12th Experts Live CTO The annual Euro CTO meeting September 11th –12th, 2020 - Berlin, Germany

1. Klinik für Innere Medizin I / Kardiologie
CTO and MVD
12th Experts Live CTO
11. - 12.09.2019
Prof. Dr. Bernward Lauer
Ltd. Oberarzt der Klinik für Innere Medizin I
Universitätsklinikum Jena

2. CTO and MVD in acute coronary syndroms
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD

3. CTO and MVD in acute coronary syndroms
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD
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
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%)

4. Infarct size
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Saad et al. (2018) Int J Cardiol; 265; 251 - 255

5. LV - EF
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Saad et al. (2018) Int J Cardiol; 265; 251 - 255

6. event rate
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Saad et al. (2018) Int J Cardiol; 265; 251 - 255

7. prognosis
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Claessen et al.; Eur Heart J. 2012 33(6) 768-775
HORIZONS-AMI

8. prognosis
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Claessen et al.; Eur Heart J. 2012 33(6) 768-775
HORIZONS-AMI

9. prognosis
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432
single vs multiple CTOs

10. prognosis
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Saad M et al. (2018) Eurointervention 14; e306-e314
in cardiogenic shock

11. prognosis
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432
IRA localisation

12. prognosis
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432
CTO localisation

13. prognosis
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Fujii T et al Int J Cardiol. 2017 (230) 346-352
CTO collateral quality

14. prognosis
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Fujii T et al. Int J Cardiol. 2016 (218) 158-163
CTO collateral donor

15. CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Higher mortality with
 a CTO vs. no CTO
 more than one CTO
 in cardiogenic shock
 LAD as IRA
 poor collaterals
 Collaterals from IRA

16. CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Henriques JP et al. J Am Coll Cardiol. 2016 Oct 11;68(15):1622-
1632
RCT: EXPLORE trial

17. CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Henriques JP et al. J Am Coll Cardiol. 2016 Oct 11;68(15):1622-
1632
RCT: EXPLORE trial

18. CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Choi IJ et al. Am J Cardiol. 2016 117(7) 1039-1046
Prognosis with/without successful recanalisation of CTO

19. CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN ACS
Valenti R et al. Am J Cardiol. 2014 114(12) 1794-1800
Prognosis with/without successful recanalisation of CTO
After an ACS, a successful CTO - PCI seems to be
associated with increased survival

20. CTO and MVD in chronic coronary syndroms
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD

21. Prevalence of a CTO:
• ACS: 10 %
• elective coronary angiography: 15 - 25 %
• after CABG: 90 %
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN CCS

22. Prevalence of a CTO:
• ACS: 10 %
• elective coronary angiography: 15 - 25 %
• after CABG: 90 %
• in MVD (Syntax study): ≈ 35,7 % !
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN CCS

23. How is the treatment of a CTO in MVD in CCS ?
CTO and MVD EuroCTO - Meeting Berlin 2020
1262
4337
3075 12751800
903897 1981077
24,3%
217 pat
22,2%
200 pat
56,6%
610 pat
36,5%
72 patCTO
CTO AND MVD IN CCS
numbers calculated and extrapolated from: Serruys et al, NEJM
2009
Syntax Trial

24. Syntax Score calculation
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN CCS
CTO proximal LAD,
unknown age:
SyntaxScore: 18,5
Probably due to the
fact, that the
EuroCTO club was
founded only in
2006 (after the
Syntax Score has
been introduced)
ESC Guidelienes myocardial revascularization 2018

25. Revascularisation in MVD with CTO
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD IN CCS
ESC Guidelienes myocardial revascularization 2018
Which lesion first ?
• no CRT !!
• which leaves you with „EBM“ („eminence based medicine“)
• Factors to consider:
• antegrade or retrograde approach
• area at risk by non-CTO lesion(s)
• complexity of the non-CTO lesion(s)
• regional LV function
• lesion in a collateral donor vessel ?
• others
• individual decision

26. Thank you
for your attention
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD

27. Thank you
for your attention
CTO and MVD EuroCTO - Meeting Berlin 2020
CTO AND MVD