High success rates with hybrid algorithm for chronic total occlusion PCI
medwireNews: Use of the hybrid algorithm to guide chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with a high rate of success, study results suggest.
Joseph Dens (Ziekenhuis Oost-Limburg, Genk, Belgium) and colleagues validated the hybrid algorithm – an approach that was developed to optimize the use of techniques and materials during CTO PCI – using data in the RECHARGE registry from 1253 procedures performed in 1177 patients.
As reported in the Journal of the American College of Cardiology, the overall procedural success rate was 86%, and antegrade wire escalation was the most commonly used strategy, applied in 77% of patients.
In an accompanying editorial comment, David Holmes (Mayo Clinic, Rochester, Minnesota, USA) and colleagues write that “by using a systematic approach, success can be achieved in the majority of cases.”
Although rates of favorable outcome were high across operators with varying levels of experience, the authors demonstrated greater chance of success in hospitals performing more than 100 procedures per year compared with less experienced centers.
Holmes and colleagues note that “[t]here is increasing convergence and agreement on how to approach CTO-PCI, which is likely to further improve outcomes and improve training of new operators.”
Looking to the future, they add that conducting well-designed randomized controlled trials “using the clinical outcomes of death, myocardial infarction, quality of life, and repeat revascularization” should be the next priority to ascertain the best way to approach CTO PCI.
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