European RECHARGE Registry Evaluates Hybrid Algorithm for Treating CTO
October 24, 2016—A report of the RECHARGE Registry, which is developing a hybrid algorithm to improve outcomes for percutaneous coronary intervention (PCI) treatment of chronic total occlusions (CTOs) in Europe, was published by Joren Maeremans, MS, et al in the Journal of the American College of Cardiology (JACC; 2016;68:1958–1970).
According to the investigators, the RECHARGE (Registry of Crossboss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom) registry aims to report achievable results using the hybrid algorithm.
As summarized in JACC, the RECHARGE investigators prospectively enrolled consecutive patients undergoing hybrid CTO-PCI at 17 centers between January 2014 and October 2015 to analyze procedural techniques, outcomes, and in-hospital complications. A total of 1,253 CTO-PCIs were performed in 1,177 patients (mean age, 66 ± 11 years), of which 86% were men.
The investigators reported that the average Japanese CTO score was 2.0 ± 1.0, and was higher in the failure group (2.6 ± 0.6 vs 1.9 ± 1.0; P < .001). Overall procedure success was 86% and major in-hospital complications occurred in 2.6% of procedures. Antegrade wire escalation was the preferred primary strategy in 77% of procedures, followed by retrograde (17%) and antegrade dissection re-entry strategies (7%).
Primary strategies were successful in 60% of procedures. Consecutive strategies were applied in 34% with a 74% success rate. Antegrade dissection re-entry and retrograde strategies were the most common bailout strategies and were successful in 67% and 62%, respectively.
The investigators found that median procedure and fluoroscopy time were 90 (interquartile range [IQR]: 60 to 120) minutes and 35 (IQR: 21 to 55) minutes. Contrast volume was 250 mL (IQR: 180 to 340), and radiation doses (air kerma and dose area product) were 1.6 Gy (IQR: 1.0 to 2.7) and 98 Gy·cm2 (IQR: 57 to 168), respectively.
High procedure and patient success rates, combined with a low event rate and improved procedural characteristics, support further use of the hybrid algorithm for a broad community of appropriately trained CTO operators, concluded the RECHARGE investigators in JACC.