European Registry Update
Georgios Sianos, MD, PhD, FESC
Aristotle University, AHEPA University Hospital
Thessaloniki, Greece
Disclosure Statement of Financial Interest
I, Georgios Sianos, DO NOT have a financial
interest/arrangement or affiliation with one
or more organizations that could be
perceived as a real or apparent conflict of
interest in the context of the subject of this
presentation.
All CTO 2015 faculty disclosures are listed on the CRF Events App.
Euro CTO Club Membership
70
61
60
52
50
55
43
38
40
33
29
30
20
21
13
10
0
2006 2007 2008 2009 2010 2011 2012 2013 2014
Web based ERCTO Registry
Online Registry 2008-2014
3000
2634
2500
2660
2615
2189
2000
1500
2603
1724
1303
1000
500
0
2008
2009
2010
2011
2012
2013
2014
Antegrade /Retrograde
Operators
N=24
N=29
N=35
N=44
N=48
N=48
N=42
79.5
81.2
85.4
83.4
20.5
18.8
14.6
16.6
100%
80%
50
69
71.4
60%
40%
50
20%
31
28.6
0%
2008
2009
2010
Antegrade only
2011
2012
2013
Retrograde + Antegrade
2014
Antegrade /Retrograde
Procedures
100%
10
11.5
10.5
14
23
29
27.6
71
72.4
80%
60%
90
40%
88.5
89.5
86
77
20%
0%
2008
2009 2010 2011
2012 2013
Antegrade
Retrograde± Antegrade
2014
Angiographic Success
%
100
80
75
77
80
82
85.3
85
85.3
87
85.8
60
40
20
0
2006 2007 2008 2009 2010 2011 2012 2013 2014
Angiographic Success
%100
85.5
80
86.5
88.1
77.1
73.6
87.6
76.5
87.8
77.8
90.3
79.5
87
82.2
64.2
60
40
20
0
2008
2009
2010
Antegrade
2011
2012
Retrograde
2013
2014
Procedural Success by JCTO Score
according to Experience in Retrograde
%
Low = <50 procedure retrograde
Moderate = 50-100 retrograde
Good = >100 retrograde
Multivariate logistic regression analysis associated with
technical failure in retrograde approach
Variable
OR
95% CI
p-value
Age, per 10-yr increase
1.19
1.04-1.36
0.01
Men
0.70
0.47-1.05
0.08
Diabetes
1.16
0.86-1.55
0.33
Ejection fraction <35%
0.89
0.50-1.58
0.68
History of MI, %
0.91
0.68-1.21
0.50
History of CABG, %
1.22
0.86-1.74
0.26
Prior PCI, %
0.98
0.74-1.29
0.87
Occlusion duration <12 months
0.95
0.80-1.12
0.55
Occlusion length < 20 mm
1.00
0.62-1.64
0.99
Operator Experience
<50 versus >100
50-100 versus >100
3.07
2.17
2.19-4.30
1.52-3.10
<0.0001
J-CTO Score
Intermediate versus very difficult
Medium difficult versus very difficult
Quite difficult versus very difficult
0.44
0.42
0.61
0.25-0.77
0.28-0.62
0.44-0.85
<0.0001
Wires to start
% 60
50
40
30
20
10
0
2011
2012
2013
2014
Wires to start
(Fielder XT Family)
% 60
50
40
Fielder XT R
30
Fielder XT A
20
Fielder XT
10
0
2014
Final wires
% 30
25
20
15
10
5
0
2011
2012
2013
2014
Guiding Catheter Selection in the ERCTO
% 60
53,8
49,8
48,5 49,8
50
48,3
45,8
43,5
40,9
37,8
40
35,4
30
20
15,6
10,9
8,7
10
7,4
7,9
0
2010
2008
2011
2009
6 French
2012
2010
7 French
2013
2011
2014
2012
8 French
No trend differences were observed between antegrade
and retrograde approach during years
Procedural Details
%
70
61,6
60
54,4
53,7
49,4
47,2
50
40
30
20
12,2
15,7
15
17,5
8,6
10
0
2008
2010
2009
2011
2010
2012
2011
2013
Controlateral injection
Radial approach
2012
2014
Use of Dedicated Devices
% 45
43.5
40
37.2
33.5
35
30
25
19.2
20
15.1
15
9.2
10
5
4.9
3.3
6
4.4
4.4
2.5
2.3
2013
2014
0
0
2008
2009
2010
2011
Tornus
2012
Corsair
IVUS
% 25
22.8
22.7
20
17.6
15
11.8
11.1
10.3
10
7.9
7.3
6
5
5
3
2.4
1
6.7
5
2.1
2
1
0
2009
2010
Antegrade
2011
2012
Retrograde
2013
Overall
2014
Procedural Complications
2.5
2.5
2.5
2.3
2.2
2
1.9
1.5
1.5
1.2
1.1
1
1
1
1
1
0.9
0.8
0.8
0.8
0.6
0.5
0.8
0.70.7
0.6
0.5 0.5
0.5
0.5
0.6 0.6
0.5
0.5
0.50.50.5
0.4
0.3
0.30.30.3
0.1
0.08
0.03
0
0.07
0
2008
2009
2010
2011
2012
2013
2014
Death
Cardiac tamponade
Myocardial infarction
Vascular complication
Coronary perforation
Donor vessel dissection
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
Courtesy C Reifart
2015 and on
10 % reabstraction of CTO
records (n = 250/ year), masked
and reviewed by a second
abstractor
At random : „ your patient was
selected for monitoring“
Automatic export of registry parameters
9
parameters to be
checked by reviewer
CD will automatically be
uploaded (Videoloader)
It automatically stores
all files to prepare
Operator
At least 4 cineruns to be uploaded
 CTO vessel with retrograde/antegrade
distal filling;
 Wire passage
 If applicable also for retrograde
access
 Final result showing residual lesion
and runoff.
Add requested runs to file
Any run can be played at high resolution and be reviewed
1
2
3
4
7
5/ 6
8
9
Monitor
The monitor will evaluate the case in a
structured way that finally results in an

agreement

agreement with slight differences or

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