15th Experts "Live" CTO: Auditorium Zubin Mehta - Friday 08:00 15th Experts Live CTO: Opening Session PLENARY - OPENING SESSION 08:05 CTO in the Revascularization Guidelines Emanuele Barbato (Rome) ___________________________________________ PLENARY - OPENING SESSION Auditorium Zubin Mehta - Friday 8:00 - 9:00 Chairpersons: Antonio Colombo (Milan), Giovanni Esposito (Naples) Discussants: John Davies (Basildon - UK), Marco Hautmann (Essen - D), Aravinda Nanjundappa (Cleveland - USA) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy If you want to know all the details of the event, click on the image below to download the final program, where you will be able to orient yourself on the day, time and place of a specific video recorded at 15th Experts Live CTO.

1. CTO in revascularization guidelines
Prof. Emanuele Barbato, MD, PhD, FESC
EAPCI President
Chair of Cardiology Sant’Andrea Hospital
Sapienza University of Rome, Italy

2. I declare speaker’s fees and honoraria from Abbott,
BSCI, Insight Lifetech
DOI

4. Revascularization – when?
Decision tree for pts undergoing invasive CAG

5. 5

6. 6
Hochman J et al. ISCHEMIA trial. AHA 2019

7. 7
Hochman J et al. ISCHEMIA trial. AHA 2019

8. 8
Hochman J et al. ISCHEMIA trial. AHA 2019

9. Gersh BJ, Bhatt DL. Eur Heart J. 2021;42:1387-1400 Gersh BJ et al. Eur Heart J 2021

10. Recommendations in Guidelines
Agreement among experts + quality and quantity of
supporting evidences

13. Contemporary evidences (i.e. RCTs) available?

14. EXPLORE trial. JACC VOL. 68, NO. 15, 2016 OCTOBER 11, 2016:1622 – 3 2

15. REVASC Trial. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 11, NO. 19, 2018

16. EuroCTO Trial. European Heart Journal (2018) 39, 2484–2493

17. IMPACTOR-CTO trial. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 11, 2018:1309–12

18. DECISION-CTO TRIAL Circulation. 2019;139:1674–1683

21. ISCHEMIA-EXTEND. Circulation. 2023;147:8–19.
Impact of revasc in CCS on longer FU

24. - Advances in medical management and a lower mortality rate with CCS
in the contemporary era
- Annualized mortality rate in the medical therapy arm of ACME-2 was
4.0%, 1.0% in FAME-2 and 1.6% in ISCHEMIA trial
- Symptomatic improvement after PCI in CTO questioned as placebo
effect
Present and future challenges

25. ORBITA-CTO trial. Front. Cardiovasc. Med. 10:1172763.

26. 1. Considering the evidences available, PCI in CTO vessels is still
supported (after having treated possible significant stenoses in
non-CTO vessels) in patients with CCS and refractory angina
2. Accurate patient selection is key to achieve the maximum
benefit-risk ratio:
- targeting large ischemic territories
- excluding other possible causes of angina (diffuse epicardial
disease or microvascular dysfunction
Conclusion