ACS and CTO – how to manage

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Euro CTO Club

ACS and CTO – how to manage Bernward Lauer, Germany The Experts “Live” Workshop 2017 Friday, September 15th, 2017

ACS AND CTO –HOW OFTEN
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Year ACS Region Study population MVD CTO
Ariza-Solé 2013 STEMI Spain 1176 125 (10,6%)
Choi 2016 STEMI Korea 4748 324 (6,8%)
Hoebers 2013 NSTEMI Netherlands 5018 1819 (36,3%) 666 (13,3%)
Lesiak 2017 STEMI Poland 836 437 (52,3%) 146 (17,5%)
Miziguchi 2013 AMI Japan 417 35 (8,0%)
Tajstra 2012 STEMI Poland 1658 666 (40,2%) 204 (12,3%)
Valenti 2012 AMI Italy 1911 169 (8,8%)
Wanatanabe 2017 STEMI Korea 5429 2045 (37,7%) 383 (7,1%)
Total 21193 2052 (9,7%)
Ariza-Solé A et al. Rev Esp Cardiol 2014; 67(5): 359-366; Choi IJ et al. Am J Cardiol 2016;117:1039-1046; Hoebers LPC et al. Eur J Heart Fail 2013 15(4) 425-432;
Lesiak M et al. Cardiol J 2017 24(2) 117-124; Mizuguchi Y et al. Int J Cardiol 2014 176(3) 1139-1141; Tajstra M et al. Am J Cardiol 2012 109(2) 208-213;
Valenti Ret al. Am J Cardiol 2014 114(12) 1794-1800; Wanatanabe H et al. Eurointervention 2017 12(15) e1874-e1882

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
HORIZONS-AMI
Claessen et al.; Eur Heart J. 2012 33(6) 768-775

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
HORIZONS-AMI
Claessen et al.; Eur Heart J. 2012 33(6) 768-775

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Single vs. Multiple CTOs
Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Survival curve of patients without cardiogenic shock on admission after
primary PCI according to the presence of CTO. Legend: survival in patients
with STEMI after primary PCI for patients with no CTO, 1 CTO, or N1CTO.
Survival curve of patients with cardiogenic shock on admission after
primary PCI according to the presence of CTO. Legend: survival in patients
with STEMI primary PCI for patients with no CTO, 1 CTO, or N1 CTO.
Bataille Y et al; Am Heart J. 2012 164(4) 509-515
in cardiogenic shock

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432
in cardiogenic shock
Total population Cardiogenic shockNo cardiogenic shock

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
IRA localisation
Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
CTO localisation
Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
CTO collateral quality
Fujii T et al Int J Cardiol. 2017 (230) 346-352

ACS AND CTO –PROGNOSIS
EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
CTO collateral quality
Elias JA et al JACC Cardiovascular Interventions 2017 10(9) 906-914

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
CTO collateral donor
Fujii T et al. Int J Cardiol. 2016 (218) 158-163

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Summary
Higher mortality with
 a CTO vs. no CTO
 more than one CTO
 in cardiogenic shock
 LAD as IRA
 poor collaterals
 Collaterals from IRA

ACS AND CTO –REVASCULARISATION
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Henriques JP et al. J Am Coll Cardiol. 2016 Oct 11;68(15):1622-1632
RCT: EXPLORE trial

ACS AND CTO –REVASCULARISATION
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
RCT: EXPLORE trial
Henriques JP et al. J Am Coll Cardiol. 2016 Oct 11;68(15):1622-1632

ACS AND CTO –REVASCULARISATION
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Choi IJ et al. Am J Cardiol. 2016 117(7) 1039-1046
Prognosis with/without successful recanalisation of CTO

ACS AND CTO –REVASCULARISATION
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Shi G et al.ScientificWorldJournal. 2014 756080
Prognosis with/without successful recanalisation of CTO

ACS AND CTO –REVASCULARISATION
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Valenti R et al. Am J Cardiol. 2014 114(12) 1794-1800
Prognosis with/without successful recanalisation of CTO

ACS AND CTO –REVASCULARISATION
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Prognosis with/without successful recanalisation of CTO
Yang ZK et al. Int J Cardiol. 2013 165(1) 76-79

ACS AND CTO –REVASCULARISATION WHEN
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Optimal time point of revascularisation of the CTO
in stable patients: ?
in cardiogenic shock: ?

ACS AND CTO –REVASCULARISATION WHEN
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Optimal time point of revascularisation of the CTO
in stable patients: ?
most probably staged procedures
in cardiogenic shock: ?

ACS AND CTO –REVASCULARISATION WHEN
22
EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Optimal time point of revascularisation of the CTO
in stable patients: ?
most probably staged procedures
in cardiogenic shock: ?
probably (short (?)) acute attempt ???

ACS AND CTO –REVASCULARISATION WHEN
23
EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Optimal time point of revascularisation of the CTO
in stable patients: ?
most probably staged procedures
in cardiogenic shock: ?
probably (short (?)) acute attempt ???
Room for discussion and trials

ACS AND CTO –HOW OFTEN
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
Conclusion
In patients with an acute coronary syndrome
• the presence of a CTO is associated with a higher mortality
• revascularisation of the CTO seems to improve prognosis
• optimal timing of CTO-revascularisation is unknown
• in stable patient: staged procedures (?)
• in cardiogenic shock: immediate complete revascularisation (?)

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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer

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THANK YOU
FOR YOUR ATTENTION
EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer

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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer

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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
THANK YOU
FOR YOUR ATTENTION

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ÜBERSCHRIFT
Calibri, 30 Pt., gesperrt, Großbuchstaben
Text
Calibri, 20 Pt.,
1927500/12
EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer

ACS AND CTO –PROGNOSIS
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EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer
O connor

1) The document discusses strategies for selecting the right patients for recanalization of a chronic total occlusion (CTO), including evaluating ischemia, viability of myocardium, and prognostic factors. 2) It reviews evidence from studies on the outcomes of CTO recanalization in different patient groups, such as those with low ejection fraction. 3) The key factors discussed for selecting patients include evaluating ischemic burden through stress testing, assessing viability through cardiac MRI, and aiming for complete revascularization of still viable myocardium.

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Where is the role for Antegrade dissection reentry?

Euro CTO Club

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marriaga1

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Euro CTO Club

This document summarizes information from a presentation on chronic total occlusions (CTOs) and multivessel disease (MVD) in acute coronary syndromes and chronic coronary syndromes. It provides data on the prevalence of CTOs in different patient populations, ranging from 10% in ACS to over 15% in elective angiography and 90% after CABG. In the SYNTAX trial, about 35.7% of patients with MVD also had a CTO. Successful recanalization of a CTO after ACS is associated with increased survival. Treatment of CTOs in patients with MVD and chronic coronary syndromes requires consideration of factors like which lesion to treat first, the ability to access lesions ante

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Euro CTO Club

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Euro CTO Club

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A 51-year-old male patient presented with angina and a history of smoking and dyslipidemia. He previously had a non-ST elevation myocardial infarction treated with percutaneous coronary intervention to his right coronary artery in 2017. Coronary angiography showed a chronic total occlusion in his proximal left anterior descending artery and a mid right coronary artery occlusion. Cardiac MRI showed preserved viability in the anteroseptal and anterior wall with residual ischemia and an ejection fraction of 35%. The target lesion is the proximal left anterior descending artery.

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Euro CTO Club

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How to monitor patients after Atrial Fibrillation Ablation

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1) Stent type, crossing technique, and patient factors influence stent patency after CTO PCI. Drug-eluting stents are superior to bare metal stents in reducing restenosis and reocclusion. 2) Techniques involving extensive subintimal dissection and re-entry are associated with higher restenosis rates, especially if outflow and final TIMI flow are poor. 3) Patient factors like diabetes are also important determinants of stent patency, with diabetics having higher restenosis risks. 4) The role of routine angiographic follow-up after CTO PCI remains controversial.

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Tim Schäufele - SuccessfultransradialretrogradeCTO revascularisation via an e...

Euro CTO Club

A 76-year-old female with recurrent angina underwent a transradial retrograde CTO revascularization via an epicardial collateral using a single 6F guide catheter. Baseline angiography and cMRI showed 3-vessel disease with functional stenosis in the RCA and RCX territories. An antegrade wire escalation approach was unsuccessful, so a retrograde approach via an epicardial collateral was used. The CTO was crossed retrogradely and externalized antegradely using the single 6F guide. Final angiography after stent placement in the RCA, LAD and RCX showed good results and the patient's angina was resolved at 9-month follow-up.

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Kedev S - AIMRADIAL 2014 Endovascular - Carotid stenting development

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International Chair on Interventional Cardiology and Transradial Approach

A brief review of complications and tips and tricks

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Francesco Burzotta: Tips & tricks on radial CTO-PCI

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Live Cases from Florence and Rome From Tor Vergata Hospital, Rome Operators: Andrea Gagnor (Turin), Mohaned Egred (Newcastle - UK), Daniela Benedetto (Rome) From Careggi University Hospital, Florence Operators: Masahisa Yamane (Tokyo - J), Stelios Pyxaras (Furth - D), Carlo Di Mario (Florence) Flash Highlights 8:30 Tips & tricks on radial CTO-PCI Francesco Burzotta (Rome) ___________________________________________ PLENARY SESSION Live Cases from Florence and Rome + Flash Highlights Auditorium Zubin Mehta - Saturday 8:30 - 10:00 Coordinator: Roberto Garbo (Turin) Chairpersons: Heinz Joachim Büttner (Bad Krozingen - D), Roberto Diletti (Rotterdam - NL) Discussants: Michael Behnes (Mannheim - D), Giacomo Boccuzzi (Turin), Alexander Bufe (Krefeld - D), Salvatore Colangelo (Turin) Challengers: Paul Knaapen (Amsterdam - NL), Gioel Gabrio Secco (Alessandria) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...

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Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...

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16:53 CTO PCI Outcome associated with poor quality of the distal target vessel Emmanouil Brilakis (Minneapolis - USA) _____________________________________________ PARALLEL SESSION Interventional CTO & Chip Research Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals) Auditorium Zubin Mehta - Friday 16:30 - 17:16 Chairpersons: Davide Capodanno (Catania), Carlo Di Mario (Florence), Giuseppe Tarantini (Padua) Panelist: Roberto Diletti (Rotterdam - NL), Giovanni Esposito (Naples), Paul Knaapen (Amsterdam - NL), Maksymilian Opolski (Warsaw - PL) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...

Euro CTO Club

16:33 EuroCTO Consensus on Guide Catheter Extensions JACC Cardiovasc Interventions Mario Iannaccone (Turin) _____________________________________________ PARALLEL SESSION Interventional CTO & Chip Research Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals) Auditorium Zubin Mehta - Friday 16:30 - 17:16 Chairpersons: Davide Capodanno (Catania), Carlo Di Mario (Florence), Giuseppe Tarantini (Padua) Panelist: Roberto Diletti (Rotterdam - NL), Giovanni Esposito (Naples), Paul Knaapen (Amsterdam - NL), Maksymilian Opolski (Warsaw - PL) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

Javier Escaned: 3 Low contrast complex and CTO PCI

Euro CTO Club

Flash Highlights 15:00 3 Low contrast complex and CTO PCI Javier Escaned (Madrid - Spain) ___________________________________________ PARALLEL SESSION Live Cases from Rome + Flash Highlights Auditorium Zubin Mehta - Friday 15:00 - 16:30 Coordinator: Andrea Gagnor (Turin) Chairpersons: Roberto Diletti (Rotterdam - NL), Bernward Lauer (Jena - D) Discussants: Alessio Gaetano La Manna (Catania), Eugenio Stabile (Potenza) Challengers: Paul Knaapen (Amsterdam - NL), Alessio Mattesini (Florence) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

Giuseppe Tarantini: Protect IV and PROTECT-Europe trial

Euro CTO Club

11:35 Protect IV and PROTECT-Europe trial Giuseppe Tarantini (Padua) _____________________________________________ PARALLEL SESSION Cto & Chip Regitries & Trials Auditorium Zubin Mehta - Friday 11:00 - 12:00 Chairpersons: Paul Knaapen (Amsterdam - NL), Gennaro Sardella (Rome) Discussants: Björn Billmann (Wolfenbuettel - D), Laurent Drogul (Nice - F), Sergey Furkalo (Kiev - UA), Maciej Lesiak (Poznan - PL) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

Paul Knaapen: The PROCTOR randomized trial

Euro CTO Club

11:28 The PROCTOR randomized trial Paul Knaapen (Amsterdam - NL) _____________________________________________ PARALLEL SESSION Cto & Chip Regitries & Trials Auditorium Zubin Mehta - Friday 11:00 - 12:00 Chairpersons: Paul Knaapen (Amsterdam - NL), Gennaro Sardella (Rome) Discussants: Björn Billmann (Wolfenbuettel - D), Laurent Drogul (Nice - F), Sergey Furkalo (Kiev - UA), Maciej Lesiak (Poznan - PL) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

John Davies: Update on the ORBITA - CTO trial

Euro CTO Club

11:21 Update on the ORBITA - CTO trial John Davies (Basildon - UK) _____________________________________________ PARALLEL SESSION Cto & Chip Regitries & Trials Auditorium Zubin Mehta - Friday 11:00 - 12:00 Chairpersons: Paul Knaapen (Amsterdam - NL), Gennaro Sardella (Rome) Discussants: Björn Billmann (Wolfenbuettel - D), Laurent Drogul (Nice - F), Sergey Furkalo (Kiev - UA), Maciej Lesiak (Poznan - PL) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

Masahisa Yamane: The Complex CTO Japanese Registry

Euro CTO Club

11:14 The Complex CTO Japanese Registry Masahisa Yamane (Tokyo - J) _____________________________________________ PARALLEL SESSION Cto & Chip Regitries & Trials Auditorium Zubin Mehta - Friday 11:00 - 12:00 Chairpersons: Paul Knaapen (Amsterdam - NL), Gennaro Sardella (Rome) Discussants: Björn Billmann (Wolfenbuettel - D), Laurent Drogul (Nice - F), Sergey Furkalo (Kiev - UA), Maciej Lesiak (Poznan - PL) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

Kambis Mashayekhi: Trends and spin-offs from the EuroCTO Registry

Euro CTO Club

11:00 Trends and spin-offs from the EuroCTO Registry Kambis Mashayekhi (Lahr - D) _____________________________________________ PARALLEL SESSION Cto & Chip Regitries & Trials Auditorium Zubin Mehta - Friday 11:00 - 12:00 Chairpersons: Paul Knaapen (Amsterdam - NL), Gennaro Sardella (Rome) Discussants: Björn Billmann (Wolfenbuettel - D), Laurent Drogul (Nice - F), Sergey Furkalo (Kiev - UA), Maciej Lesiak (Poznan - PL) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

Emmanouil Brilakis: Update on the PROGRESS Registry

Euro CTO Club

11:07 Update on the PROGRESS Registry Emmanouil Brilakis (Minneapolis - USA) _____________________________________________ PARALLEL SESSION Cto & Chip Regitries & Trials Auditorium Zubin Mehta - Friday 11:00 - 12:00 Chairpersons: Paul Knaapen (Amsterdam - NL), Gennaro Sardella (Rome) Discussants: Björn Billmann (Wolfenbuettel - D), Laurent Drogul (Nice - F), Sergey Furkalo (Kiev - UA), Maciej Lesiak (Poznan - PL) ___________________________________________ 15th Experts Live CTO EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

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ACS and CTO – how to manage

1. ACS and CTO – how to manage E u r o C T O - C l u b , „ T h e E x p e r t s L i v e “ , B e r n w a r d L a u e r , B e r l i n , S e p t e m b e r 1 5 t h 2 0 1 7

2. ACS AND CTO –HOW OFTEN 2 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Year ACS Region Study population MVD CTO Ariza-Solé 2013 STEMI Spain 1176 125 (10,6%) Choi 2016 STEMI Korea 4748 324 (6,8%) Hoebers 2013 NSTEMI Netherlands 5018 1819 (36,3%) 666 (13,3%) Lesiak 2017 STEMI Poland 836 437 (52,3%) 146 (17,5%) Miziguchi 2013 AMI Japan 417 35 (8,0%) Tajstra 2012 STEMI Poland 1658 666 (40,2%) 204 (12,3%) Valenti 2012 AMI Italy 1911 169 (8,8%) Wanatanabe 2017 STEMI Korea 5429 2045 (37,7%) 383 (7,1%) Total 21193 2052 (9,7%) Ariza-Solé A et al. Rev Esp Cardiol 2014; 67(5): 359-366; Choi IJ et al. Am J Cardiol 2016;117:1039-1046; Hoebers LPC et al. Eur J Heart Fail 2013 15(4) 425-432; Lesiak M et al. Cardiol J 2017 24(2) 117-124; Mizuguchi Y et al. Int J Cardiol 2014 176(3) 1139-1141; Tajstra M et al. Am J Cardiol 2012 109(2) 208-213; Valenti Ret al. Am J Cardiol 2014 114(12) 1794-1800; Wanatanabe H et al. Eurointervention 2017 12(15) e1874-e1882

3. ACS AND CTO –PROGNOSIS 3 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer HORIZONS-AMI Claessen et al.; Eur Heart J. 2012 33(6) 768-775

4. ACS AND CTO –PROGNOSIS 4 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer HORIZONS-AMI Claessen et al.; Eur Heart J. 2012 33(6) 768-775

5. ACS AND CTO –PROGNOSIS 5 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Single vs. Multiple CTOs Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432

6. ACS AND CTO –PROGNOSIS 6 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Survival curve of patients without cardiogenic shock on admission after primary PCI according to the presence of CTO. Legend: survival in patients with STEMI after primary PCI for patients with no CTO, 1 CTO, or N1CTO. Survival curve of patients with cardiogenic shock on admission after primary PCI according to the presence of CTO. Legend: survival in patients with STEMI primary PCI for patients with no CTO, 1 CTO, or N1 CTO. Bataille Y et al; Am Heart J. 2012 164(4) 509-515 in cardiogenic shock

7. ACS AND CTO –PROGNOSIS 7 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432 in cardiogenic shock Total population Cardiogenic shockNo cardiogenic shock

8. ACS AND CTO –PROGNOSIS 8 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer IRA localisation Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432

9. ACS AND CTO –PROGNOSIS 9 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer CTO localisation Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432

10. ACS AND CTO –PROGNOSIS 10 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer CTO collateral quality Fujii T et al Int J Cardiol. 2017 (230) 346-352

11. ACS AND CTO –PROGNOSIS EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer CTO collateral quality Elias JA et al JACC Cardiovascular Interventions 2017 10(9) 906-914

12. ACS AND CTO –PROGNOSIS 12 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer CTO collateral donor Fujii T et al. Int J Cardiol. 2016 (218) 158-163

13. ACS AND CTO –PROGNOSIS 13 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Summary Higher mortality with  a CTO vs. no CTO  more than one CTO  in cardiogenic shock  LAD as IRA  poor collaterals  Collaterals from IRA

14. ACS AND CTO –REVASCULARISATION 14 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Henriques JP et al. J Am Coll Cardiol. 2016 Oct 11;68(15):1622-1632 RCT: EXPLORE trial

15. ACS AND CTO –REVASCULARISATION 15 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer RCT: EXPLORE trial Henriques JP et al. J Am Coll Cardiol. 2016 Oct 11;68(15):1622-1632

16. ACS AND CTO –REVASCULARISATION 16 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Choi IJ et al. Am J Cardiol. 2016 117(7) 1039-1046 Prognosis with/without successful recanalisation of CTO

17. ACS AND CTO –REVASCULARISATION 17 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Shi G et al.ScientificWorldJournal. 2014 756080 Prognosis with/without successful recanalisation of CTO

18. ACS AND CTO –REVASCULARISATION 18 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Valenti R et al. Am J Cardiol. 2014 114(12) 1794-1800 Prognosis with/without successful recanalisation of CTO

19. ACS AND CTO –REVASCULARISATION 19 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Prognosis with/without successful recanalisation of CTO Yang ZK et al. Int J Cardiol. 2013 165(1) 76-79

20. ACS AND CTO –REVASCULARISATION WHEN 20 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Optimal time point of revascularisation of the CTO in stable patients: ? in cardiogenic shock: ?

21. ACS AND CTO –REVASCULARISATION WHEN 21 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Optimal time point of revascularisation of the CTO in stable patients: ? most probably staged procedures in cardiogenic shock: ?

22. ACS AND CTO –REVASCULARISATION WHEN 22 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Optimal time point of revascularisation of the CTO in stable patients: ? most probably staged procedures in cardiogenic shock: ? probably (short (?)) acute attempt ???

23. ACS AND CTO –REVASCULARISATION WHEN 23 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Optimal time point of revascularisation of the CTO in stable patients: ? most probably staged procedures in cardiogenic shock: ? probably (short (?)) acute attempt ??? Room for discussion and trials

24. ACS AND CTO –HOW OFTEN 24 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer Conclusion In patients with an acute coronary syndrome • the presence of a CTO is associated with a higher mortality • revascularisation of the CTO seems to improve prognosis • optimal timing of CTO-revascularisation is unknown • in stable patient: staged procedures (?) • in cardiogenic shock: immediate complete revascularisation (?)

25. 25 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer

26. 26 THANK YOU FOR YOUR ATTENTION EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer

27. 27 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer

28. 28 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer THANK YOU FOR YOUR ATTENTION

29. 29 ÜBERSCHRIFT Calibri, 30 Pt., gesperrt, Großbuchstaben Text Calibri, 20 Pt., 1927500/12 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer

30. ACS AND CTO –PROGNOSIS 30 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer

31. ACS AND CTO –PROGNOSIS 31 EuroCTO-Club, "The Experts Live", Berlin, September 2017, Bernward Lauer O connor

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