International survey of chronic total occlusion percutaneous coronary intervention operators
Bahadir Simsek MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorAthanasios Rempakos MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorSpyridon Kostantinis MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorMichaella Alexandrou MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorJudit Karacsonyi MD, PhD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorBavana V. Rangan BDS, MPH
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorOlga C. Mastrodemos BA
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorDeniz Mutlu MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorNidal Abi Rafeh MD
Department of Cardiology, North Oaks Health System, Hammond, Louisiana, USA
Search for more papers by this authorKhaldoon Alaswad MD
Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
Search for more papers by this authorAlexandre Avran MD
Centre Hospitalier de Valenciennes, Valenciennes, France
Search for more papers by this authorLorenzo Azzalini MD, PhD, MSc
Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
Search for more papers by this authorAhmed ElGuindy MD
Adult Cardiology Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
Search for more papers by this authorMohaned Egred MD
Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
Search for more papers by this authorOmer Goktekin MD
Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
Search for more papers by this authorSevket Gorgulu MD
Department of Cardiology, Biruni University, Istanbul, Turkey
Search for more papers by this authorWissam Jaber MD
Department of Cardiology, Emory University, Atlanta, Georgia, USA
Search for more papers by this authorKathleen E. Kearney MD
Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
Search for more papers by this authorAjay J. Kirtane MD, SM
Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
Search for more papers by this authorWilliam L. Lombardi MD
Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
Search for more papers by this authorKambis Mashayekhi MD
Department for Internal Medicine and Cardiology, Heartcenter Lahr, Lahr, Germany
Search for more papers by this authorMargaret McEntegart MD
Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
Search for more papers by this authorWilliam Nicholson MD
Department of Cardiology, Emory University, Atlanta, Georgia, USA
Search for more papers by this authorStephane Rinfret MD, SM
Department of Cardiology, Emory University, Atlanta, Georgia, USA
Search for more papers by this authorSalman S. Allana MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorYader Sandoval MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorM. Nicholas Burke MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorCorresponding Author
Emmanouil S. Brilakis MD, PhD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Correspondence Emmanouil S. Brilakis, MD, PhD, Center for Coronary Artery Disease at the Minneapolis Heart Institute Foundation, Minneapolis Heart Institute, 920 E 28th St #300, Minneapolis, MN 55407, USA.
Email: [email protected]
Search for more papers by this authorBahadir Simsek MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorAthanasios Rempakos MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorSpyridon Kostantinis MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorMichaella Alexandrou MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorJudit Karacsonyi MD, PhD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorBavana V. Rangan BDS, MPH
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorOlga C. Mastrodemos BA
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorDeniz Mutlu MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorNidal Abi Rafeh MD
Department of Cardiology, North Oaks Health System, Hammond, Louisiana, USA
Search for more papers by this authorKhaldoon Alaswad MD
Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
Search for more papers by this authorAlexandre Avran MD
Centre Hospitalier de Valenciennes, Valenciennes, France
Search for more papers by this authorLorenzo Azzalini MD, PhD, MSc
Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
Search for more papers by this authorAhmed ElGuindy MD
Adult Cardiology Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
Search for more papers by this authorMohaned Egred MD
Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
Search for more papers by this authorOmer Goktekin MD
Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
Search for more papers by this authorSevket Gorgulu MD
Department of Cardiology, Biruni University, Istanbul, Turkey
Search for more papers by this authorWissam Jaber MD
Department of Cardiology, Emory University, Atlanta, Georgia, USA
Search for more papers by this authorKathleen E. Kearney MD
Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
Search for more papers by this authorAjay J. Kirtane MD, SM
Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
Search for more papers by this authorWilliam L. Lombardi MD
Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
Search for more papers by this authorKambis Mashayekhi MD
Department for Internal Medicine and Cardiology, Heartcenter Lahr, Lahr, Germany
Search for more papers by this authorMargaret McEntegart MD
Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
Search for more papers by this authorWilliam Nicholson MD
Department of Cardiology, Emory University, Atlanta, Georgia, USA
Search for more papers by this authorStephane Rinfret MD, SM
Department of Cardiology, Emory University, Atlanta, Georgia, USA
Search for more papers by this authorSalman S. Allana MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorYader Sandoval MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorM. Nicholas Burke MD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Search for more papers by this authorCorresponding Author
Emmanouil S. Brilakis MD, PhD
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Correspondence Emmanouil S. Brilakis, MD, PhD, Center for Coronary Artery Disease at the Minneapolis Heart Institute Foundation, Minneapolis Heart Institute, 920 E 28th St #300, Minneapolis, MN 55407, USA.
Email: [email protected]
Search for more papers by this authorAbstract
Background
Contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) practice has received limited study.
Aim
To examine the contemporary CTO PCI practice.
Methods
We performed an online, anonymous, international survey of CTO PCI operators.
Results
Five hundred forty-five CTO PCI operators and 190 interventional cardiology fellows with an interest in CTO PCI participated in this survey. Almost half were from the United States (41%), most (93%) were men, and the median h/week spent in the hospital was 58. Median annual case numbers were 205 (150−328) for PCIs and 20 (5−50) for CTO PCIs. Almost one-fifth (17%) entered CTO cases into registries, such as PROGRESS-CTO (55%) and EuroCTO (20%). More than one-third worked at academic institutions (39%), 31% trained dedicated CTO fellows, and 22% proctored CTO PCI. One-third (34%) had dedicated CTO PCI days. Most (51%) never discharged CTO patients the same day, while 17% discharged CTO patients the same day >50% of the time. After successful guidewire crossing, 38% used intravascular imaging >90% of the time. Most used CTO scores including J-CTO (81%), PROGRESS-CTO (35%), and PROGRESS-CTO complications scores (30%). Coronary artery perforation was encountered within the last month by 19%. On a scale of 0−10, the median comfort levels in treating coronary artery perforation were: covered stents 8.8 (7.0−10), coil embolization 5.0 (2.1−8.5), and fat embolization 3.7 (0.6−7.3). Most (51%) participants had a complication cart/kit and 25% conducted regular complication drills with catheterization laboratory staff.
Conclusion
Contemporary CTO PCI practices vary widely. Further research on barriers to following the guiding principles of CTO PCI may improve patient outcomes.
Open Research
DATA AVAILABILITY STATEMENT
Research data are not shared.
REFERENCES
- 1Rempakos A, Kostantinis S, Simsek B, et al. Update on chronic total occlusion percutaneous coronary intervention. J Invasive Cardiol. 2023; 35(4): 194.
10.25270/jic/22.00375 Google Scholar
- 2Brilakis ES, Mashayekhi K, Tsuchikane E, et al. Guiding principles for chronic total occlusion percutaneous coronary intervention. Circulation. 2019; 140(5): 420-433.
- 3Ybarra LF, Rinfret S, Brilakis ES, et al. Definitions and clinical trial design principles for coronary artery chronic total occlusion therapies: CTO-ARC consensus recommendations. Circulation. 2021; 143(5): 479-500.
- 4Patel SM, Menon RV, Burke MN, et al. Current perspectives and practices on chronic total occlusion percutaneous coronary interventions. J Invasive Cardiol. 2018; 30(2): 43-50.
- 5Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009; 42(2): 377-381.
- 6Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inf. 2019; 95:103208.
- 7Harold JG, Bass TA, Bashore TM, et al. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on clinical competence and training (writing committee to revise the 2007 clinical competence statement on cardiac interventional procedures). Circulation. 2013; 128(4): 436-472.
- 8Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011; 124(23): 574-651.
- 9Fanaroff AC, Zakroysky P, Dai D, et al. Outcomes of PCI in relation to procedural characteristics and operator volumes in the United States. J Am Coll Cardiol. 2017; 69(24): 2913-2924.
- 10Krishnamurthy A, Keeble CM, Anderson M, et al. Association between operator volume and mortality in primary percutaneous coronary intervention. Open Heart. 2022; 9(2):e002072.
- 11Saito Y, Tateishi K, Kanda M, et al. Volume-outcome relationships for percutaneous coronary intervention in acute myocardial infarction. J Am Heart Assoc. 2022; 11(6):e023805.
- 12Simsek B, Kostantinis S, Karacsonyi J, et al. International percutaneous coronary intervention complication survey. Catheter Cardiovasc Interv. 2022; 99(6): 1733-1740.
- 13Azzalini L, Karmpaliotis D, Santiago R, et al. Contemporary issues in chronic total occlusion percutaneous coronary intervention. JACC: Cardiovasc Interve. 2022; 15(1): 1-21.
- 14Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022; 145(3): e4-e17.
- 15Simsek B, Kostantinis S, Karacsonyi J, et al. Predicting periprocedural complications in chronic total occlusion percutaneous coronary intervention. JACC: Cardiovasc Interve. 2022; 15(14): 1413-1422.
- 16Hannan EL, Zhong Y, Reddy P, et al. Percutaneous coronary intervention with and without intravascular ultrasound for patients with complex lesions: utilization, mortality, and target vessel revascularization. Circulation: Cardiovasc Interve. 2022; 15(6):e011687.
- 17Park DY, Vemmou E, An S, et al. Trends and impact of intravascular ultrasound and optical coherence tomography on percutaneous coronary intervention for myocardial infarction. IJC Heart Vasculature. 2023; 45:101186.
- 18Karacsonyi J, Kostantinis S, Simsek B, et al. Intravascular imaging use in percutaneous coronary interventions of chronic total occlusions. J Invasive Cardiol. 2023; 35(5): 265.
10.25270/jic/23.00002 Google Scholar
- 19Kostantinis S, Simsek B, Karacsonyi J, et al. Equipment utilization in chronic total occlusion percutaneous coronary interventions: update from the PROGRESS-CTO registry. J Invasive Cardiol. 2023; 35(2): E61-e69.
- 20Simsek B, Kostantinis S, Karacsonyi J, et al. Educational experience of interventional cardiology fellows in the United States and Canada. JACC: Cardiovasc Interve. 2023; 16(3): 247-257.
- 21Medscape. Medscape cardiologist lifestyle, happiness & burnout report 2023. 2023.
- 22Medscape. Medscape cardiologist lifestyle, happiness & burnout report 2022. 2022.
- 23Simsek B, Rempakos A, Kostantinis S, et al. International psychological well-being survey of interventional cardiologists. JACC: Cardiovasc Interve. 2023; 16(11): 1401-1407.
