Invited Faculty at EuroCTO 2024: Trials vs. Real-World Registries in CTO PCI

In September 2024, Dr. Michael Megaly was among the invited faculty at EuroCTO 2024, the annual meeting of the European CTO Society, held in Istanbul, Turkey.

The Euro CTO Meeting 2024 took place in Istanbul from September 19 to 21, co-organized with CTO Essentials 2024, and brought together experienced CTO operators from across Europe, Asia, and North America for live cases, lectures, and scientific sessions.

Dr. Megaly's presentation addressed the gap between randomized controlled trial data and real-world registry data in CTO PCI, a distinction with direct implications for how operators and programs interpret the existing evidence base.

The lecture drew on research he led in JACC: Cardiovascular Interventions, which systematically compared patient characteristics across CTO revascularization trials versus real-world registries. The analysis identified consistent and meaningful differences: trial populations tend to be younger, with fewer comorbidities and less anatomically complex lesions than the patients treated in high-volume CTO programs in routine practice. Registry populations — reflecting surgical turn-downs, prior CABG patients, heavily calcified vessels, and hemodynamically compromised presentations — represent a substantially different clinical landscape.

The consequence is not abstract. Applying trial-derived success rates or complication benchmarks to a real-world operator panel without adjusting for case complexity introduces systematic error into performance assessment. Programs managing higher-risk patients should not be held to — or hold themselves to — benchmarks derived from populations that do not reflect their case mix.

The distinction is one that experienced operators understand intuitively but that the literature had not formally characterized before this analysis. Its relevance to program development, credentialing, and outcome reporting makes it a recurring topic at major CTO conferences.

Megaly M, Buda K, Mashayekhi K, Werner GS, Grantham JA, Rinfret S, McEntegart M, Brilakis ES, Alaswad K. Comparative Analysis of Patient Characteristics in Chronic Total Occlusion Revascularization Studies: Trials vs Real-World Registries. JACC: Cardiovascular Interventions. 2022 Jul 25;15(14):1441–9. https://www.jacc.org/doi/10.1016/j.jcin.2022.05.023

Dr. Michael Megaly specializes in complex and high-risk coronary interventions, chronic total occlusion (CTO) PCI, surgical turn-downs, complex peripheral artery disease, and limb salvage at Integris Health Heart Hospital in Oklahoma City.