CTO techniques: is there any room in daily practice? · 2017. 10. 11. · EURO CTO CLUB Sept 30th...
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9 th Interventional Symposium on High Risk and innovative Cardiac Interventions Meet The Experts MTE 2016 Prof. Alfredo R. Galassi MD, FESC, FACC, FSCAI Department of Medical Sciences and Pediatrics Cannizzaro Hospital, University of Catania, Italy CTO techniques: is there any room in daily practice?
Transcript of CTO techniques: is there any room in daily practice? · 2017. 10. 11. · EURO CTO CLUB Sept 30th...
9th I n t e r v e n t i o n a l S y m p o s i u m o n H i g h R i s k
a n d i n n o v a t i v e C a r d i a c I n t e r v e n t i o n s
Meet The Experts
MTE 2016
Prof. Alfredo R. Galassi MD, FESC, FACC, FSCAI Department of Medical Sciences and Pediatrics Cannizzaro Hospital, University of Catania, Italy
CTO techniques: is there any room in daily practice?
ü Looking at the advance in CTO PCI
CTO techniques: is there any room in
daily practice?
YES INDEED!!!!
Course Directors Nicolaus Reifart Main Taunus Kliniken Bad Soden, Germany Gerald S. Werner Medizinische Klinik Klinikum Darmstadt Darmstadt, Germany Co-Directors Alfredo R. Galassi Ferrarotto Hospital University of Catania Catania, Italy George Sianos AHEPA University Hospital Thessaloniki, Greece Hans Bonnier University Hospital Brussels Brussels, Belgium
Procedural complications and in-hospital outcome
Galassi et al, EuroIntervention 2011
0
500
1000
1500
2000
2500
3000
2008 2009 2010 2011 2012 2013 2014 2015
1303
1724
2189
2634 2603 2660 2615 2404
Online Registry 2008-2015
0%
20%
40%
60%
80%
100%
2008 2009 2010 2011 2012 2013 2014 2015
50 31 28.6 20.5 18.8 14.6 16.6
5.5
50 69 71.4 79.5 81.2 85.4 83.4
94.5
Antegrade only Retrograde + Antegrade
Antegrade/Retrograde Operators
0%
20%
40%
60%
80%
100%
2008 2009 2010 2011 2012 2013 2014 2015
90 88.5 89.5 86 77 71 72.4 64.9
10 11.5 10.5 14 23 29 27.6 35.1
Antegrade Retrograde± Antegrade
Antegrade/Retrograde Procedures
0
20
40
60
80
100
2008 2009 2010 2011 2012 2013 2014 2015
85.5 86.5 88.1 87.6 87.8 90.3 87 89.3
73.6 64.2
77.1 76.5 77.8 79.5 82.2 83.3
Antegrade Retrograde
Angiographic Success %
0
0.5
1
1.5
2
2.5
3
3.5
2008 2009 2010 2011 2012 2013 2014 2015
Death
Myocardial infarction Vascular complication
Donor vessel dissection
Cardiac tamponade
Coronary perforation
Procedural Complications
Course Directors Nicolaus Reifart Main Taunus Kliniken Bad Soden, Germany Gerald S. Werner Medizinische Klinik Klinikum Darmstadt Darmstadt, Germany Co-Directors Alfredo R. Galassi Ferrarotto Hospital University of Catania Catania, Italy George Sianos AHEPA University Hospital Thessaloniki, Greece Hans Bonnier University Hospital Brussels Brussels, Belgium
ü Looking at the importance on Health Outcomes
CTO techniques: is there any room in
daily practice?
YES INDEED!!!!
Health outcomes (symptoms, functional status, and quality of life)
The concept of health outcomes involves:
ü Angina
ü Dyspnea
ü Exercice tolerance
ü Limitation of activities
ü Medication burden
ü Self-image
ü Social functioning
Course Directors Nicolaus Reifart Main Taunus Kliniken Bad Soden, Germany Gerald S. Werner Medizinische Klinik Klinikum Darmstadt Darmstadt, Germany Co-Directors Alfredo R. Galassi Ferrarotto Hospital University of Catania Catania, Italy George Sianos AHEPA University Hospital Thessaloniki, Greece Hans Bonnier University Hospital Brussels Brussels, Belgium
Course Directors Nicolaus Reifart Main Taunus Kliniken Bad Soden, Germany Gerald S. Werner Medizinische Klinik Klinikum Darmstadt Darmstadt, Germany Co-Directors Alfredo R. Galassi Ferrarotto Hospital University of Catania Catania, Italy George Sianos AHEPA University Hospital Thessaloniki, Greece Hans Bonnier University Hospital Brussels Brussels, Belgium
Antegrade Retrograde Overall
1582 pts enrolled in 44 European centers
Course Directors Nicolaus Reifart Main Taunus Kliniken Bad Soden, Germany Gerald S. Werner Medizinische Klinik Klinikum Darmstadt Darmstadt, Germany Co-Directors Alfredo R. Galassi Ferrarotto Hospital University of Catania Catania, Italy George Sianos AHEPA University Hospital Thessaloniki, Greece Hans Bonnier University Hospital Brussels Brussels, Belgium
Galassi AR et al, on behalf of the Euro CTO Club
ü Looking at the importance on Survival Outcome
CTO techniques: is there any room in
daily practice?
YES INDEED!!!!
Khan et al. CCI 2013
Comparison between successful and failed procedures
CTO Long-term survival and overall clinical outcomes
Meta-analysis of 23 studies (12.970 pts at a mean FU of 3.7+2.1 years)
Jang et al. JACC intv 2015
Tomasello et al, Eur Heart J 2015
Tomasello et al, Eur Heart J 2015
Survival free from MACCE and cardiac death in pts (No:619) treated with PCI or medical therapy after propensity score adjustement
The EURO-CTO Trial (NCT01760083) Evaluation of the Utilisation of Revascularisation vs Optimal medical therapy for CTOs
450 patients
40 operators >80% success rate
Started 2012 Summer 2016 expected result
Primary efficacy endpoint: Quality of life after 1 year Primary safety endpoint: MACE from procedure through 3 years
Galassi et al, Eur Heart J 2015
Indications of CTO revascularization according to symptoms, ischemia and viability
Galassi et al, Eur Heart J 2015
EURO CTO CLUB Sept 30th – Oct 01st, 2016 Krakow, Poland
8th Experts "Live" CTO Workshop 2016
ECC-President Alfredo R. Galassi, Italy
Course Directors Co-Directors Jaroslaw Wójcik, Poland George Sianos, Greece Leszek Bryniarski, Poland Nicolas Boudou, France
Thank You For Your Attention
www.alfredogalassi.com
