{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T23:12:24Z","timestamp":1784157144221,"version":"3.55.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:00:00Z","timestamp":1694390400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:00:00Z","timestamp":1694390400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100014584","name":"Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014584","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Aims<\/jats:title>\n                <jats:p>Recently, interventional techniques and material to treat chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) have evolved significantly. Nevertheless, it is still unknown whether this progress improved treatment success and patients\u2019 outcome. In a nationwide sample, we sought to analyze trends of patients\u2019 characteristics, complications and in-hospital case-fatality of patients undergoing CTO revascularization in Germany.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods and Results<\/jats:title>\n                <jats:p>We analyzed data on characteristics, treatments, and in-hospital outcomes for all coronary artery disease (CAD) patients (ICD-code I25) undergoing dual-injection CTO recanalization (OPS procedural code: 8\u2013839.9) in Germany from 2009 to 2020. Overall, 4,998,457 inpatients aged\u2009\u2265\u200918\u00a0years with diagnosis of CAD were treated in German hospitals in this period. Among these, 52,879 patients (1.1%) underwent CTO recanalization. Annual number of CTO PCIs increased from 1263 in 2009 to 6435 in 2020 (\u03b2 3.48 [95% CI 3.44\u20133.52]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) in parallel with a significant decrease of case-fatality (2.2% in 2009 to 1.4% in 2020; \u03b2 \u2009\u2013\u20090.60 [95% CI \u2009\u2013\u20090.82 to \u2009\u2013\u20090.39]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Overall, 754 (1.4%) patients with CTO recanalization died during the in-hospital stay and in-hospital case-fatality grew exponentially with age (\u03b2 0.82 [95% CI 0.73\u20130.90]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Significant predictors of in-hospital case fatality with an OR\u2009&gt;\u20093 were cancer, stroke, hemopericardium, acute renal failure, pulmonary embolism and shock.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Annual number of CTO procedures performed in Germany increased from 2009 to 2020 with a concomitant anti-proportional decrease in the case-fatality. Our findings may help to draw more attention to predictors of in-hospital case fatality in patients hospitalized for CTO recanalization.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1007\/s00392-023-02298-x","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T09:02:00Z","timestamp":1694422920000},"page":"987-994","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Temporal trends of case-fatality in patients undergoing dual-injection coronary chronic total occlusion recanalization"],"prefix":"10.1007","volume":"113","author":[{"given":"Recha","family":"Blessing","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsten","family":"Keller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zisis","family":"Dimitriadis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"M\u00fcnzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Gori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4312-0366","authenticated-orcid":false,"given":"Lukas","family":"Hobohm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,9,11]]},"reference":[{"issue":"7","key":"2298_CR1","doi-asserted-by":"publisher","first-page":"535","DOI":"10.4244\/EIJ-D-21-01117","volume":"18","author":"C Di Mario","year":"2022","unstructured":"Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS (2022) Recanalisation of coronary chronic total occlusions. EuroIntervention 18(7):535\u2013561","journal-title":"EuroIntervention"},{"issue":"11","key":"2298_CR2","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1016\/j.jacc.2011.12.007","volume":"59","author":"P Fefer","year":"2012","unstructured":"Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S et al (2012) Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol 59(11):991\u2013997","journal-title":"J Am Coll Cardiol"},{"issue":"15","key":"2298_CR3","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1016\/j.jcin.2016.04.031","volume":"9","author":"T R\u00e5munddal","year":"2016","unstructured":"R\u00e5munddal T, Hoebers LP, Henriques JPS, Dworeck C, Anger\u00e5s O, Odenstedt J et al (2016) Prognostic impact of chronic total occlusions: a report from SCAAR (Swedish Coronary Angiography and Angioplasty Registry). JACC Cardiovasc Interv 9(15):1535\u20131544","journal-title":"JACC Cardiovasc Interv"},{"issue":"12","key":"2298_CR4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.121.010546","volume":"14","author":"BH Strauss","year":"2021","unstructured":"Strauss BH, Knudtson ML, Cheema AN, Galbraith PD, Elbaz-Greener G, Abuzeid W et al (2021) Canadian multicenter chronic total occlusion registry: ten-year follow-up results of chronic total occlusion revascularization. Circ Cardiovasc Interv 14(12):e010546","journal-title":"Circ Cardiovasc Interv"},{"issue":"21","key":"2298_CR5","doi-asserted-by":"publisher","first-page":"2144","DOI":"10.1016\/j.jcin.2017.06.024","volume":"10","author":"Y Suzuki","year":"2017","unstructured":"Suzuki Y, Tsuchikane E, Katoh O, Muramatsu T, Muto M, Kishi K et al (2017) Outcomes of percutaneous coronary interventions for chronic total occlusion performed by highly experienced Japanese specialists: The first report from the Japanese CTO-PCI expert registry. JACC Cardiovasc Interv 10(21):2144\u20132154","journal-title":"JACC Cardiovasc Interv"},{"issue":"15","key":"2298_CR6","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1016\/j.jcin.2017.05.065","volume":"10","author":"J Sapontis","year":"2017","unstructured":"Sapontis J, Salisbury AC, Yeh RW, Cohen DJ, Hirai T, Lombardi W et al (2017) Early procedural and health status outcomes after chronic total occlusion angioplasty: a report from the OPEN-CTO registry (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures). JACC Cardiovasc Interv 10(15):1523\u20131534","journal-title":"JACC Cardiovasc Interv"},{"issue":"26","key":"2298_CR7","doi-asserted-by":"publisher","first-page":"2484","DOI":"10.1093\/eurheartj\/ehy220","volume":"39","author":"GS Werner","year":"2018","unstructured":"Werner GS, Martin-Yuste V, Hildick-Smith D, Boudou N, Sianos G, Gelev V et al (2018) A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. Eur Heart J 39(26):2484\u20132493","journal-title":"Eur Heart J"},{"issue":"13","key":"2298_CR8","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1016\/j.jcin.2018.04.017","volume":"11","author":"AA Obedinskiy","year":"2018","unstructured":"Obedinskiy AA, Kretov EI, Boukhris M, Kurbatov VP, Osiev AG, Ibn Elhadj Z et al (2018) The Impactor-CTO trial. JACC Cardiovasc Interv 11(13):1309\u20131311","journal-title":"JACC Cardiovasc Interv"},{"issue":"1","key":"2298_CR9","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.ijcard.2011.04.023","volume":"161","author":"F Borgia","year":"2012","unstructured":"Borgia F, Viceconte N, Ali O, Stuart-Buttle C, Saraswathyamma A, Parisi R et al (2012) Improved cardiac survival, freedom from MACE and angina-related quality of life after successful percutaneous recanalization of coronary artery chronic total occlusions. Int J Cardiol 161(1):31\u201338","journal-title":"Int J Cardiol"},{"issue":"4","key":"2298_CR10","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.jcin.2012.01.012","volume":"5","author":"DA Jones","year":"2012","unstructured":"Jones DA, Weerackody R, Rathod K, Behar J, Gallagher S, Knight CJ et al (2012) Successful recanalization of chronic total occlusions is associated with improved long-term survival. JACC Cardiovasc Interv 5(4):380\u2013388","journal-title":"JACC Cardiovasc Interv"},{"issue":"14","key":"2298_CR11","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1161\/CIRCULATIONAHA.118.031313","volume":"139","author":"S-W Lee","year":"2019","unstructured":"Lee S-W, Lee PH, Ahn J-M, Park D-W, Yun S-C, Han S et al (2019) Randomized trial evaluating percutaneous coronary intervention for the treatment of chronic total occlusion. Circulation 139(14):1674\u20131683","journal-title":"Circulation"},{"issue":"15","key":"2298_CR12","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1016\/j.jacc.2016.07.744","volume":"68","author":"JPS Henriques","year":"2016","unstructured":"Henriques JPS, Hoebers LP, R\u00e5munddal T, Laanmets P, Eriksen E, Bax M et al (2016) Percutaneous intervention for concurrent chronic total occlusions in patients with STEMI: The EXPLORE trial. J Am Coll Cardiol 68(15):1622\u20131632","journal-title":"J Am Coll Cardiol"},{"issue":"19","key":"2298_CR13","doi-asserted-by":"publisher","first-page":"1982","DOI":"10.1016\/j.jcin.2018.05.041","volume":"11","author":"K Mashayekhi","year":"2018","unstructured":"Mashayekhi K, N\u00fchrenberg TG, Toma A, Gick M, Ferenc M, Hochholzer W et al (2018) A randomized trial to assess regional left ventricular function after stent implantation in chronic total occlusion: The REVASC trial. JACC Cardiovasc Interv 11(19):1982\u20131991","journal-title":"JACC Cardiovasc Interv"},{"issue":"2","key":"2298_CR14","doi-asserted-by":"publisher","first-page":"198","DOI":"10.4244\/EIJ-D-18-00826","volume":"15","author":"AR Galassi","year":"2019","unstructured":"Galassi AR, Werner GS, Boukhris M, Azzalini L, Mashayekhi K, Carlino M et al (2019) Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EuroIntervention 15(2):198\u2013208","journal-title":"EuroIntervention"},{"issue":"13","key":"2298_CR15","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1093\/eurheartj\/ehab703","volume":"43","author":"AP Banning","year":"2022","unstructured":"Banning AP, Serruys P, de Maria GL, Ryan N, Walsh S, Gonzalo N et al (2022) Five-year outcomes after state-of-the-art percutaneous coronary revascularization in patients with de novo three-vessel disease: final results of the SYNTAX II study. Eur Heart J 43(13):1307\u20131316","journal-title":"Eur Heart J"},{"key":"2298_CR16","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.hjc.2022.02.005","volume":"66","author":"I Nikolakopoulos","year":"2022","unstructured":"Nikolakopoulos I, Vemmou E, Karacsonyi J, Alaswad K, Karmpaliotis D, Abi Rafeh N et al (2022) Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry. Hellenic J Cardiol 66:80\u201383","journal-title":"Hellenic J Cardiol"},{"issue":"9","key":"2298_CR17","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1016\/j.jcin.2017.01.047","volume":"10","author":"L Azzalini","year":"2017","unstructured":"Azzalini L, Dautov R, Ojeda S, Benincasa S, Bellini B, Giannini F et al (2017) Procedural and long-term outcomes of percutaneous coronary intervention for in-stent chronic total occlusion. JACC Cardiovasc Interv 10(9):892\u2013902","journal-title":"JACC Cardiovasc Interv"},{"key":"2298_CR18","doi-asserted-by":"crossref","unstructured":"Hernandez-Suarez DF, Azzalini L, Moroni F, Tinoco de Paula JE, Lamelas P, Campos CM et al (2022) Outcomes of chronic total occlusion percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the LATAM CTO registry. Catheter Cardiovasc Interv 99(2):245\u2013253","DOI":"10.1002\/ccd.30041"},{"issue":"22","key":"2298_CR19","doi-asserted-by":"publisher","first-page":"2276","DOI":"10.1016\/j.jcin.2018.07.058","volume":"11","author":"Y Khariton","year":"2018","unstructured":"Khariton Y, Airhart S, Salisbury AC, Spertus JA, Gosch KL, Grantham JA et al (2018) Health status benefits of successful chronic total occlusion revascularization across the spectrum of left ventricular function: insights from the OPEN-CTO registry. JACC Cardiovasc Interv 11(22):2276\u20132283","journal-title":"JACC Cardiovasc Interv"},{"issue":"6","key":"2298_CR20","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1002\/ccd.28928","volume":"97","author":"C Patterson","year":"2021","unstructured":"Patterson C, Sapontis J, Nicholson WJ, Lombardi W, Karmpaliotis D, Moses J et al (2021) Impact of body mass index on outcome and health status after chronic total occlusion percutaneous coronary intervention: Insights from the OPEN-CTO study. Catheter Cardiovasc Interv 97(6):1186\u20131193","journal-title":"Catheter Cardiovasc Interv"},{"issue":"21","key":"2298_CR21","doi-asserted-by":"publisher","first-page":"2174","DOI":"10.1016\/j.jcin.2017.08.043","volume":"10","author":"AC Salisbury","year":"2017","unstructured":"Salisbury AC, Sapontis J, Grantham JA, Qintar M, Gosch KL, Lombardi W et al (2017) Outcomes of chronic total occlusion percutaneous coronary intervention in patients with diabetes: insights from the open CTO registry. JACC Cardiovasc Interv 10(21):2174\u20132181","journal-title":"JACC Cardiovasc Interv"},{"issue":"11","key":"2298_CR22","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1016\/j.jcin.2020.02.025","volume":"13","author":"H Othman","year":"2020","unstructured":"Othman H, Seth M, Zein R, Rosman H, Lalonde T, Yamasaki H et al (2020) Percutaneous coronary intervention for chronic total occlusion-The Michigan experience: insights from the BMC2 registry. JACC Cardiovasc Interv 13(11):1357\u20131368","journal-title":"JACC Cardiovasc Interv"},{"issue":"2","key":"2298_CR23","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.jcin.2014.08.014","volume":"8","author":"ES Brilakis","year":"2015","unstructured":"Brilakis ES, Banerjee S, Karmpaliotis D, Lombardi WL, Tsai TT, Shunk KA et al (2015) Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv 8(2):245\u2013253","journal-title":"JACC Cardiovasc Interv"},{"issue":"10","key":"2298_CR24","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.117.006229","volume":"11","author":"NV Konstantinidis","year":"2018","unstructured":"Konstantinidis NV, Werner GS, Deftereos S, Di Mario C, Galassi AR, Buettner JH et al (2018) Temporal trends in chronic total occlusion interventions in Europe. Circ Cardiovasc Interv 11(10):e006229","journal-title":"Circ Cardiovasc Interv"},{"issue":"11","key":"2298_CR25","doi-asserted-by":"publisher","first-page":"e929","DOI":"10.4244\/EIJ-D-22-00599","volume":"18","author":"S Kostantinis","year":"2022","unstructured":"Kostantinis S, Simsek B, Karacsonyi J, Alaswad K, Krestyaninov O, Khelimskii D et al (2022) In-hospital outcomes and temporal trends of percutaneous coronary interventions for chronic total occlusion. EuroIntervention 18(11):e929\u2013e932","journal-title":"EuroIntervention"},{"issue":"1","key":"2298_CR26","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1080\/14779072.2021.1850264","volume":"19","author":"F Moroni","year":"2021","unstructured":"Moroni F, Brilakis ES, Azzalini L (2021) Chronic total occlusion percutaneous coronary intervention: managing perforation complications. Expert Rev Cardiovasc Ther 19(1):71\u201387","journal-title":"Expert Rev Cardiovasc Ther"},{"issue":"4","key":"2298_CR27","first-page":"153","volume":"32","author":"I Xenogiannis","year":"2020","unstructured":"Xenogiannis I, Gkargkoulas F, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW et al (2020) Temporal trends in chronic total occlusion percutaneous coronary interventions: insights From the PROGRESS-CTO registry. J Invasive Cardiol 32(4):153\u2013160","journal-title":"J Invasive Cardiol"}],"container-title":["Clinical Research in Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00392-023-02298-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00392-023-02298-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00392-023-02298-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T08:10:15Z","timestamp":1719907815000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00392-023-02298-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,11]]},"references-count":27,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["2298"],"URL":"https:\/\/doi.org\/10.1007\/s00392-023-02298-x","relation":{},"ISSN":["1861-0684","1861-0692"],"issn-type":[{"value":"1861-0684","type":"print"},{"value":"1861-0692","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,11]]},"assertion":[{"value":"16 April 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 September 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Since our study did not comprise direct access by the investigators to individual patient data but only an access to summarized results provided by the RDC, approval by an ethics committee as well as patients\u2019 informed consent were not required, in accordance with German law.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}