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Castaldi G, Kovacic M, Poletti E, Benedetti A, Moroni A, Scott B, Wilgenhof A, Bezzeccheri A, Vescovo G, Budassi S, El Jattari H, Convens C, Verheye S, Vermeersch P, Zivelonghi C, Tumscitz C, Agostoni P. Minimalistic Hybrid Approach for the Percutaneous Treatment of Coronary Chronic Total Occlusions: Midterm Follow-Up of an International Multicenter Cohort. Am J Cardiol 2024; 214:77-84. [PMID: 38160923 DOI: 10.1016/j.amjcard.2023.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/26/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
The minimalistic hybrid approach (MHA) is a recently proposed algorithm to perform chronic total occlusion (CTO) percutaneous coronary intervention (PCI), reducing the overall invasiveness of the procedure without impacting the acute results. However, data on midterm results are lacking. This study aimed to evaluate the midterm clinical outcomes of a multicenter international cohort of CTO PCI treated according to the MHA. Data from a consecutive series of patients with a CTO who underwent PCI according to the MHA between February 2019 and March 2022 were prospectively collected in 3 European centers and retrospectively analyzed. The main outcome was the first occurrence of a major adverse cardiac event (MACE), defined as a composite outcome of all-cause death, any myocardial infarction, and target vessel revascularization, at the last follow-up available. A total of 212 patients were included. The majority of the patients were symptomatic for angina (Canadian Cardiovascular Society class 2 or 3: 63.7%) at the time of the index procedure. The mean Japanese-CTO and CASTLE scores were 2.1 ± 1.2 and 2.0 ± 1.3, respectively. Technical success (CTO open with optimal flow) was achieved in 198 patients (93.9%) and procedural success (technical success without in-hospital MACEs) in 195 (91.9%). At the last follow-up available (median 677 days), the cumulative incidence rate of MACEs was 11.5%; in particular, all-cause death was 7.4%, any myocardial infarction was 4.3%, and unplanned target vessel revascularization was 6.5%. In conclusion, the midterm results of the MHA seem to be in line with contemporary results of other CTO PCI algorithms, thus potentially validating the MHA as a valuable alternative, provided that interventionalists are already expert CTO operators and accustomed to the definitions and peculiarities of MHA.
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Affiliation(s)
- Gianluca Castaldi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | - Enrico Poletti
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alice Benedetti
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alice Moroni
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Adriaan Wilgenhof
- Cardiovascular Center Aalst, Onze Lieve Vrouw Clinic, Aalst, Belgium
| | - Andrea Bezzeccheri
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Giovanni Vescovo
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science, Ospedale dell'Angelo, Venice, Italy
| | - Simone Budassi
- Cardiovascular Sciences Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Hicham El Jattari
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carl Convens
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Tumscitz
- Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
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