Article  Google Scholar 

  29. Saito Y, Kobayashi Y, Fujii K, Sonoda S, Tsujita K, Hibi K et al. (2021) Clinical expert consensus document on intravascular ultrasound from the Japanese Association of Cardiovascular Intervention and Therapeutics (2021). Cardiovasc Interv Ther

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19, Nishiazabu, Minatoku, Tokyo, 106-0031, Japan

    Shunsuke Matsuno & Yuji Oikawa

  2. Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan

    Maoto Habara & Etsuo Tsuchikane

  3. Department of Cardiology, Tokyo Heart Center, Tokyo, Japan

    Toshiya Muramatsu

  4. Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan

    Koichi Kishi

  5. Division of Cardiology, Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan

    Makoto Mutoh

  6. Cardiology Department, Saitama Sekishinkai Hospital, Saitama, Japan

    Masahisa Yamane

  7. Department of Cardiology, Tokorozawa Heart Center, Saitama, Japan

    Masami Sakurada

  8. Department of Cardiology, Mie Heart Center, Mie, Japan

    Masatoshi Miyahara

Authors
  1. Shunsuke Matsuno
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  2. Maoto Habara
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  3. Toshiya Muramatsu
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  4. Koichi Kishi
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  5. Makoto Mutoh
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  6. Yuji Oikawa
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  7. Masahisa Yamane
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  10. Etsuo Tsuchikane
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Correspondence to Shunsuke Matsuno.

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Supplementary Information

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12928_2022_840_MOESM1_ESM.tif

Supplementary Figure 1. Comparison in frequency and technical success rate of guidewire crossing strategies taken in the PAA group. ER = The Japanese CTO-PCI Expert Registry; RSGR = The Retrograde Summit General Registry (TIF 723 KB)

12928_2022_840_MOESM2_ESM.tif

Supplementary Figure 2. Comparison of ultimately used collateral channels in the PRA group. ER = The Japanese CTO-PCI Expert Registry; RSGR= The Retrograde Summit General Registry (TIF 501 KB)

12928_2022_840_MOESM3_ESM.tif

Supplementary Figure 3. The impact of the operator on the technical success in each subgroup. CABG = coronary artery bypass grafting; CI = confidence interval; eGFR = estimated glomerular filtration rate; J-CTO = multicenter CTO registry in Japan; PCI = percutaneous coronary intervention (TIF 1752 KB)

Supplementary file4 (DOCX 42 KB)

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Matsuno, S., Habara, M., Muramatsu, T. et al. Operator experience and clinical outcomes of percutaneous coronary intervention for chronic total occlusion: insights from a pooled analysis of the Japanese CTO PCI Expert Registry and the Retrograde Summit General Registry. Cardiovasc Interv and Ther 37, 670–680 (2022). https://doi.org/10.1007/s12928-022-00840-8

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  • DOI: https://doi.org/10.1007/s12928-022-00840-8

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