Supplemental Table 1 – Part 1: Characteristics of selected publications reporting at least one CTO complication
Year
Author
Journal
Location
Procedure Dates
2011
Galassi AR (1)
Catheter Cardiovasc Interv
Italy
3/2009 - 6/2010
2011
Jolicoeur EM (2)
Catheter Cardiovasc Interv
USA (Duke)
1/1/1999 - 12/31/2008
2011
Garcia-Garcia HM (3)
EuroIntervention
Netherlands, Italy
2/2006 - 6/2007
2011
Galassi HR (4)
EuroIntervention
Europe (multicenter)
1/2008 - 12/2008
2011
Borgia F (5)
Int J Cardiol
UK
4/2003 - 7/2009
2011
Wu CJ (6)
Int Heart J
Taiwan
5/2006 - 5/2010
2011
Werner GS (7)
EuroIntervention
Germany
7/2008 - 6/2009
2011
Tomasello SD (8)
J Interv Cardiol
Italy (Ferrarotto)
10/2005 - 6/2009
2011
Liu W (9)
J Interv Cardiol
Japan (Toho University)
1/2003 - 5/2009
2011
Ramcharitar S (10)
EuroIntervention
Netherlands
2/2004 - 5/2008
2011
Park Y (11)
Int J Cardiol
Korea (Gyeongsang National University Hospital)
1/2005 - 9/2008
2010
Yang CH (12)
Chang Gung Med J
Taiwan (Chang Gung Memorial)
2/1998 - 12/2003
2010
Al-Lamee R (13)
American Journal of Cardiology
Italy (San Raffaele)
5/2002 - 7/2009
2010
Werner GS (14)
EuroIntervention
Germany (ALKK Multicenter Registry)
1/2006 - 12/2006
2010
Matsukage (15)
Catheter Cardiovasc Interv
Japan (Tokai University, PIKACHU Registry)
4/2008 - 3/2009
2010
Ge L (16)
Chinese Medical Journal
China (Zhongshan Hospital)
7/2005 - 11/2009
J Interv Cardiol
Revista espanola de cardiologia
China (Grantham Hospital)
1/2005 - 10/2007
2010
2010
Jim MH (17)
Fernandez-Diaz JA (18)
Spain (Hospital Universitario Puerta de Hierro)
12/2007 - 10/2009
2010
Galassi AR (19)
J Interv Cardiol
Italy (Ferrarotto)
5/2007 - 2/2009
2010
Rathore S (20)
JACC Cardiovasc Interv
Japan (Toyohashi Heart Center)
3/2007 - 9/2008
2010
Morino Y (21)
JACC Cardiovasc Interv
Japan (Multicenter Registry)
4/2006 - 11/2007
2010
Lee NH (22)
Int J Cardiol
Korea (SoonChunHyang University)
7/2006 - 4/2008
2009
Chen SL (23)
Chinese Medical Journal
China (Multicenter)
1/2004 - 5/2005
2009
Rathore S (24)
Circ Cardiovasc Interv
Japan (Toyohashi Heart Center)
1/2002 - 8/2008
2009
Chung SH (25)
Korean Circulation Journal
Korea (Dong-A University)
2/2007 - 7/2008
2009
Park CS (26)
Korean Circulation Journal
Korea (Catholic University of Korea)
1/2006 - 7/2007
2009
Kimura M (27)
JACC Cardiovasc Interv
Japan, Germany, UK (Multicenter CART Registry)
10/2005 - 4/2008
2009
Thompson CA (28)
JACC Cardiovasc Interv
USA (Yale, St Joseph's)
1/2005 - 3/2008
2009
Rathore S (29)
JACC Cardiovasc Interv
Japan (Toyohashi Heart Center)
1/2001 - 7/2008
2009
Rathore S (30)
Catheter Cardiovasc Interv
UK (Liverpool Heart and Chest Hospital)
1/2003 - 12/2005
2009
Paizis I (31)
EuroIntervention
Greece (Onassis Cardiac Surgery Centre)
1/2004 - 2/2007
2009
Hsu JT (32)
Catheter Cardiovasc Interv
Taiwan (Kusatsu Heart Center)
3/2006 - 12/2007
2008
Sianos G (33)
EuroIntervention
Europe (multicenter)
2/2005 - 12/2007
2008
Tiroch K (34)
Catheter Cardiovasc Interv
USA (multicenter, FACTOR Study)
1/2005 - 7/2006
2008
Carlino M (35)
Catheter Cardiovasc Interv
Italy (San Raffaele)
1/2005 - 10/2007
2008
Mitsudo K (36)
J Invasive Cardiol
Japan (Multicenter, CONQUEST Trial)
1/2003 - 3/2004
2008
de Labriolle A (37)
Am J Cardiol
USA (Washington Hospital Center)
1/2003 - 9/2005
2008
Valenti R (38)
Eur Heart J
Italy (Careggi Hospital)
1/2003 - 12/2006
2008
Chamie D (39)
Catheter Cardiovasc Interv
Brazil (Sao Paolo, RAPID-CTO study)
3/2006 - 11/2006
2008
Han YL (40)
Chin Med J (Engl)
China (General Hospital of Shenyang Military Command)
7/2000 - 10/2007
2008
Barlis P (41)
Catheter Cardiovasc Interv
UK (Royal Brompton Hospital)
5/2003 - 10/2006
2008
Biondi-Zoccai GG (42)
Int J Cardiol
Italy (University of Turin)
1/2003 - 2/2007
2008
Saito S (43)
Catheter Cardiovasc Interv
Japan (ShonanKamakura General Hospital)
1/2006 - 1/2007
2008
Suzuki S (44)
Catheter Cardiovasc Interv
Japan (Teikyo University)
10/2005 - 9/2006
2007
Prasad A (45)
J Am Coll Cardiol
USA (Mayo)
10/1/1979 - 7/31/2005
2007
Di Mario C (46)
EuroIntervention
UK (Royal Brompton Hospital)
4/2005 - 4/2007
2007
Aziz S (47)
Catheter Cardiovasc Interv
UK (Royal Blackburn Hospital)
1/2000 - 6/2004
2007
Werner GS (48)
Clin Res Cardiol
Germany
2/2002 - 6/2004
2006
Kim JY (49)
Yonsei Med J
Korea (Yonsei University)
3/2000 - 10/2003
2006
Drozd J (50)
Kardiol Pol
Poland (Medical University in Poland)
1/1996 - 12/2003
2006
Han YL (51)
Chin Med J (Engl)
China (Shenyang General Hospital)
6/1995 - 12/2005
2006
Melzi G (52)
Catheter Cardiovasc Interv
Italy (San Raffaele)
11/2003 - 11/2004
2005
Abbas AE (53)
Am J Cardiol
USA (William Beaumont Hospital)
1/2002 - 12/2003
2005
Drozd J (54)
Kardiol Pol
Poland (Medical University in Poland)
1/1996 - 12/2003
2005
Dong S (55)
J Interv Cardiol
Israel (Hadassah Medical Center)
1/1997 - 12/1999
2004
Baim DS (56)
Am J Cardiol
USA (Multicenter, GREAT Study)
NA
2004
Hoye A (57)
Catheter Cardiovasc Interv
Netherlands (Thoraxcentre)
NA
2004
Sheiban I (58)
J Invasive Cardiol
Italy (University of Torino)
1/2000 - 6/2002
2003
Olivari Z (59)
J Am Coll Cardiol
Italy (Multicenter)
1/1999 - 1/2000
2002
Mathew OP (60)
J Assoc Physicians India
India (Military Hospital in Pune)
1/1999 - 3/2001
2001
Suero JA (61)
J Am Coll Cardiol
USA (Mid America Heart Institute)
6/1980 - 12/1999
2000
Sheiban I (62)
Int J Cardiovasc Intervent
Italy (University of Torina, San Raffaele)
1/1998 - 12/2000
2000
Serruys PW (63)
Eur Heart J
Europe (multicenter, TOTAL trial)
5/1995 - 6/1997
2000
Lefevre T (64)
Am J Cardiol
France (Institut Cardiovascularie Paris)
NA
2000
Noguchi T (65)
Catheter Cardiovasc Interv
Japan (National Cardiovascular Center)
1986-1996
Supplemental Table 1 – Part 2: Patient demographics and angiographic characteristics of selected publications
Year
Author
Number of
Patients
Number of
Lesions
Age
Male
Sex
Prior
CABG
LAD
LCx
RCA
LM
Graft
Other
Number
Retrograde
2011
Galassi AR (1)
225
225
61.2
209
32
69
34
122
0
0
0
33
2011
Jolicoeur EM (2)
346
346
59.2
254
75
104
100
142
0
0
0
.
2011
Garcia-Garcia HM (3)
80
80
64.1
68
8
14
17
49
0
0
0
0
2011
Galassi HR (4)
1914
1983
64.1
1627
285
589
385
993
6
10
0
234
2011
Borgia F (5)
302
302
64
248
52
99
54
148
1
0
0
78
2011
Wu CJ (6)
85
85
59.7
80
6
34
1
50
0
0
0
85
2011
Werner GS (7)
42
42
66.3
36
17
9
9
24
0
0
0
0
2011
Tomasello SD (8)
303
328
61
272
33
118
63
147
0
0
0
42
2011
Liu W (9)
116
120
65
102
9
54
26
38
0
2
0
7
2011
Ramcharitar S (10)
43
43
67.1
33
6
18
17
8
0
0
0
.
2011
Park Y (11)
31
32
61
24
1
.
.
.
.
.
.
.
2010
Yang CH (12)
419
419
61.5
358
.
176
94
148
0
1
0
.
2010
Al-Lamee R (13)
34
34
64.6
30
34
0
0
0
0
34
0
0
2010
Werner GS (14)
674
714
67
508
85
219
177
293
4
21
0
.
2010
Matsukage (15)
141
141
69
113
7
58
33
50
0
0
0
3
2010
Ge L (16)
42
42
62.8
41
2
24
0
14
3
1
0
42
22
22
73
15
22
0
0
0
0
22
0
0
2010
2010
Jim MH (17)
Fernandez-Diaz JA (18)
9
9
66.9
7
.
2
0
7
0
0
0
9
2010
Galassi AR (19)
171
178
60.8
157
18
.
.
.
.
.
.
.
2010
Rathore S (20)
31
31
62.4
26
9
4
2
25
0
0
0
31
2010
Morino Y (21)
498
528
66.9
406
48
190
101
234
3
0
0
136
2010
Lee NH (22)
22
24
56
17
0
9
2
13
0
0
0
24
2009
Chen SL (23)
152
152
64.4
114
.
63
30
59
0
0
0
.
2009
Rathore S (24)
157
157
65
134
28
50
12
93
1
1
0
157
2009
Chung SH (25)
28
31
63.4
20
0
16
1
14
0
0
0
31
2009
Park CS (26)
134
136
.
.
.
.
.
.
.
.
.
.
2009
Kimura M (27)
224
224
61.3
193
39
54
9
156
3
2
0
224
2009
Thompson CA (28)
636
636
64.6
511
171
166
182
281
7
0
0
.
2009
Rathore S (29)
806
904
65.5
748
114
267
201
355
5
2
74
.
2009
Rathore S (30)
468
468
64.4
380
15
187
108
173
0
0
0
.
2009
Paizis I (31)
106
106
59
94
.
45
20
41
0
0
0
.
2009
Hsu JT (32)
96
119
65
93
7
32
33
54
0
0
0
50
2008
Sianos G (33)
175
175
61.4
154
19
37
12
125
1
0
0
175
2008
Tiroch K (34)
125
125
62.8
105
24
39
23
63
0
0
0
0
2008
Carlino M (35)
68
68
61.5
65
26
1
13
54
0
0
0
.
2008
Mitsudo K (36)
110
116
66.3
89
10
41
35
39
0
1
0
.
2008
de Labriolle A (37)
172
172
61.4
131
22
53
45
73
1
0
0
.
2008
Valenti R (38)
486
527
68.1
395
53
151
92
220
0
8
56
0
2008
Chamie D (39)
16
16
56.3
9
.
7
1
8
0
0
0
0
2008
Han YL (40)
152
164
62.9
112
.
64
39
61
0
0
0
.
2008
Barlis P (41)
202
203
64.4
154
23
64
42
96
1
0
0
.
2008
Biondi-Zoccai GG (42)
17
17
67
16
7
1
3
11
2
0
0
17
2008
Saito S (43)
45
45
64
38
.
11
3
31
0
0
0
45
2008
Suzuki S (44)
72
72
68.9
64
.
.
.
.
.
.
.
.
2007
Prasad A (45)
1262
1277
63.2
957
208
466
352
459
0
0
0
.
2007
Di Mario C (46)
17
17
65.3
16
.
6
0
11
0
0
0
17
2007
Aziz S (47)
543
570
58.8
421
25
233
107
230
0
0
0
.
2007
Werner GS (48)
34
34
.
.
.
.
.
.
.
.
.
.
2006
Kim JY (49)
85
87
61.6
56
.
45
11
31
0
0
0
.
2006
Drozd J (50)
459
459
57.3
369
.
.
.
.
.
.
.
.
2006
Han YL (51)
1263
1596
60
1037
.
569
305
543
7
0
172
.
2006
Melzi G (52)
28
30
61.9
25
4
4
5
21
0
0
0
.
2005
Abbas AE (53)
289
313
63.5
234
85
104
46
133
0
0
30
.
2005
Drozd J (54)
460
460
57.2
376
.
203
94
160
3
0
0
.
2005
Dong S (55)
253
283
62.7
235
52
81
87
104
0
0
11
.
2004
Baim DS (56)
113
113
62.4
93
30
29
18
66
0
0
0
.
2004
Hoye A (57)
27
29
.
20
2
9
3
17
0
0
0
.
2004
Sheiban I (58)
89
89
61
64
44
41
9
39
0
0
0
.
2003
Olivari Z (59)
376
390
58.3
323
19
156
86
147
1
0
0
.
2002
Mathew OP (60)
80
80
46.7
72
.
40
12
28
0
0
0
.
2001
Suero JA (61)
2007
2074
60.6
1570
357
752
583
729
10
0
0
.
2000
Sheiban I (62)
62
62
61
42
16
25
16
21
0
0
0
.
2000
Serruys PW (63)
303
303
58.7
248
22
117
37
149
0
0
0
.
2000
Lefevre T (64)
88
88
59.3
73
.
.
.
.
.
.
.
.
2000
Noguchi T (65)
226
226
61
179
.
107
28
86
0
5
0
.
CABG, coronary artery bypass graft surgery; LAD, left anterior descending; LCx, left circumflex; RCA, right coronary
artery; LM, left main
Supplemental Table 1 – Part 3: Outcomes from selected publications
Year
Author
Deaths
Emergent
CABG
Stroke
Overall
MI
Q Wave
MI
Overall
Perforations
Tamponade
Stent
Thrombosis
Vascular
Major
Bleed
2011
Galassi AR (1)
0
0
0
4
1
9
1
0
0
0
2011
Jolicoeur EM (2)
0
0
0
11
0
8
2
0
.
.
2011
Garcia-Garcia HM (3)
0
0
0
2
0
3
1
.
.
.
2011
Galassi HR (4)
7
3
1
26
3
53
11
1
14
0
2011
Borgia F (5)
0
0
2
6
0
.
1
.
.
0
2011
Wu CJ (6)
0
0
0
2
0
2
3
1
0
0
2011
Werner GS (7)
0
0
0
2
0
0
0
0
0
.
2011
Tomasello SD (8)
0
0
0
13
.
15
1
0
.
.
2011
Liu W (9)
1
0
0
0
0
3
1
0
0
0
2011
Ramcharitar S (10)
0
1
0
.
.
2
2
.
.
.
2011
Park Y (11)
0
0
0
6
0
2
0
0
.
.
2010
Yang CH (12)
3
1
0
11
0
16
6
0
.
2
2010
Al-Lamee R (13)
0
0
0
1
.
1
0
0
.
.
2010
Werner GS (14)
2
0
1
3
.
.
.
.
7
.
2010
Matsukage (15)
0
0
0
0
0
2
0
0
.
0
2010
Ge L (16)
0
0
0
3
0
1
1
0
.
.
0
0
0
2
.
1
0
.
.
.
2010
2010
Jim MH (17)
Fernandez-Diaz JA (18)
0
0
0
0
0
0
0
.
.
.
2010
Galassi AR (19)
0
0
0
4
0
6
2
.
.
.
2010
Rathore S (20)
0
0
0
.
.
3
0
.
.
.
2010
Morino Y (21)
2
0
0
11
1
36
2
0
2
8
2010
Lee NH (22)
0
0
0
0
0
.
1
0
.
.
2009
Chen SL (23)
3
0
0
.
4
5
4
3
.
.
2009
Rathore S (24)
0
1
0
6
1
6
1
.
.
.
2009
Chung SH (25)
1
0
0
.
.
.
0
.
.
.
2009
Park CS (26)
1
0
0
0
0
.
.
.
.
.
2009
Kimura M (27)
1
1
0
10
2
7
1
.
.
.
2009
Thompson CA (28)
0
0
0
18
.
6
.
.
.
.
2009
Rathore S (29)
5
2
0
27
5
103
6
7
.
.
2009
Rathore S (30)
1
3
0
17
.
.
.
.
1
1
2009
Paizis I (31)
0
0
0
12
.
0
0
.
3
.
2009
Hsu JT (32)
0
0
0
6
.
12
.
.
.
.
2008
Sianos G (33)
0
0
1
7
0
0
0
.
.
.
2008
Tiroch K (34)
0
1
0
6
1
2
1
.
.
.
2008
Carlino M (35)
0
0
0
7
0
5
0
0
.
.
2008
Mitsudo K (36)
0
0
0
0
0
9
2
.
.
.
2008
de Labriolle A (37)
0
1
0
.
0
3
1
1
.
.
2008
Valenti R (38)
0
0
0
21
0
.
2
.
.
18
2008
Chamie D (39)
0
0
0
0
0
1
0
.
.
.
2008
Han YL (40)
0
0
0
0
0
1
0
.
.
.
2008
Barlis P (41)
1
0
0
5
0
.
0
.
.
.
2008
Biondi-Zoccai GG (42)
0
0
0
1
0
.
.
.
.
.
2008
Saito S (43)
0
0
0
0
0
1
1
0
.
.
2008
Suzuki S (44)
0
0
0
.
.
.
.
.
.
.
2007
Prasad A (45)
12
14
0
104
30
.
9
.
.
.
2007
Di Mario C (46)
0
0
0
0
0
.
0
.
.
.
2007
Aziz S (47)
3
0
4
32
0
.
.
.
.
.
2007
Werner GS (48)
0
0
0
.
.
3
0
.
.
.
2006
Kim JY (49)
0
0
0
1
0
2
.
.
0
0
2006
Drozd J (50)
1
1
0
2
1
5
1
.
3
.
2006
Han YL (51)
3
1
0
.
.
9
3
6
.
.
2006
Melzi G (52)
0
0
0
1
.
1
0
.
.
.
2005
Abbas AE (53)
0
1
0
1
0
4
0
.
.
3
2005
Drozd J (54)
1
1
0
.
1
8
1
.
2
.
2005
Dong S (55)
1
0
0
4
.
4
0
.
.
.
2004
Baim DS (56)
0
0
0
6
0
3
3
.
.
.
2004
Hoye A (57)
0
0
0
0
0
.
0
.
.
.
2004
Sheiban I (58)
0
2
0
4
0
3
2
0
0
.
2003
Olivari Z (59)
1
2
0
17
1
8
0
2
.
.
2002
Mathew OP (60)
0
0
0
1
1
0
0
0
Suero JA (61)
27
1
15
0
2001
1
48
10
.
.
30
34
.
2000
Sheiban I (62)
0
0
0
0
0
1
0
0
.
.
2000
Serruys PW (63)
0
0
0
17
.
36
0
.
.
.
2000
Lefevre T (64)
0
0
0
.
.
6
0
.
.
.
2000
Noguchi T (65)
0
0
1
3
.
.
.
.
.
.
CABG, coronary artery bypass graft surgery; MI, myocardial infarction
Supplemental Table 2. Cumulative proportion and 95% confidence intervals for overall cohort
Outcome
Cumulative Rate
Cumulative Proportion
Cumulative Proportion
%
95% CI
Angiographic Success
14414/18828
76.6
75.9 - 77.2
MACE
500/15718
3.2
2.9 – 3.5
Death
77/18061
0.4
0.3 – 0.5
Emergent coronary artery bypass graft
52/18061
0.3
0.2 – 0.4
Stroke
11/18061
< 0.01
0 – 0.1
Myocardial infarction
490/15718
3.1
2.9 – 3.4
Q Wave myocardial infarction
61/13353
0.5
0.3 – 0.6
Coronary perforation (per lesion)
418/12254
3.4
3.1 – 3.7
Tamponade
74/13103
0.6
0.4 – 0.7
Acute Stent thrombosis
51/9338
0.6
0.4 – 0.7
Vascular complication
66/7308
0.9
0.7 – 1.1
Major bleed
32/5108
0.6
0.4 – 0.9
Contrast nephropathy
165/4796
3.4
2.9 – 4.0
Radiation injury
3/2857
0.1
0 – 0.3
surgery
MACE, major adverse cardiac events
Supplemental Table 3. Cumulative proportion and 95% confidence intervals for retrograde cohort
Outcome
Cumulative Rate Cumulative Proportion
Cumulative Proportion
%
95% CI
Angiographic Success
707/886
80.0
75.9 - 77.2
MACE
31/853
3.6
2.5 – 5.1
Death
1/884
0.1
0 – 0.6
Emergent coronary artery bypass graft
1/884
0.1
0 – 0.6
Stroke
1/884
0.1
0 – 0.6
Myocardial infarction
28/853
3.3
2.2 – 4.7
Q Wave myocardial infarction
2/803
0.2
0 – 0.9
Coronary perforation (per lesion)
31/828
3.7
2.6 – 5.3
Tamponade
9/817
1.1
0.5 – 2.1
Acute Stent thrombosis
1/428
0.2
0 – 1.3
Contrast nephropathy
6/378
1.6
0.6 – 3.4
Radiation injury
1/293
0.3
0 – 1.9
surgery
MACE, major adverse cardiac events
Supplemental Figure 1. Funnel plot for angiographic success rate
Supplemental Figure 2. Funnel plot for death rate
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Supplemental Table 1 – Part 1: Characteristics of selected