The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe

The RECHARGE Registry

Joren Maeremans, Simon Walsh, Paul Knaapen, James C. Spratt, Alexandre Avran, Colm G. Hanratty, Benjamin Faurie, Pierfrancesco Agostoni, Erwan Bressollette, Peter Kayaert, Alan J. Bagnall, Mohaned Egred, Dave Smith, Alexander Chase, Margaret B. McEntegart, William H. T. Smith, Alun Harcombe, Paul Kelly, John Irving, Elliot J. Smith & 2 others Julian W. Strange, Joseph Dens

    Research output: Contribution to journalArticle

    65 Citations (Scopus)

    Abstract

    Background: The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking.

    Objectives: 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.

    Methods: Between January 2014 and October 2015, consecutive patients undergoing hybrid CTO-PCI were prospectively enrolled in 17 centers. Procedural techniques, outcomes, and in-hospital complications were analyzed.

    Results: A total of 1,253 CTO-PCIs were performed in 1,177 patients, of which 86% were men. Mean age was 66 ± 11 years. 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 < 0.001). Overall procedure success was 86% and major in-hospital complications occurred in 2.6%. Antegrade wire escalation was the preferred primary strategy in 77%, followed by retrograde (17%) and antegrade dissection re-entry strategies (7%). Primary strategies were successful in 60%. Consecutive strategies were applied in 34% and were successful in 74%. Antegrade dissection re-entry and retrograde strategies were the most common bailout strategies and were successful in 67% and 62%, respectively. Median procedure and fluoroscopy time were 90 (interquartile range [IQR]: 60 to 120) min and 35 (IQR: 21 to 55) min, contrast volume was 250 (IQR: 180 to 340) ml, and radiation doses (air kerma and dose area product) were 1.6 (IQR: 1.0 to 2.7) Gy and 98 (IQR: 57 to 168) Gy·cm(2), respectively.

    Conclusions: 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.

    Original languageEnglish
    Pages (from-to)1958-1970
    Number of pages13
    JournalJournal of the American College of Cardiology
    Volume68
    Issue number18
    Early online date24 Oct 2016
    DOIs
    Publication statusPublished - 1 Nov 2016

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    Registries
    Percutaneous Coronary Intervention
    Dissection
    Fluoroscopy
    Belgium
    Netherlands
    France
    Air
    Prospective Studies
    Radiation

    Keywords

    • Chronic total occlusion
    • Hybrid
    • Percutaneous coronary intervention

    Cite this

    Maeremans, J., Walsh, S., Knaapen, P., Spratt, J. C., Avran, A., Hanratty, C. G., ... Dens, J. (2016). The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe: The RECHARGE Registry. Journal of the American College of Cardiology, 68(18), 1958-1970. https://doi.org/10.1016/j.jacc.2016.08.034
    Maeremans, Joren ; Walsh, Simon ; Knaapen, Paul ; Spratt, James C. ; Avran, Alexandre ; Hanratty, Colm G. ; Faurie, Benjamin ; Agostoni, Pierfrancesco ; Bressollette, Erwan ; Kayaert, Peter ; Bagnall, Alan J. ; Egred, Mohaned ; Smith, Dave ; Chase, Alexander ; McEntegart, Margaret B. ; Smith, William H. T. ; Harcombe, Alun ; Kelly, Paul ; Irving, John ; Smith, Elliot J. ; Strange, Julian W. ; Dens, Joseph. / The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe : The RECHARGE Registry. In: Journal of the American College of Cardiology. 2016 ; Vol. 68, No. 18. pp. 1958-1970.
    @article{7922c4d7e2704e5b9d06870b39606a9a,
    title = "The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe: The RECHARGE Registry",
    abstract = "Background: The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking.Objectives: 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.Methods: Between January 2014 and October 2015, consecutive patients undergoing hybrid CTO-PCI were prospectively enrolled in 17 centers. Procedural techniques, outcomes, and in-hospital complications were analyzed.Results: A total of 1,253 CTO-PCIs were performed in 1,177 patients, of which 86{\%} were men. Mean age was 66 ± 11 years. 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 < 0.001). Overall procedure success was 86{\%} and major in-hospital complications occurred in 2.6{\%}. Antegrade wire escalation was the preferred primary strategy in 77{\%}, followed by retrograde (17{\%}) and antegrade dissection re-entry strategies (7{\%}). Primary strategies were successful in 60{\%}. Consecutive strategies were applied in 34{\%} and were successful in 74{\%}. Antegrade dissection re-entry and retrograde strategies were the most common bailout strategies and were successful in 67{\%} and 62{\%}, respectively. Median procedure and fluoroscopy time were 90 (interquartile range [IQR]: 60 to 120) min and 35 (IQR: 21 to 55) min, contrast volume was 250 (IQR: 180 to 340) ml, and radiation doses (air kerma and dose area product) were 1.6 (IQR: 1.0 to 2.7) Gy and 98 (IQR: 57 to 168) Gy·cm(2), respectively.Conclusions: 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.",
    keywords = "Chronic total occlusion, Hybrid, Percutaneous coronary intervention",
    author = "Joren Maeremans and Simon Walsh and Paul Knaapen and Spratt, {James C.} and Alexandre Avran and Hanratty, {Colm G.} and Benjamin Faurie and Pierfrancesco Agostoni and Erwan Bressollette and Peter Kayaert and Bagnall, {Alan J.} and Mohaned Egred and Dave Smith and Alexander Chase and McEntegart, {Margaret B.} and Smith, {William H. T.} and Alun Harcombe and Paul Kelly and John Irving and Smith, {Elliot J.} and Strange, {Julian W.} and Joseph Dens",
    note = "Copyright {\circledC} 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.",
    year = "2016",
    month = "11",
    day = "1",
    doi = "10.1016/j.jacc.2016.08.034",
    language = "English",
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    Maeremans, J, Walsh, S, Knaapen, P, Spratt, JC, Avran, A, Hanratty, CG, Faurie, B, Agostoni, P, Bressollette, E, Kayaert, P, Bagnall, AJ, Egred, M, Smith, D, Chase, A, McEntegart, MB, Smith, WHT, Harcombe, A, Kelly, P, Irving, J, Smith, EJ, Strange, JW & Dens, J 2016, 'The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe: The RECHARGE Registry', Journal of the American College of Cardiology, vol. 68, no. 18, pp. 1958-1970. https://doi.org/10.1016/j.jacc.2016.08.034

    The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe : The RECHARGE Registry. / Maeremans, Joren; Walsh, Simon; Knaapen, Paul; Spratt, James C.; Avran, Alexandre; Hanratty, Colm G.; Faurie, Benjamin; Agostoni, Pierfrancesco; Bressollette, Erwan; Kayaert, Peter; Bagnall, Alan J.; Egred, Mohaned; Smith, Dave; Chase, Alexander; McEntegart, Margaret B.; Smith, William H. T.; Harcombe, Alun; Kelly, Paul; Irving, John; Smith, Elliot J.; Strange, Julian W.; Dens, Joseph (Lead / Corresponding author).

    In: Journal of the American College of Cardiology, Vol. 68, No. 18, 01.11.2016, p. 1958-1970.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - The Hybrid Algorithm for Treating Chronic Total Occlusions in Europe

    T2 - The RECHARGE Registry

    AU - Maeremans, Joren

    AU - Walsh, Simon

    AU - Knaapen, Paul

    AU - Spratt, James C.

    AU - Avran, Alexandre

    AU - Hanratty, Colm G.

    AU - Faurie, Benjamin

    AU - Agostoni, Pierfrancesco

    AU - Bressollette, Erwan

    AU - Kayaert, Peter

    AU - Bagnall, Alan J.

    AU - Egred, Mohaned

    AU - Smith, Dave

    AU - Chase, Alexander

    AU - McEntegart, Margaret B.

    AU - Smith, William H. T.

    AU - Harcombe, Alun

    AU - Kelly, Paul

    AU - Irving, John

    AU - Smith, Elliot J.

    AU - Strange, Julian W.

    AU - Dens, Joseph

    N1 - Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

    PY - 2016/11/1

    Y1 - 2016/11/1

    N2 - Background: The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking.Objectives: 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.Methods: Between January 2014 and October 2015, consecutive patients undergoing hybrid CTO-PCI were prospectively enrolled in 17 centers. Procedural techniques, outcomes, and in-hospital complications were analyzed.Results: A total of 1,253 CTO-PCIs were performed in 1,177 patients, of which 86% were men. Mean age was 66 ± 11 years. 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 < 0.001). Overall procedure success was 86% and major in-hospital complications occurred in 2.6%. Antegrade wire escalation was the preferred primary strategy in 77%, followed by retrograde (17%) and antegrade dissection re-entry strategies (7%). Primary strategies were successful in 60%. Consecutive strategies were applied in 34% and were successful in 74%. Antegrade dissection re-entry and retrograde strategies were the most common bailout strategies and were successful in 67% and 62%, respectively. Median procedure and fluoroscopy time were 90 (interquartile range [IQR]: 60 to 120) min and 35 (IQR: 21 to 55) min, contrast volume was 250 (IQR: 180 to 340) ml, and radiation doses (air kerma and dose area product) were 1.6 (IQR: 1.0 to 2.7) Gy and 98 (IQR: 57 to 168) Gy·cm(2), respectively.Conclusions: 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.

    AB - Background: The hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to improve procedural outcomes. Large, prospective studies validating the algorithm in a broad multicenter setting with operators of different experience levels are lacking.Objectives: 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.Methods: Between January 2014 and October 2015, consecutive patients undergoing hybrid CTO-PCI were prospectively enrolled in 17 centers. Procedural techniques, outcomes, and in-hospital complications were analyzed.Results: A total of 1,253 CTO-PCIs were performed in 1,177 patients, of which 86% were men. Mean age was 66 ± 11 years. 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 < 0.001). Overall procedure success was 86% and major in-hospital complications occurred in 2.6%. Antegrade wire escalation was the preferred primary strategy in 77%, followed by retrograde (17%) and antegrade dissection re-entry strategies (7%). Primary strategies were successful in 60%. Consecutive strategies were applied in 34% and were successful in 74%. Antegrade dissection re-entry and retrograde strategies were the most common bailout strategies and were successful in 67% and 62%, respectively. Median procedure and fluoroscopy time were 90 (interquartile range [IQR]: 60 to 120) min and 35 (IQR: 21 to 55) min, contrast volume was 250 (IQR: 180 to 340) ml, and radiation doses (air kerma and dose area product) were 1.6 (IQR: 1.0 to 2.7) Gy and 98 (IQR: 57 to 168) Gy·cm(2), respectively.Conclusions: 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.

    KW - Chronic total occlusion

    KW - Hybrid

    KW - Percutaneous coronary intervention

    U2 - 10.1016/j.jacc.2016.08.034

    DO - 10.1016/j.jacc.2016.08.034

    M3 - Article

    VL - 68

    SP - 1958

    EP - 1970

    JO - Journal of the American College of Cardiology

    JF - Journal of the American College of Cardiology

    SN - 0735-1097

    IS - 18

    ER -