Chronic total occlusion (CTO) revascularization a comparison from Japanese and European expert CTO operators registries

Abstract Background Development of different strategies and devices improved CTO revascularization. However, technical and procedural success might be influenced by several factors including geographical expertise. Methods A total of 4412 CTO coronary treated lesions (Japan 1531 Europe 2881) (mean age 64.5±10.7, male 85.2%, JCTO score 2.09±1.24) were analyzed in European and Japanese registries during the year 2016. The primary endpoint was to assess technical success rate of CTO-PCI cases and procedural outcomes. Results Primary Antegrade approach and success rate were 71.5% and 90.8% respectively in Japan while 77.0% and 94.1%, respectively in Europe, (p<0001). Primary Retrograde approach and success rate were 28.5% and 84.0% respectively in Japan, while 22.6% and 69.2%, in Europe (p<0001). There were no differences in technical success rate between Japan and Europe (89.9% vs 88.5%, p=0.13). Procedural time was higher in Japan than in Europe 156.3±1.8 vs 107.1±1.3 mins (p<0.001), but contrast media volume resulted the opposite 209.6±3.2 ml vs 267.5±2.4 ml, (p<0.001). Procedural complications were higher in Japan than Europe (death: 0.4% vs 0.07%, p=0.024, myocardial infarction: 1.2% vs 0.57% p=0.045, coronary artery occlusion: 0.26% vs 0.07% p=0.026, coronary perforation: 4.22% vs 3.04% p=0.045). A multivariate analysis showed that independent predictors of failed procedure were both for Japan and Europe unsuccessful retrograde crossing channel, severe lesion calcification and occlusion length>20mm. Conclusions Technical success rate was similar between Japan and Europe, but more retrograde approach was common in Japan. Unsuccessful retrograde crossing channel, severe lesion calcification and occlusion length>20mm were independent predictors of failed procedures for both countries. Procedural complications were higher in Japan probably because of longer procedural time and higher frequency of retrograde approach. Funding Acknowledgement Type of funding source: None