Improvement of angiographic and clinical outcomes of percutaneous coronary intervention for chronic total occlusion after implementation of a dedicated team: a single-centre experience

Introduction In a Dutch heart centre, a dedicated chronic total occlusion (CTO) team was implemented in June 2017. The aim of this study was to the evaluate treatment success and clinical outcomes before and after this implementation. Methods A total of 662 patients who underwent percutaneous coronary intervention (PCI) for a CTO between January 2013 and June 2020 were included and divided into pre- and post-CTO team groups. The primary endpoint was the angiographic success rate of CTO-PCI. Secondary endpoints included angiographic success stratified by complexity using the J-CTO score and the following clinical outcomes: in-hospital complications and myocardial infarction, target vessel revascularisation, all-cause mortality, quality of life (QoL) and major adverse cardiac events (MACE) at 30-day and 1-year follow-up. Results Compared with the pre-CTO team group, the success rate in the post-CTO team group was higher after the first attempt (81.4% vs 62.7%; p < 0.001) and final attempt (86.7% vs 73.8%; p = 0.001). This was mainly driven by higher success rates for difficult and very difficult CTO lesions according to the J-CTO score. The MACE rate at 1 year was lower in the post-CTO team group than in the pre-CTO team group (6.4% vs 16.0%; p < 0.01), while it was comparable at 30-day follow-up (0.1% vs 1.7%; p = 0.74). Angina symptoms were significantly reduced at 30-day and 1-year follow-up, and QoL scores were higher after 1 year. Conclusion This study demonstrated higher success rates of CTO-PCI and improved clinical outcomes and QoL at 1-year follow-up after implementation of a dedicated CTO team using the hybrid algorithm.

Automated summary

This study examined the impact of implementing a dedicated chronic total occlusion (CTO) team in a Dutch heart centre. The results showed that the success rate of CTO-PCI procedures increased after the implementation of the CTO team, especially for difficult and very difficult CTO lesions. The clinical outcomes and quality of life of patients also improved at the 1-year follow-up.