14:05 Galassi - Update EuroCTO Registry
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Transcript of 14:05 Galassi - Update EuroCTO Registry
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Alfredo R. Galassi and Nicolaus ReifartThe Sicilian and the German (sicilian)
Update Euro CTO Registry
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Euro CTO Club Membership
2006 2007 2008 2009 2010 2011 2012 20130
10
20
30
40
50
60
13
21
2933
3843
5255
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2008 2009 2010 2011 2012 20130
500
1000
1500
2000
2500
3000
1303
1724
2189
2634 2603 2660
Online Registry 2008-2013
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2006 2007 2008 2009 2010 2011 2012 20130
20
40
60
80
100
75 7780 82
85.3 85 85.3 87
Angiographic Success
%
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2008 2009 2010 2011 2012 20130%
20%
40%
60%
80%
100%
90 88.5 89.5 8677 71
10 11.5 10.5 1423 29
Antegrade Retrograde± Antegrade
Antegrade /Retrograde Procedures
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2008 2009 2010 2011 2012 20130%
20%
40%
60%
80%
100%
5031 28.6
20.5 18.8 14.6
5069 71.4
79.5 81.2 85.4
Antegrade only Retrograde + Antegrade
Antegrade /Retrograde Operators
N=48N=48N=44N=35N=29N=24
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2008 2009 2010 2011 2012 20130
20
40
60
80
10085.5 86.5 88.1 87.6 87.8 90.3
73.664.2
77.1 76.5 77.8 79.5
Antegrade Retrograde
Angiographic Success
%
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J-CTO score
Morino et al. J Am Coll Cardiol 2011
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2008 2009 2010 2011 2012 201370
80
90
100
1
2
3
0
Ang
iogr
aphi
c su
cces
s (%
) J-CTO
score (median)
J-CTO score / Success
1.6 1.7 1.62
2.3 2.4
8082
86 85 85. 3 87
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2008 2009 2010 2011 2012 20130%
20%
40%
60%
80%
100%
50
23 17 11 13 5
33
27
1725 16
22
17
40
49
34 3723
10 17
36 3142
4 8 8
<50 50-100 100-200 200-500 >500
Operators ExperienceN=48N=48N=44N=35N=29N=24
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2008-2012 CTO interventions
8647 patients
9643 lesions
Drop out for missing data
47 patients
54 lesions
Included
8600 patients
9589 lesionsRetrograde (16.5%)
1395 patients
1582 lesions
Antegrade (83.5%)
7205 patients
8007 lesions
Procedural success (75%)
1060 patients
1191 lesions
Procedural failure (25%)
335 patients
391 lesions
Clinical follow-up
24.7 ± 15 months
931 patients (66.7%)
Retrograde CTO revascularization in Europe
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Clinical Follow-up
MACCE Death MI Stroke Revasc.0
10
20
30
40
50
13.6
1.9 3.20.6
138.7
0.6 2.3 0.9
8.6
23.9
4.3 5.4
0
23.6
Overall Successful Unsuccessful
%
P<0.001
P=0.001 P=0.014 P=0.120
P<0.001
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Gender (M)
COPD
Prior MI
Prior PCI
LVEF < 35%
J-CTO score
Failure p<0.001
p<0.001
p=0.005
p=0.018
p=0.221
p=0.074
p=0.001
Predictors of MACCE Occurrence
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Symptoms(Successful Procedures)
CCS pre CCS post NYHA pre NYHA post0%
20%
40%
60%
80%
100%
27.1
83.5
53.2
78.4
44
15.1
36.7
18.328.9
1.49.2 2.3
0 0 0.9 0.9
Class I Class II Class III Class IV
P<0.001 P<0.001
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Credibility check of the online EuroCTO-registry 2008-14
• Logical checks on data ( predefined value ranges)
• Logical consistency-tests with respect to other data fields
• Automatic warnings when data are missing
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At random : „ your patient was selected for monitoring“
Automatic export of registry parameters
9 parameters to be
checked by reviewer
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Step 1 CD will automatically be uploaded (Videoloader)
Operator
It automatically stores all files to prepare
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Step 2 select EuroCTO Club-owned page
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Step 3 select the runs to be reviewed
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Any run can be played at high resolution and be reviewed
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4 Cineruns to be uploaded
1. CTO vessel with retrograde/antegrade distal filling;
2. Wire passage 3. If applicable also for retrograde access4. Final result showing residual lesion
and runoff.
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1
2
34
5/ 67
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8 9
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Monitor:
• The monitor will evaluate the case in a structured way that finally results in an
• a) agreement, • b) agreement with slight differences or • c) relevant disagreement (i.e. no CTO or
no TIMI 3 flow)
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Test: Operator NR Monitor GW
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Calculated accordance 84 %
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Summary: ERCTO-Monitoring
• Randomly selects 10% of cases• Non biased controll of data entry• Will indentify: errors of data entry,
interpretation or coding and errors of intention
• Will increase credibility and scientific value ( at no costs except our efforts)