Impact of proctoring on success rates for percutaneous revascularisation of coronary chronic total occlusions

Vinoda Sharma, S T Jadhav, A A Harcombe, P A Kelly, A Mozid, A Bagnall, J Richardson, M Egred, M McEntegart, A Shaukat, K Oldroyd, G Vishwanathan, O Rana, S Talwar, M McPherson, J W Strange, C G Hanratty, S J Walsh, J C Spratt, W H T Smith, Vinoda Sharma, S T Jadhav, A A Harcombe, P A Kelly, A Mozid, A Bagnall, J Richardson, M Egred, M McEntegart, A Shaukat, K Oldroyd, G Vishwanathan, O Rana, S Talwar, M McPherson, J W Strange, C G Hanratty, S J Walsh, J C Spratt, W H T Smith

Abstract

Objective: To assess the impact of proctoring for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in six UK centres.

Methods: We retrospectively analysed 587 CTO procedures from six UK centres and compared success rates of operators who had received proctorship with success rates of the same operators before proctorship (pre-proctored) and operators in the same institutions who had not been proctored (non-proctored). There were 232 patients in the pre-proctored/non-proctored group and 355 patients in the post-proctored group. Complexity was assessed by calculating the Japanese CTO (JCTO) score for each case.

Results: CTO PCI success was greater in the post-proctored compared with the pre-proctored/non-proctored group (77.5% vs 62.1%, p<0.0001). In more complex cases where JCTO≥2, the difference in success was greater (70.7% vs 49.5%, p=0.0003). After proctoring, there was an increase in CTO PCI activity in centres from 2.5% to 3.5%, p<0.0001 (as a proportion of total PCI), and the proportion of very difficult cases with JCTO score ≥3 increased from 15.3% (35/229) to 29.7% (105/354), p<0.0001.

Conclusions: Proctoring resulted in an increase in procedural success for CTO PCI, an increase in complex CTO PCI and an increase in total CTO PCI activity. Proctoring may be a valuable way to improve access to CTO PCI and the likelihood of procedural success.

Figures

Figure 1
Figure 1
Success rates for procedures undertaken by pre-proctored/non-proctored and post-proctored operators categorised according to JCTO score. JCTO score 0/1 implies easy or moderate and JCTO score ≥2 implies difficult or very difficult. In each bar successful procedures are further categorised by final successful strategy. The proctored group had significantly more overall success compared with the pre-proctored/non-proctored group (77.5% vs 62.1%, respectively, p

References

    1. Patel VG, Brayton KM, Tamayo A et al. . Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies. JACC Cardiovasc Interv 2013;6:128–36. 10.1016/j.jcin.2012.10.011
    1. Syrseloudis D, Secco GG, Barrero EA et al. . Increase in J-CTO lesion complexity score explains the disparity between recanalisation success and evolution of chronic total occlusion strategies: insights from a single-centre 10-year experience. Heart 2013;99:474–9. 10.1136/heartjnl-2012-303205
    1. Fefer P, Knudtson ML, Cheema AN et al. . Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol 2012;59:991–7. 10.1016/j.jacc.2011.12.007
    1. Morino Y, Abe M, Morimoto T et al. . J-CTO Registry Investigators. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv 2011;4:213–21. 10.1016/j.jcin.2010.09.024
    1. Rinfret S, Joyal D, Nguyen CM et al. . Retrograde recanalization of chronic total occlusions from the transradial approach; early Canadian experience. Catheter Cardiovasc Interv 2011;78:366–74. 10.1002/ccd.23140
    1. Brilakis ES, Grantham JA, Rinfret S et al. . A percutaneous treatment algorithm for crossing coronary chronic total occlusions. JACC Cardiovasc Interv 2012;5:367–79. 10.1016/j.jcin.2012.02.006
    1. Pershad A, Eddin M, Girotra S et al. . Validation and incremental value of the hybrid algorithm for CTO PCI. Catheter Cardiovasc Interv 2014;84:654–9. 10.1002/ccd.25370
    1. Grantham JA, Marso SP, Spertus J et al. . Chronic total occlusion angioplasty in the United States. JACC Cardiovasc Interv 2009;2:479–86. 10.1016/j.jcin.2009.02.008
    1. Michael TT, Karmpaliotis D, Brilakis ES et al. . Impact of prior coronary artery bypass graft surgery on chronic total occlusion revascularisation: insights from a multicentre US registry. Heart 2013;99:1515–18. 10.1136/heartjnl-2013-303763
    1. Smith EJ, Strange JW, Hanratty CG et al. . Percutaneous intervention for chronic total occlusion: integrating strategies to address an unmet need. Heart 2013;99:1471–4. 10.1136/heartjnl-2013-304521
    1. Michael TT, Karmpaliotis D, Brilakis ES et al. . Procedural outcomes of revascularization of chronic total occlusion of native coronary arteries (from a multicenter United States registry). Am J Cardiol 2013;112:488–92. 10.1016/j.amjcard.2013.04.008

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅