Aim To assess the impact of a new CTO PCI program on the procedural success rates and reduction in major complications
Background Successful CTO PCI has been shown to reduce burden of angina, left ventricular function and survival. Patient selection, lesion complexity, treatment approach, operator experience and use of new technology are some of the determinants of a successful procedure. BCIS and Eurpean CTO club recommended > 50 cases/operator as one of the parameters of an optimal CTO service. Taking all these factors in to account, we embarked upon a new program in March 2011, with the aim of achieving 80% success rate.
Methods The new program included identifying two leads for CTO service backed by two other CTO enthusiasts, who would deal with majority of CTO referrals; learning the new techniques and using the new technologies; buddying up for complex cases; optimise patient selection by using stress imaging and engaging with local cardiologists and surgeons; use hybrid approach; modify working patterns by using ‘double slots’ and educating and involving the cath lab staff and nurses.
Success was defined as TIMI 3 flow in the target vessel at the end of the procedure. Major complications included coronary perforations, tamponade, aortic dissection, emergency CABG; in-hospital repeat PCI in the target vessel, acute myocardial infarction and death.
We retrospectively analysed the yearly outcome data.
Results Before implementation of the program, in 2010–2011, CTO PCI was attempted in 172 patients with a procedural success of 70% and 4.6% major complications. In 2012, 169 patients underwent CTO PCI with success rate of 82% and major complication rate of 4.1%. In 2013, CTO PCI was attempted in 156 patients. Success rate was 81% and rate of major complication was 2.5%
Conclusions With the new approach to dealing with CTOs we have achieved higher success rate and low rates of major complication which is compatible with internationally published data, Our experience could serve as a template for establishing successful CTO program in other interventional centres in UK and wider world.
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