Alfredo R. Galassi and Nicolaus ReifartThe Sicilian and the German (sicilian)

Update Euro CTO Registry

Euro CTO Club Membership

2006 2007 2008 2009 2010 2011 2012 20130

10

20

30

40

50

60

13

21

2933

3843

5255

2008 2009 2010 2011 2012 20130

500

1000

1500

2000

2500

3000

1303

1724

2189

2634 2603 2660

Online Registry 2008-2013

2006 2007 2008 2009 2010 2011 2012 20130

20

40

60

80

100

75 7780 82

85.3 85 85.3 87

Angiographic Success

%

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

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

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

%

J-CTO score

Morino et al. J Am Coll Cardiol 2011

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

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

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

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

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

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

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

At random : „ your patient was selected for monitoring“

Automatic export of registry parameters

9 parameters to be

checked by reviewer

Step 1 CD will automatically be uploaded (Videoloader)

Operator

It automatically stores all files to prepare

Step 2 select EuroCTO Club-owned page

Step 3 select the runs to be reviewed

Any run can be played at high resolution and be reviewed

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.

1

2

34

5/ 67

8 9

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)

Test: Operator NR Monitor GW

Calculated accordance 84 %

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)