Calcium Modification Strategies in Treatment of Calcified Coronary Chronic Total Occlusions: Insights From the PROGRESS-CTO Registry
Document Type
Conference Proceeding
Publication Date
11-2025
Publication Title
European Heart Journal
Abstract
Background: Coronary calcification increases the difficulty of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), and various calcium modification strategies (CMS) are currently available to modify calcific plaque. (1,2) Purpose: To describe the outcomes of PCI of calcified CTOs performed with and without CMS. Methods: We analyzed data from 16,916 CTO PCIs enrolled in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) between 2012 and 2025. Results: Moderate or severe calcification was present in 49.6% (n=8,385) and CMS was used in 9.4% (n=1,595) of CTO lesions. The most common CMS was rotational atherectomy (n=620), followed by intravascular lithotripsy (n=497), and laser atherectomy (n=292). Compared with non-CMS, CMS group had higher rates of successful antegrade wiring (63.3% vs. 44.2%; p< 0.001) and technical success (94.4% vs 81.6%; p< 0.001), with similar incidence of in-hospital major adverse cardiovascular events (MACE) (3.0% vs. 2.8%; p=0.657) and perforation (6.2% vs. 6.1%; p=0.933) (Figure 1). On multivariable analysis, the presence of moderate/severe calcification was independently associated with lower technical success (odds ratio, OR=0.77, 95% CI: 0.63-0.95) and higher MACE (OR=2.03, 95% CI: 1.51-2.74) (Figure 2). The use of CMS was also independently associated with higher technical success (OR=6.69, 95% CI: 4.57-10.0), but not MACE (OR=1.2, 95% CI: 0.85-1.68) (Figure 2). Conclusions: Moderate/severe calcification was present in nearly half of CTO lesions, and was associated with lower technical success rates, and higher incidence of in-hospital MACE. The application of CMS in calcified CTOs was associated with higher technical success and similar MACE.
Volume
46
Issue
Suppl 1
Recommended Citation
Kostantinis S, Strepkos D, Gorgulu S, Goktekin O, Alaswad K, Alexandrou M, et al. [Rempakos A]. Calcium modification strategies in treatment of calcified coronary chronic total occlusions: insights from the PROGRESS-CTO registry. Eur Heart J. 2025 Nov;46(Suppl). doi:10.1093/eurheartj/ehaf784.3174
DOI
10.1093/eurheartj/ehaf784.3174
Comments
European Society of Cardiology (ESC) Congress 2025 together with World Congress of Cardiology, August 29 - September 1, 2025, Madrid, Spain