1. 1-year Outcome of The Italian Registry on Chronic Total Occlusion:
February 27- March 1, 2011
Washington DC
1-year Outcome of The Italian
Registry on Chronic Total Occlusion:
The IRCTO Registry
AR Galassi, MD, FACC, FESC, FSCAI
Head of Cardiac Catheterization and
Interventional Cardiology Unit,
Division of Cardiology, Ferrarotto Hospital
Associate Professor of Cardiology
University of Catania, ITALY

2. Background
The incidence and the prevalence of coronary CTO lesions are unknown
Demographic characteristics of patients affected by CTO’s are still unknown
There is no definite consensus on the therapeutic strategy to apply in these patients

3. Aim
To assess the prevalence, demographics, clinical characteristics and therapeutic strategy of patients with CTOs in order to improve the management of pts with chronically occluded coronary arteries

4. Study design Phase 1 (12 months) Phase 2 (12 months)
Enrollment of patients showing at least 1 CTO in a main coronary artery (>3 months duration with vessel size >2.5mm) at CAG, independently from therapeutic strategy choosen (optimal medical therapy, PCI, CABG)
Phase 1 (12 months)
Phase 2 (12 months)
Enrollment of patients undergoing PCI
Clinical follow up at 1,6-month and 1, 2, 3-years

5. On-line at http://www.ircto.it
Reaching IRCTO
On-line at

6. Committed Centers 1777 patients enrolled CTO prevalence 12.3%
OSPEDALE FERRAROTTO CATANIA
OSPEDALE POLICLINICO GEMELLI ROMA
OSPEDALE S.S. CROCE E CARLE CUNEO
CASA DI CURA S. M. BARI
POL. S.ORSOLA MALPIGHI BOLOGNA
CASA DI CURA MONTEVERGINE MERCOGLIANO
OSPEDALE DEGLI INFERMI RIVOLI
S. G. BATTISTA TORINO
OSPEDALI GALLIERA GENOVA
S. G. BOSCO TORINO
OSPEDALE S. GIACOMO CASTELFRANCO VENETO
OSPEDALE DEGLI INFERMI RIMINI
1777 patients enrolled
CTO prevalence 12.3%

7. Baseline characteristics
All patients
N=1777
OMT*
N=826
PCI
N=776
Surgical
N=175
AGE, mean ± SD
68.6±11.5
70.1±12.5
67±10.6
68.8±8.9
MALE (%)
1485 (84,.1)
690 (83.5)
658 (84.8)
147 (84)
HYPERTENSION (%)
1390 (78.2)
645 (78.1)
604 (77.8)
141 (80.6)
DISLIPIDEMIA (%)
1114 (62.7)
533 (64.5)
476 (61.3)
105 (60)
FAMILY HISTORY OF CAD (%)
483 (27.2)
235 (28.5)
213 (27.4)
35 (20)
CURRENT SMOKERS (%)
791 (44.5)
384 (46.5)
324 (41.8)
83 (47.4)
DIABETES MELLITUS (%)
535 (30.1)
245 (29.7)
232 (29.9)
58 (33.1)
CRONIC RENAL FAILURE (%)
182 (10.2)
107 (13)
56 (7.2)
19 (10.9)
CHRONIC LUNG DISEASE (%)
185 (10.4)
97 (11.7)
69 (8.9)
LVEF < 35% (%)
299 (16.8)
169 (20.5)
92 (11.9)
38 (21.7)
THREE VESSEL DISEASE (%)
726 (40.9)
375 (45.4)
212 (27.3)
139 (79.4)
= p<0.05
*OMT=optimal medical therapy

8. Baseline characteristics% %

9. Clinical presentation
1777 patients
ACUTE MI
(16.7)
297
UNSTAB ANG.
378 (21.3)
STABLE ANG.
686 (38.6)
NO SYMPTOMS
(23.4)
416 %

10. CTO related myocardium wall motion
2.3%
30.7%
31.1%
35.9%
Presence of abnormal ECG in CTO related artery
Presence of Viable Myocardium
in CTO related artery, in pts with abnormal 2D-ECHO
24.2%
49.6%

11. Angiographic characteristics 10 patients with three CTO
LCX
423 (21.5%)
LAD
567 (28.8%)
RCA
978 (49.7%)
Total number of CTO 1968
1596 patients with one CTO
171 patients with two CTO
10 patients with three CTO

12. 1-month clinical outcome
Unadjusted result %
All P=NS

13. 6-month clinical outcome
Unadjusted result %
p=0.003
p=0.03
p=0.02

14. 12-month clinical outcome
Unadjusted result %
P<0.001
P=NS
P=0.006

15. Multivariate predictors of hard-event at COX regression analysis
Univariate predictors
Multivariate predictors HR
95% CI p
Age
1.06
0.0001
1.05
FE<35%
1.76
0.01
Multivessel disease
2.07
OMT/surgical treatment
3.12
2.69

16. Symptoms relief after treatment
Clinical status at the presentation %
Clinical status at 1-year %

17. Survival free from hard events adjusted Kaplain-Maier curve
Successful PCI
Surgery
OMT

18. Survival free from hard events
Kaplain-Maier curve
Successful PCI (75%)
Unsuccessful PCI (25%)
P=0.03

19. Conclusions
The prevalence of coronary CTO lesions in 2010, in this registry, in italy is about 12%
Outcome is related to patient clinical conditions rather than to strategy of treatment used
Patients with successful PCI have better outcome than those with un successful one