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Friday 08:26 - Hildick-Smith -CTO Indication
- 1. When is CTO PCI indicated? David Hildick-Smith Sussex Cardiac Centre, UK TVT 2012
- 2. When is CTO PCI not indicated? David Hildick-Smith Sussex Cardiac Centre, UK TVT 2012
- 3. Conflict of interest • I believe CTO angioplasty to be some of the best angioplasty that we do
- 4. PCI not indicated • When the muscle subtended by the infarcted vessel is genuinely akinetic • This is rare
- 5. What do we currently know? 1. 95% of patients with CTO have inadequate distal collateral supply (CFR <2) 2. Ischaemia is bad for your health 3. Successful CTO PCI cases have better prognosis than failed CTO PCI cases
- 6. Inadequate collateral flow • ~95% of patients with CTO have inadequate distal collateral supply • CFR >2 in 7% • CFR <0.85 in 30% (i.e. coronary steal) • FFR 0.32 ± 0.13 Werner et al, EHJ 2006; 27; 2406-12
- 7. Residual ischaemia Shaw et al, Circulation 2008; 117; 1283-91
- 8. Successful vs unsuccessful PCI Hoye et al, EHJ 2005
- 9. Successful vs unsuccessful CTO PCI Aziz et al, CCI 2007
- 10. Is PCI indicated only for symptoms? Highly Symptomatic Few symptoms Easy case Complex case Novice Capable Expert Super-expert
- 11. BCIS database • 13,000 CTO PCI patients between 2005-2009 • Procedural success 70% George et al, JACC 2014
- 14. What remains concerning? • Is success in CTO PCI merely a marker of the risk profile of the patient? • ….and if this is true, is the apparent mortality advantage with successful CTO PCI merely a mirage? • The randomised EuroCTO trial may tell us…..