Validation and incremental value of the hybrid algorithm for CTO PCI.

Objectives: To evaluate the outcomes and benefits of using the hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Background: The hybrid algorithm harmonizes antegrade and retrograde techniques for performing CTO PCI. It has the potential to increase success rates and improve efficiency for CTO PCI. No previous data have analyzed the impact of this algorithm on CTO PCI success rates and procedural efficiency.

Methods: Retrospective analysis of contemporary CTO PCI performed at two high-volume centers with adoption of the hybrid technique was compared to previously published CTO outcomes in a well matched group of patients and lesion subsets.

Results: After adoption of the hybrid algorithm, technical success was significantly higher in the post hybrid algorithm group 189/198 (95.4%) vs the pre-algorithm group 367/462 (79.4%) (P < 0.001). Procedural success in the post hybrid algorithm group 175/198 (88.3%) when compared to the pre-algorithm group 360/462 (77.9%) (P < 0.001) was also significantly improved. Failure rates were significantly lower. Efficiency parameters including procedure time, contrast volume, fluoroscopy time, and radiation doses all favored the post hybrid group but did not reach statistical significance.

Conclusions: The validation of the hybrid algorithm has the potential to disseminate adoption of CTO PCI.