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Brilakis ES, Mashayekhi K, Burke MN. How DECISION-CTO Can Help Guide the Decision to Perform Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation 2019; 139:1684-1687. [DOI: 10.1161/circulationaha.119.039835] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Emmanouil S. Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (E.S.B., M.N.B.)
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany (K.M.)
| | - M. Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (E.S.B., M.N.B.)
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102
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Sheehy JP, Qintar M, Arnold SV, Hirai T, Sapontis J, Jones PG, Tang Y, Lombardi W, Karmpaliotis D, Moses JW, Patterson C, Cohen DJ, Amin AP, Nicholson WJ, Spertus JA, Grantham JA, Salisbury AC. Anti-anginal medication titration among patients with residual angina 6-months after chronic total occlusion percutaneous coronary intervention: insights from OPEN CTO registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:370-379. [DOI: 10.1093/ehjqcco/qcz015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 01/09/2023]
Abstract
Abstract
Aims
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been shown to reduce angina and improve quality of life, but the frequency of new or residual angina after CTO PCI and its relationship with titration of anti-anginal medications (AAMs) has not been described.
Methods and results
Among consecutive CTO PCI patients treated at 12 US centres in the OPEN CTO registry, angina was assessed 6 months after the index PCI using the Seattle Angina Questionnaire (SAQ) Angina Frequency scale (a score <100 defined new or residual angina). We then compared the proportion of patients with AAM escalation (defined as an increase in the number or dosage of AAMs between discharge and follow-up) between those with and without 6-month angina. Of 901 patients who underwent CTO PCI, 197 (21.9%) reported angina at 6-months, of whom 80 (40.6%) had de-escalation, 66 (33.5%) had no change, and only 51 (25.9%) had escalation of their AAM by the 6-month follow-up. Rates of AAM escalation were similar when stratifying patients by the ultimate success of the CTO PCI, completeness of physiologic revascularization, presence or absence of angina at baseline, history of heart failure, and by degree of symptomatic improvement after CTO PCI.
Conclusions
One in five patients reported angina 6 months after CTO PCI. Although patients with new or residual angina were more likely to have escalation of AAMs in follow-up compared with those without residual symptoms, only one in four patients with residual angina had escalation of AAMs. Although it is unclear whether this finding reflects maximal tolerated therapy at baseline or therapeutic inertia, these findings suggest an important potential opportunity to further improve symptom control in patients with complex stable ischaemic heart disease.
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Affiliation(s)
- Justin P Sheehy
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
| | - Mohammed Qintar
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
| | - Suzanne V Arnold
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Taishi Hirai
- Section of Cardiology, University of Chicago Medical Center, 924 East 57th Street, Chicago, IL, USA
| | - James Sapontis
- Monash Heart, Cardiovascular Research Centre, Monash Medical Centre, 246 Clayton Road, Clayton Victoria, Australia
| | - Philip G Jones
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Yuanyuan Tang
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - William Lombardi
- Division of Cardiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, USA
| | - Dimitiri Karmpaliotis
- Division of Cardiology, New York Presbyterian Hospital, 161 Fort Washington Ave, New York, NY, NY, USA
| | - Jeffrey W Moses
- Division of Cardiology, New York Presbyterian Hospital, 161 Fort Washington Ave, New York, NY, NY, USA
| | - Christian Patterson
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - David J Cohen
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Amit P Amin
- Division of Cardiology, Washington University in Saint Louis, 660 S Euclid Ave, St. Louis, MO, USA
| | | | - John A Spertus
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - James Aaron Grantham
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
| | - Adam C Salisbury
- Cardiovascular Division, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research 9th floor, Kansas City, MO, USA
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103
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Rinfret S. A Heartbreaking Sadness: Does Percutaneous Coronary Intervention Breathe New Life Into the Health Status of Patients With Chronic Total Occlusion? JACC Cardiovasc Interv 2019; 12:659-661. [PMID: 30878473 DOI: 10.1016/j.jcin.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/05/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Stéphane Rinfret
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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104
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Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients with Diabetes Mellitus: a Treatment-Risk Paradox. Curr Cardiol Rep 2019; 21:9. [PMID: 30790113 DOI: 10.1007/s11886-019-1091-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). This review aims to summarize the available evidence on CTO recanalization in patients with DM. RECENT FINDINGS Coronary artery bypass grafting (CABG) surgery is the recommended revascularization modality for patients with DM and multivessel coronary artery disease (CAD). However, the optimal management strategy in diabetic patients with CTO and single-vessel disease or prior CABG remains a clinical dilemma. Contemporary, large-scale, observational registries support the notion that CTO PCI, if performed at high-volume CTO PCI centers by highly experienced operators, conveys similar high procedural success and low complication rates in patients with and without DM. Although DM patients have more frequently CTOs and may derive greater benefit from complete revascularization, they are less frequently exposed to CTO PCI than non-DM patients (treatment-risk paradox). CTO PCI performed by highly experienced operators constitutes a safe and effective treatment option for selected diabetic CTO patients who are not candidates for CABG. Randomized studies are warranted to compare long-term outcomes of CTO PCI and medical therapy in this high-risk subset.
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105
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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106
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Maeremans J, Cottens D, Azzalini L, Pereira B, Godino C, Carlino M, Colombo A, Frambach P, Bellini B, Candilio L, Briguori C, Pierri A, Lamers S, Roux L, Duponselle J, Vrolix M, Dens J. Outcomes of the amphilimus-eluting polymer-free stent for chronic total occlusion treatment: a multicentre experience. J Cardiovasc Med (Hagerstown) 2019; 19:564-570. [PMID: 30124545 DOI: 10.2459/jcm.0000000000000704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Late stent thrombosis and delayed vessel wall healing remain an important issue in coronary vessels treated with drug-eluting stents (DES), especially when long-vessel segments need to be covered, like in chronic total occlusions (CTO). Avoiding polymer use to avoid chronic inflammatory responses is a potential solution to reduce target vessel failure (TVF). We aimed to validate the clinical safety and efficacy at 1 year of the polymer-free Cre8 DES vs. nonpolymer-free DES for the percutaneous treatment of CTO. METHODS Between September 2011 and August 2016, patients were prospectively enrolled in three CTO centres. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), including cardiac death, any myocardial infarction, stent thrombosis, TVF and target vessel revascularization. RESULTS A total of 102 Cre8 and 133 non-Cre8 patients were enrolled. At 1 year, a low cumulative MACCE was observed in the Cre8 group (6.9%, respectively). Moreover, a numerical trend towards better MACCE was observed in the Cre8 group vs. the non-Cre8 group (6.9 vs. 14.3%; P = 0.065). The clinically driven TVF rate was not statistically different between Cre8 and non-Cre8 patients (6.9 vs. 9.8%; P = 0.373). A borderline significant difference regarding mortality was observed in favour of Cre8 patients (0 vs. 3.8%; P = 0.049). CONCLUSION Low rates of MACCE and TVF up to 1 year were observed in the Cre8 group, supportive of the use of polymer-free DES for lesions with high complexity.
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Affiliation(s)
- Joren Maeremans
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk.,Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | - Daan Cottens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk
| | - Lorenzo Azzalini
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Pereira
- Department of Cardiology, Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle, Luxembourg, Luxembourg
| | - Cosmo Godino
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Peter Frambach
- Department of Cardiology, Institut de Chirurgie Cardiaque et de Cardiologie Interventionelle, Luxembourg, Luxembourg
| | - Barbara Bellini
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Luciano Candilio
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Briguori
- Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Adele Pierri
- Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Scott Lamers
- Faculty of Medicine and Health Sciences - Universiteit Antwerpen, Antwerp, Belgium
| | - Lien Roux
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | - Jolien Duponselle
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
| | | | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk.,Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium
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107
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Szijgyarto Z, Rampat R, Werner GS, Ho C, Reifart N, Lefevre T, Louvard Y, Avran A, Kambis M, Buettner HJ, Di Mario C, Gershlick A, Escaned J, Sianos G, Galassi A, Garbo R, Goktekin O, Meyer-Gessner M, Lauer B, Elhadad S, Bufe A, Boudou N, Sievert H, Martin-Yuste V, Thuesen L, Erglis A, Christiansen E, Spratt J, Bryniarski L, Clayton T, Hildick-Smith D. Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry. JACC Cardiovasc Interv 2019; 12:335-342. [DOI: 10.1016/j.jcin.2018.11.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/09/2018] [Accepted: 11/13/2018] [Indexed: 12/25/2022]
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108
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Roffi M, Iglesias JF. CTO PCI in Patients With Diabetes Mellitus: Sweet Perspectives. JACC Cardiovasc Interv 2019; 10:2182-2184. [PMID: 29122131 DOI: 10.1016/j.jcin.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Marco Roffi
- Cardiology Division, Geneva University Hospital, Geneva, Switzerland.
| | - Juan F Iglesias
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
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109
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Grantham JA. Survival and Chronic Total Occlusion Percutaneous Coronary Intervention: The Never-Ending Debate Continues. JACC Cardiovasc Interv 2019; 10:876-878. [PMID: 28473109 DOI: 10.1016/j.jcin.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/11/2017] [Accepted: 03/12/2017] [Indexed: 01/07/2023]
Affiliation(s)
- J Aaron Grantham
- University of Missouri Kansas City and Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
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110
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Completeness of Revascularization as a Determinant of Outcome: A Contemporary Review and Clinical Perspectives. Can J Cardiol 2019; 35:948-958. [PMID: 31167712 DOI: 10.1016/j.cjca.2018.12.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/24/2018] [Accepted: 12/30/2018] [Indexed: 11/23/2022] Open
Abstract
It has been debated whether patients with multivessel coronary artery disease should undergo complete revascularization (CR). The benefit of CR is biologically plausible, and numerous studies and large meta-analyses suggested that CR achievement was associated with a substantial reduction of mortality and future coronary events. In patients with multivessel coronary artery disease, the aim of myocardial revascularization is to minimize residual ischemia. Therefore, CR of all significant coronary lesions has been proposed as the first priority in decision-making for myocardial revascularization between coronary artery bypass grafting and percutaneous coronary intervention (PCI). Reflecting the contemporary practice of ischemia-based revascularization, a physiological/functional approach, such as measurement of fractional flow reserve or instantaneous wave-free ratio, is considered more reasonable and should be encouraged for appropriate CR. In patients who present with acute ST-elevation myocardial infarction, current evidence suggests that an immediate or staged CR strategy might be equivalent or superior to culprit-only revascularization. There is still uncertainty on when and how to perform CR in ST-elevation myocardial infarction patients; comprehensive studies dedicated to this issue are required. Hybrid coronary revascularization includes the advantages of minimally invasive bypass grafting for the left anterior descending artery and PCI for non-left anterior descending arteries and has been proposed as a viable alternative for coronary artery bypass grafting or PCI only for achieving CR. In clinical practice, the extent of revascularization and strategy for CR should be individualized, taking account of different aspects of the patients, lesions, and treating physicians. Collaboration of coronary heart teams would confer balanced decision-making and advanced therapeutic capabilities.
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111
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Chen Y, Zheng X, Jin H, Deng S, Ren D, Greiser A, Fu C, Gao H, Zeng M. Role of Myocardial Extracellular Volume Fraction Measured with Magnetic Resonance Imaging in the Prediction of Left Ventricular Functional Outcome after Revascularization of Chronic Total Occlusion of Coronary Arteries. Korean J Radiol 2018; 20:83-93. [PMID: 30627024 PMCID: PMC6315067 DOI: 10.3348/kjr.2018.0069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/11/2018] [Indexed: 01/18/2023] Open
Abstract
Objective The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). Materials and Methods Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. Results In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77–0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = −0.61, p < 0.001) and changes in EF (β = −0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17–0.85; p = 0.019). Conclusion Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.
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Affiliation(s)
- Yinyin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xinde Zheng
- Department of Radiology, Zhongshan Hospital, Fudan University; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Shengming Deng
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Daoyuan Ren
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance (C.F.), Shenzhen, China
| | - Hongxiang Gao
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
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112
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Iannaccone M, D'ascenzo F, Piazza F, De Benedictis M, Doronzo B, Behnes M, Garbo R, Mashayekhi K. Optimal medical therapy vs. coronary revascularization for patients presenting with chronic total occlusion: A meta-analysis of randomized controlled trials and propensity score adjusted studies. Catheter Cardiovasc Interv 2018; 93:E320-E325. [PMID: 30549199 DOI: 10.1002/ccd.28037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/21/2018] [Accepted: 12/02/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The optimal management of patients with coronary chronic total occlusions (CTO) remains controversial. This meta-analysis aims to compare percutaneous coronary intervention of CTO (CTO-PCI) versus optimal medical therapy (OMT) in CTO patients. METHODS A literature search with highly specific terms was conducted using MEDLINE, EMBASE, and Web of Science to identify most relevant randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) evaluating differences in between CTO-PCI versus OMT. The primary endpoint was the incidence of major adverse cardiac events (MACEs, composite of cardiovascular death, acute coronary syndrome, and repeat PCI, re-PCI) while its single components were defined as secondary endpoints. RESULTS A total of eight studies was included, four RCTs and four PSMs. 3,971 patients were included in the analysis (2,050 CTO-PCI versus 1,921 OMT) with a mean follow-up of 3 years. No significant differences were found regarding overall MACE, re-PCI and AMI. Regarding CV-death, CTO-PCI was associated with a better outcome compared with OMT driven by PSMs (OR 0.52, 0.0.81, P < 0.01). CONCLUSIONS As compared to OMT, CTO-PCI was associated with similar MACE rate; however, CTO-PCI may be associated with reduced CV death, mainly due to PSMs effect.
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Affiliation(s)
| | - Fabrizio D'ascenzo
- Department of Cardiology, Città della Scienza e dalla Salute Hospital, University of Turin, Turin, Italy
| | - Fabio Piazza
- SS. Annunziata Hospital, ASL CN 1, Savigliano, Italy
| | | | | | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site, Mannheim, Germany
| | | | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
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113
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Goleski PJ, Nakamura K, Liebeskind E, Salisbury AC, Grantham JA, McCabe JM, Lombardi WL. Revascularization of coronary chronic total occlusions with subintimal tracking and reentry followed by deferred stenting: Experience from a high‐volume referral center. Catheter Cardiovasc Interv 2018; 93:191-198. [DOI: 10.1002/ccd.27783] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Patrick J. Goleski
- Saint Luke's Mid America Heart Institute Kansas City Missouri
- Department of Internal Medicine Section of Cardiovascular DiseaseUniversity of Missouri Kansas City Kansas City Missouri
| | - Kenta Nakamura
- Department of Medicine Division of CardiologyUniversity of Washington Seattle Washington
| | - Emily Liebeskind
- Department of Medicine Division of CardiologyUniversity of Washington Seattle Washington
| | - Adam C. Salisbury
- Saint Luke's Mid America Heart Institute Kansas City Missouri
- Department of Internal Medicine Section of Cardiovascular DiseaseUniversity of Missouri Kansas City Kansas City Missouri
| | - J. Aaron Grantham
- Saint Luke's Mid America Heart Institute Kansas City Missouri
- Department of Internal Medicine Section of Cardiovascular DiseaseUniversity of Missouri Kansas City Kansas City Missouri
| | - James M. McCabe
- Department of Medicine Division of CardiologyUniversity of Washington Seattle Washington
| | - William L. Lombardi
- Department of Medicine Division of CardiologyUniversity of Washington Seattle Washington
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114
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115
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Chronic Total Occlusion Revascularization and Quality-of-Life Improvement Across All Levels of Left Ventricular Function. JACC Cardiovasc Interv 2018; 11:2284-2286. [DOI: 10.1016/j.jcin.2018.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/21/2018] [Indexed: 11/30/2022]
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116
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Successful percutaneous coronary intervention for chronic total occlusion via the radial artery. North Clin Istanb 2018; 5:160-162. [PMID: 30374486 PMCID: PMC6191555 DOI: 10.14744/nci.2017.20092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/05/2017] [Indexed: 12/03/2022] Open
Abstract
Over the past decade, percutaneous coronary interventions (PCIs) performed via radial artery (RA) access have become popular among interventional cardiologists. Since the radial approach may limit the options in complex cases, most interventional cardiologists prefer femoral access to RA access for complex procedures, such as chronic total occlusions (CTOs) and bifurcation lesions. Presently described is a case of CTO of the right coronary artery that was successfully treated with PCI via the left RA. This study demonstrates that if there is an indication for revascularization and the CTO lesions are short and without poor prognostic factors, an intervention for CTO should still be considered, even if there is no femoral access.
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117
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Assessing Benefit vs Risk of Complex Percutaneous Coronary Intervention in People With Chronic Kidney Disease. Can J Cardiol 2018; 34:1244-1246. [DOI: 10.1016/j.cjca.2018.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 11/23/2022] Open
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118
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Maeremans J, Kayaert P, Bataille Y, Bennett J, Ungureanu C, Haine S, Vandendriessche T, Sonck J, Scott B, Coussement P, Dendooven D, Pereira B, Frambach P, Janssens L, Debruyne P, Van Mieghem C, Barbato E, Cornelis K, Stammen F, De Vroey F, Vercauteren S, Drieghe B, Aminian A, Debrauwere J, Carlier S, Coosemans M, Van Reet B, Vandergoten P, Dens JA. Assessing the landscape of percutaneous coronary chronic total occlusion treatment in Belgium and Luxembourg: the Belgian Working Group on Chronic Total Occlusions (BWGCTO) registry. Acta Cardiol 2018; 73:427-436. [PMID: 29183248 DOI: 10.1080/00015385.2017.1408891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Important developments in materials, devices, and techniques have improved outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), and resulted in a growing interest in CTO-PCI. The Belgian Working Group on Chronic Total Occlusions (BWGCTO) working group aims to assess the evolution within the CTO-PCI landscape over the next years. Methods: From May 2016 onwards, patients undergoing CTO-PCI were included in the BWGCTO registry by 15 centres in Belgium and Luxemburg. Baseline, angiographic, and procedural data were collected. Here, we report on the one-year in-hospital outcomes. Results: Over the course of one year, 411 procedures in 388 patients were included with a mean age of 64 ± 11 years. The majority were male (81%). Relatively complex CTOs were treated (Japanese CTO score =2.2 ± 1.2) with a high procedure success rate (82%). Patient- and lesion-wise success rates were 83 and 85%, respectively. Major adverse in-hospital events were acceptably low (3.4%). Antegrade wire escalation technique was applied most frequently (82%). On the other hand, antegrade dissection and re-entry and retrograde strategies were more frequently applied in higher volume centres and successful for lesions with higher complexity. Conclusion: Satisfactory procedural outcomes and a low rate of adverse events were obtained in a complex CTO population, treated by operators with variable experience levels. Antegrade wire escalation was the preferred strategy, regardless of operator volume.
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Affiliation(s)
- Joren Maeremans
- Faculty of Medicine and Life Sciences, Universiteit Hasselt , Hasselt , Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg , Genk , Belgium
| | - Peter Kayaert
- Department of Cardiology, Universitair Ziekenhuis Brussel , Brussels , Belgium
- Department of Cardiology, Universitair Ziekenhuis Gent , Ghent , Belgium
| | - Yoann Bataille
- Department of Cardiology, CHR de la Citadelle , Liège , Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, Universitair Ziekenhuis Leuven , Leuven , Belgium
| | - Claudiu Ungureanu
- Department of Cardiology, Hôpital de Jolimont , Haine-Saint-Paul , Belgium
| | - Steven Haine
- Department of Cardiology, Universitair Ziekenhuis Antwerpen , Edegem , Belgium
| | - Tom Vandendriessche
- Department of Cardiology, Universitair Ziekenhuis Antwerpen , Edegem , Belgium
| | - Jeroen Sonck
- Department of Cardiology, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Benjamin Scott
- Department of Cardiology, Hartcentrum ZNA , Antwerpen , Belgium
| | | | | | - Bruno Pereira
- Department of Cardiology, INCCI Haerz Zenter , Luxembourg , Luxembourg
| | - Peter Frambach
- Department of Cardiology, INCCI Haerz Zenter , Luxembourg , Luxembourg
| | - Luc Janssens
- Department of Cardiology, Imelda Ziekenhuis , Bonheiden , Belgium
| | | | - Carlos Van Mieghem
- Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis Aalst , Aalst , Belgium
| | - Emanuele Barbato
- Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis Aalst , Aalst , Belgium
| | | | | | - Frederic De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi , Charleroi , Belgium
| | | | - Benny Drieghe
- Department of Cardiology, Universitair Ziekenhuis Gent , Ghent , Belgium
| | - Adel Aminian
- Department of Cardiology, CHU Charleroi , Charleroi , Belgium
| | | | | | - Mark Coosemans
- Department of Cardiology, AZ Turnhout , Turnhout , Belgium
| | - Bert Van Reet
- Department of Cardiology, AZ Turnhout , Turnhout , Belgium
| | | | - Jo Andre Dens
- Faculty of Medicine and Life Sciences, Universiteit Hasselt , Hasselt , Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg , Genk , Belgium
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Abouzaki NA, Exaire JE, Guzmán LA. Role of Percutaneous Chronic Total Occlusion Interventions in Patients with Ischemic Cardiomyopathy and Reduced Left Ventricular Ejection Fraction. Curr Cardiol Rep 2018; 20:124. [PMID: 30276495 DOI: 10.1007/s11886-018-1066-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine current evidence on the benefit of chronic total occlusion (CTO) revascularization in patients with ischemic cardiomyopathy and propose a systematic approach on how and when to accomplish revascularization in these patients. RECENT FINDINGS Coronary revascularization in patients with reduced ejection fraction (EF) is advocated for to improve left ventricular function and consequently clinical outcomes. Approximately 16-31% of angiograms in patients with advanced CAD are noted to have a concomitant coronary CTO. Its presence is a main predictor of worse outcomes. Over the past 15 years, advancements in interventional technologies and techniques have made it possible to treat CTO lesions percutaneously with success rates exceeding 90%. Different revascularization techniques have been organized into widely used algorithms for systematic CTO lesion crossing and treatment. Patients with reduced EF can be revascularized percutaneously with goal of complete functional revascularization. However, randomized prospective data is needed to justify the increased patient risks and healthcare costs associated with these procedures.
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Affiliation(s)
- Nayef A Abouzaki
- Division of Cardiology, Medical College of Virginia/VCU School of Medicine, Virginia Commonwealth University, 1200 East Broad St, 5th Floor-West wing, Room #526, Richmond, VA, 23298, USA.,Hunter Holmes McGuire Richmond VA Medical Center, Richmond, VA, 23249, USA
| | - Jose E Exaire
- Division of Cardiology, Medical College of Virginia/VCU School of Medicine, Virginia Commonwealth University, 1200 East Broad St, 5th Floor-West wing, Room #526, Richmond, VA, 23298, USA.,Hunter Holmes McGuire Richmond VA Medical Center, Richmond, VA, 23249, USA
| | - Luis A Guzmán
- Division of Cardiology, Medical College of Virginia/VCU School of Medicine, Virginia Commonwealth University, 1200 East Broad St, 5th Floor-West wing, Room #526, Richmond, VA, 23298, USA.
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Outcomes of Percutaneous Antegrade Intraluminal Coronary Intervention of Chronic Total Occlusion With Remote Surgical Backup. Curr Probl Cardiol 2018; 44:100390. [PMID: 30243488 DOI: 10.1016/j.cpcardiol.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 11/22/2022]
Abstract
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is not favored in facilities without on-site surgical backup. We reviewed outcomes of patients who had CTO intervention with remote surgical backup in our institution. All patients who underwent attempted antegrade intraluminal CTO PCI from January 2013 to July 2017 were analyzed. Twenty cases (18 patients, 58.1 ± 7.0 years, 70% males) were identified. Procedure was successful in 85% (17 of 20). There were 2 nonflow limiting dissections and 1 wire perforation. Two patients had post-PCI myocardial infarction. There was no cardiac death, myocardial infarction, target vessel revascularization, or stroke at 30 days and at mean follow-up of 19.5 ± 13.7 months. There were 4 rehospitalizations for angina requiring repeat angiogram in 3 cases: 2 without intervention, and 1 referred for coronary artery bypass grafting. Careful attempt at antegrade intraluminal CTO intervention done at a center with remote surgical backup is feasible in selected patients.
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Tousoulis D. Chronic total occlusion: The puzzle is not yet solved. Hellenic J Cardiol 2018; 59:251-253. [DOI: 10.1016/j.hjc.2018.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 11/15/2022] Open
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Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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123
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Pica S, Di Giovine G, Bollati M, Testa L, Bedogni F, Camporeale A, Pontone G, Andreini D, Monti L, Gasparini G, Grancini L, Secco GG, Maestroni A, Ambrogi F, Milani V, Lombardi M. Cardiac magnetic resonance for ischaemia and viability detection. Guiding patient selection to revascularization in coronary chronic total occlusions: The CARISMA_CTO study design. Int J Cardiol 2018; 272:356-362. [PMID: 30173921 DOI: 10.1016/j.ijcard.2018.08.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/21/2018] [Accepted: 08/20/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND It is debated whether percutaneous revascularization (PCI) of total coronary chronic occlusion (CTO) is superior to optimal medical therapy (OMT) in improving symptoms, left ventricular (LV) function and major adverse cardiac/cerebrovascular events (MACCE). Furthermore, CTO-PCI is a challenging technique, with lower success rate than in other settings. A systematic analysis of baseline LV function, infarction extent and ischaemic burden to predict response to revascularization has never been performed. PURPOSES To establish a CMR protocol to identify patients (pts) who can benefit most from CTO-PCI. Myocardial viability/ischaemia retains high biological plausibility as predictors of response to revascularization. Therefore, baseline viability (necrotic tissue extent, response to inotropic stimulation) and ischaemia (perfusion defect, wall motion abnormality during stress) will be studied as potential predictors of mechanical LV segmental improvement and ischaemic burden reduction in CTO territory (primary endpoint), LV remodelling and global function, Seattle Angina Questionnaire, and MACCE improvement (secondary endpoints) in the follow-up. METHODS Pts with CTO suitable for PCI undergo stress-CMR for viability/ischaemia assessment. Pts with normal LV function undergo adenosine, those with moderately-reduced ejection fraction (EF) and wall motion abnormalities high-dose dobutamine, pts with EF <35% low-dose dobutamine. All pts undergo late gadolinium enhancement and repeat the same scan at 12 ± 3 months, regardless of PCI success or decision for OMT. CONCLUSIONS A multi-parameter CMR protocol tailored on pts characteristics to study viability/ischaemia could help in identifying responders in terms of LV function, ischaemic burden and clinical outcome among pts suitable for CTO-PCI, improving selection of best candidates to percutaneous revascularization.
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Affiliation(s)
- S Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - G Di Giovine
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M Bollati
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - L Testa
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - F Bedogni
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - A Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - G Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - D Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - L Monti
- Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - G Gasparini
- Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - L Grancini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G G Secco
- A.O.Ss. Antonio e Biagio, Alessandria, Italy
| | - A Maestroni
- ASTT Valle Olona, Busto Arsizio, Varese, Italy
| | - F Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - V Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Opolski MP, Gransar H, Lu Y, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJ, Cury RC, DeLago A, Feuchtner GM, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei EC, Marques H, Pontone G, Raff G, Rubinshtein R, Shaw LJ, Villines TC, Gomez M, Jones EC, Peña JM, Min JK, Lin FY. Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography. Heart 2018; 105:196-203. [PMID: 30061160 DOI: 10.1136/heartjnl-2017-312907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Data describing clinical relevance of chronic total occlusion (CTO) identified by coronary CT angiography (CCTA) have not been reported to date. We investigated the prognosis of CTO on CCTA. METHODS We identified 22 828 patients without prior known coronary artery disease (CAD), who were followed for a median of 26 months. Based on CCTA, coronary lesions were graded as normal (no atherosclerosis), non-obstructive (1%-49%), moderate-to-severe (50%-99%) or totally occluded (100%). All-cause mortality, and major adverse cardiac events defined as mortality, non-fatal myocardial infarction and late coronary revascularisation (≥90 days after CCTA) were assessed. RESULTS The distribution of patients with normal coronaries, non-obstructive CAD, moderate-to-severe CAD and CTO was 10 034 (44%), 7965 (34.9%), 4598 (20.1%) and 231 (1%), respectively. The mortality rate per 1000 person-years of CTO patients was non-significantly different from patients with moderate-to-severe CAD (22.95; 95% CI 12.71 to 41.45 vs 14.46; 95% CI 12.34 to 16.94; p=0.163), and significantly higher than of those with normal coronaries and non-obstructive CAD (p<0.001 for both). Among 14 382 individuals with follow-up for the composite end point, patients with CTO had a higher rate of events than those with moderate-to-severe CAD (106.56; 95% CI 76.51 to 148.42 vs 65.45; 95% CI 58.01 to 73.84, p=0.009). This difference was primarily driven by an increase in late revascularisations in CTO patients (27 of 35 events). After multivariable adjustment, compared with individuals with normal coronaries, the presence of CTO conferred the highest risk for adverse cardiac events (14.54; 95% CI 9.11 to 23.20, p<0.001). CONCLUSIONS The detection of CTO on non-invasive CCTA is associated with increased rate of late revascularisation but similar 2-year mortality as compared with moderate-to-severe CAD. TRIAL REGISTRATION NUMBER NCT01443637.
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Affiliation(s)
- Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yao Lu
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | | | - Mouaz H Al-Mallah
- King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Riyadh, Saudi Arabia
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, HARTZ, Leiden, The Netherlands
| | - Daniel S Berman
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California, USA
| | - Filippo Cademartiri
- Department of Radiology, SDN IRCCS Cardiovascular Imaging Center, Naples, Italy
| | - Tracy Q Callister
- Tennessee Heart and Vascular Institute, Hendersonville, Tennessee, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan, USA
| | - Benjamin Jw Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | | | - Gudrun M Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erica C Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Gilbert Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Todd C Villines
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Millie Gomez
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Erica C Jones
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Jessica M Peña
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - James K Min
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
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Impact of Coronary Artery Chronic Total Occlusion on Arrhythmic and Mortality Outcomes: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol 2018; 4:1214-1223. [PMID: 30236396 DOI: 10.1016/j.jacep.2018.06.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/03/2018] [Accepted: 06/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to examine the relationship between chronic coronary artery total occlusion (CTO) status and the occurrence of ventricular tachycardia (VT)/ventricular fibrillation (VF) or appropriate implantable cardioverter-defibrillator (ICD) therapy. BACKGROUND CTO is a significant problem in patients with ischemic heart disease. However, the extent to which it predisposes affected individuals to VT/VF and whether these arrhythmic events could be prevented by revascularization are unclear. Therefore, a systematic review and meta-analysis were conducted to examine the relationship between CTO status and the occurrence of VT/VF or appropriate ICD therapy. METHODS PubMed and Embase databases were searched until November 16, 2017, identifying 137 studies. RESULTS Seventeen studies involving 54,594 subjects (mean age, 61 ± 21 years of age, 81% male) with a mean follow-up of 43 ± 31 months were included. The presence of CTO was associated with higher risk of VT/VF or appropriate ICD therapy (adjusted hazard ratio [aHR]: 1.99; 95% confidence interval (CI): 1.53 to 2.59; p < 0.0001, I2 = 3%) but not in cardiac mortality (aHR: 2.59; 95% CI: 0.64 to 10.59; p = 0.18, I2 = 86%) or in all-cause mortality (aHR: 1.70; 95% CI: 0.84 to 3.46; p = 0.14; I2 = 64%). Compared to patients with non-infarct-related CTOs, those with infarct-related CTOs have a higher risk of VT/VF or appropriate ICD therapy (aHR: 2.47; 95% CI: 1.76 to 3.46; p < 0.0001; I2 = 14%), cardiac mortality (aHR: 2.73; 95% CI: 1.02 to 7.30; p < 0.05; I2 = 79%) and higher all-cause mortality (aHR: 1.69; 95% CI: 1.19 to 2.40; p < 0.01; I2 = 40%). Nonrevascularization of CTOs tended to be associated with an increased risk of all-cause mortality compared to successful revascularization (unadjusted HR: 1.52; 95% CI: 0.96 to 2.43; p = 0.08; I2 = 76). CONCLUSIONS CTOs, especially infarct-related, are associated with high risk of VT/VF or appropriate ICD therapy and mortality. ICD implantation could be beneficial. However, it is not clear that revascularization has an impact on the outcome of patients with CTOs.
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126
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Incidence and in-hospital outcomes of single-vessel coronary chronic total occlusion treated with percutaneous coronary intervention. Int J Cardiol 2018; 269:61-66. [PMID: 30075968 DOI: 10.1016/j.ijcard.2018.07.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/02/2018] [Accepted: 07/16/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Coronary chronic total occlusion (CTO) using percutaneous coronary intervention (PCI) presents a distinct challenge in the field of cardiology owing to multiple reasons including the increased risk of peri-procedural complications. We sought to explore rates of hospitalization, outcomes, use of mechanical circulatory support devices, and economic burden associated with single-vessel coronary CTO undergoing PCI for stable coronary artery disease (CAD). METHODS The National Inpatient Sample spanning from 2008 through 2014 was queried to identify hospitalizations associated with single-vessel coronary CTO-PCI for stable CAD by excluding hospitalizations with ST-elevation and non-ST elevation myocardial infarction. Survey-Specific logistic regression was used to analyze adjusted incidence of in-hospital mortality and acute renal failure. RESULTS A total of 109,094 hospitalizations were identified as having single-vessel coronary CTO-PCI for stable CAD from 2008 to 2014. An increasing number of coronary CTO-PCI hospitalizations (2465 to 2688 per 100,000 PCI procedures, Ptrend < 0.001) with an overall in-hospital mortality of 0.5% was observed. The rate of in-hospital mortality remained unchanged (Ptrend = 0.13), but an increasing rate of acute renal failure was observed in the multivariate-adjusted analysis (Ptrend < 0.001). Furthermore, a rise in the utilization of intra-aortic balloon pumps and percutaneous left ventricular assist devices during single-vessel coronary CTO-PCI was noted. Taken together, these may account for increasing costs of hospitalization for single-vessel coronary CTO-PCI ($13,909 in 2008 to $17,729 in 2014, Ptrend < 0.001). CONCLUSION In a large retrospective study, slightly increased rates of single-vessel coronary CTO-PCI for stable CAD were observed. This is accompanied by a rise in morbidity and growing healthcare costs.
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127
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Kim CH, Yang JH, Park TK, Song YB, Hahn JY, Choi JH, Lee SH, Gwon HC, Ahn J, Carriere KC, Choi SH. Revascularization vs. Medical Therapy for Coronary Chronic Total Occlusions in Patients With Chronic Kidney Disease. Circ J 2018; 82:2136-2142. [PMID: 29899202 DOI: 10.1253/circj.cj-17-1272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We investigated whether the outcome of revascularization differed from the outcome of medical therapy in chronic kidney disease (CKD) and non-CKD patients with chronic total occlusion (CTO).Methods and Results:A total of 2,010 patients with CTO who underwent revascularization (n=1,355), including percutaneous coronary intervention (n=878) and coronary artery bypass grafting (n=477), or had medical therapy alone (n=655) were examined. The primary outcome was all-cause death during follow-up. Among the non-CKD patients (n=1,679), revascularization had a lower incidence of all-cause death (adjusted hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.41-0.72, P<0.001) compared with medical therapy. Among the CKD patients (n=331), the difference in the incidence of all-cause death was not as marked between the 2 treatments (adjusted HR 0.71, 95% CI 0.48-1.06, P=0.09). There was a significant interaction between kidney function and treatment strategy (revascularization vs. medical therapy) on all-cause death (P for interaction=0.014). CONCLUSIONS Based on the clinical outcomes, in CTO patients with preexisting CKD, revascularization via PCI or bypass surgery might not be as effective as in non-CKD patients.
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Affiliation(s)
- Chung Hun Kim
- Division of Cardiology, Department of Internal Medicine, Hyemin General Hospital
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine.,Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Ho Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Sang Hoon Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | | | - Keumhee Chough Carriere
- Statistics and Data Center, Samsung Medical Center.,Department of Mathematical and Statistical Sciences, University of Alberta
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Efficacy and Safety of Polymer-Free Ultrathin Strut Sirolimus-Probucol Coated Drug-Eluting Stents for Chronic Total Occlusions: Insights from the Coroflex ISAR 2000 Worldwide Registry. Cardiol Res Pract 2018; 2018:8053168. [PMID: 29686890 PMCID: PMC5852858 DOI: 10.1155/2018/8053168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 12/04/2022] Open
Abstract
Objective Coronary revascularization in chronic total occlusion (CTO) is associated with improved clinical outcomes. The choice of the coronary stent is crucial in maintaining long-term vessel patency after CTO revascularization. We investigated the efficacy and safety of polymer-free ultrathin strut sirolimus-probucol coated drug-eluting stents (PF-SES) for CTO lesions. Methods Patients with CTO lesions treated with PF-SES were identified from the prospective multicenter international ISAR 2000 registry. The primary endpoint was clinically driven target lesion revascularization (TLR) at 9 months. Secondary endpoints were 9-month major adverse cardiac events (death, myocardial infarction, or TLR) (MACE) and the occurrence of stent thrombosis. Results A total of 111 patients with CTO lesions (n=127) were available for analysis. The 9-month clinical follow-up rate was 91%. The mean reference vessel diameter and lesion length were 2.76 mm ± 0.40 and 26.8 mm ± 13.1, respectively. The overall DAPT duration was 9.7 ± 2.8 months. Only one (1%) in-hospital MI was reported. The TLR and MACE rates at 9 months were 2% (2/101) and 5.9% (6/101), respectively. The 9-month accumulated rates of definite or probable stent thrombosis was 0% (0/101). Conclusion Revascularizations for CTO with PF-SES are associated with low rates of TLR and MACE at 9 months with no stent thrombosis. These initial findings need to be compared with results of other new generation DES of larger studies.
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Villablanca PA, Olmedo W, Weinreich M, Gupta T, Mohananey D, Albuquerque FN, Kassas I, Briceño D, Sanina C, Brevik TA, Ong E, Ramakrishna H, Attubato M, Menegus M, Wiley J, Kalra A. Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2018; 7:JAHA.117.008415. [PMID: 29654206 PMCID: PMC6015413 DOI: 10.1161/jaha.117.008415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Studies have shown that chronic total occlusion (CTO) in a noninfarct‐related artery in patients with ST‐segment–elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct‐related artery CTO in patients with ST‐segment–elevation myocardial infarction translates to improved outcomes. We performed a meta‐analysis to compare outcomes between patients presenting with ST‐segment–elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct‐related artery CTO versus those who did not. Method and Results We conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all‐cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Random effects model was used and heterogeneity was considered if I2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32–0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20–0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36–0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all‐cause mortality (OR, 0.47; 95% CI, 0.22–1.00), myocardial infarction (OR, 0.78; 95% CI, 0.41–1.46), repeat revascularization (OR, 1.13; 95% CI, 0.56–2.27), and stroke (OR, 0.51; 95% CI, 0.20–1.33). Conclusions In this meta‐analysis, CTO percutaneous coronary intervention of the noninfarct‐related artery in patients presenting with ST‐segment–elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.
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Affiliation(s)
- Pedro A Villablanca
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Wilman Olmedo
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Michael Weinreich
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Tanush Gupta
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | | | - Felipe N Albuquerque
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Ibrahim Kassas
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
| | - David Briceño
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Cristina Sanina
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Thomas A Brevik
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Emily Ong
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ
| | - Michael Attubato
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Mark Menegus
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Jose Wiley
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
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Update in the Percutaneous Management of Coronary Chronic Total Occlusions. JACC Cardiovasc Interv 2018; 11:615-625. [DOI: 10.1016/j.jcin.2017.10.052] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/10/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022]
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Dautov R, Ybarra LF, Nguyen CM, Gibrat C, Joyal D, Rinfret S. Incidence, predictors and longer-term impact of troponin elevation following hybrid chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv 2018; 92:E308-E316. [PMID: 29481724 DOI: 10.1002/ccd.27545] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 01/17/2018] [Accepted: 01/28/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We examined the incidence of periprocedural cardiac enzyme rise (PCER) [troponin T (TnT) or high-sensivity (hs)TnT >5× the upper limit of normal (ULN)] and periprocedural myocardial infarction (PMI), predictors of PCER and impact of PCER on the longer-term major adverse cardiac events (MACE) following hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND PCER and PMI after CTO PCI, risk factors for PCER and its impact on longer-term MACE are not fully understood. METHODS Among 469 CTO PCI cases performed between 01/2010 and 12/2015, next-day TnT or hsTnT was measured in 455 (97%). We examined the incidence of PCER and PMI (with clinical context or TnT ≥70× ULN). In 269 successful cases who had TnT measured, longer-term MACE (death, MI or target-vessel revascularisation/re-occlusion) were assessed. RESULTS Overall, 420 CTOs (92.3%) were treated successfully. PCER was documented in 34%, while PMI in 2.9%. By multivariable analyses, higher J-CTO score (OR = 1.3 per point; P = 0.002), lower creatinine clearance (OR = 1.01 per each cc/min decrease; P < 0.0001) and recent MI (OR = 2.4; P = 0.007) were independent pre-PCI risk factors for PCER. Among procedural variables, retrograde approach (OR = 1.9; P = 0.014) and procedure duration (OR = 1.2 per 30 min; P = 0.007) were associated with PCER. At a median follow-up of 396 days following successful CTO PCI, PCER was not associated with higher MACE (9.3% vs. 8.1%; P = 0.60), and was not a predictor of MACE in multivariable analysis. CONCLUSIONS PCER following hybrid CTO PCI is detected in 1/3 of patients. However, true PMI occurs in 2.9%. PCER does not predict adverse long-term outcomes.
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Affiliation(s)
- Rustem Dautov
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.,McGill University Health Centre, McGill University, Montreal, Quebec, Canada.,Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Luiz Fernando Ybarra
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada.,Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Can Manh Nguyen
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Claire Gibrat
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Dominique Joyal
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Stéphane Rinfret
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Elias J, van Dongen IM, Råmunddal T, Laanmets P, Eriksen E, Meuwissen M, Michels HR, Bax M, Ioanes D, Suttorp MJ, Strauss BH, Barbato E, Marques KM, Claessen BEPM, Hirsch A, van der Schaaf RJ, Tijssen JGP, Henriques JPS, Hoebers LP. Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction. Heart 2018; 104:1432-1438. [DOI: 10.1136/heartjnl-2017-312698] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/04/2018] [Accepted: 01/13/2018] [Indexed: 01/16/2023] Open
Abstract
BackgroundDuring primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO.MethodsThe Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO. Patients were randomised to either CTO-PCI or CTO-No PCI. The primary end point of the current study was occurrence of major adverse cardiac events (MACE): cardiac death, coronary artery bypass grafting and MI. Other end points were 1-year left ventricular function (LVF); LV-ejection fraction and LV end-diastolic volume and angina status.ResultsThe median long-term follow-up was 3.9 (2.1–5.0) years. MACE was not significantly different between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93). Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02) with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI 0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms. However, there were more patients with freedom of angina in the CTO-PCI arm at 1 year (94% vs 87%, P=0.03).ConclusionsIn this randomised trial involving patients with STEMI with a concurrent CTO, CTO-PCI was not associated with a reduction in long-term MACE compared to CTO-No PCI. One-year LVF was comparable between both treatment arms. The finding that there were more patients with freedom of angina after CTO-PCI at 1-year follow-up needs further investigation.Clinical trial registrationEXPLORE trial number NTR1108 www.trialregister.nl.
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Nef HM, Abdel-Wahab M, Achenbach S, Joner M, Levenson B, Mehilli J, Möllmann H, Thiele H, Zahn R, Zeus T, Elsässer A. Medikamentenfreisetzende Koronarstents/-scaffolds und medikamentenbeschichtete Ballonkatheter. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-017-0202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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134
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Accuracy of J-CTO Score Derived From Computed Tomography Versus Angiography to Predict Successful Percutaneous Coronary Intervention. JACC Cardiovasc Imaging 2018. [DOI: 10.1016/j.jcmg.2017.01.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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135
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Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN
- Department of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX
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136
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Goel PK, Khanna R, Pandey CM, Ashfaq F. Long-term outcomes post chronic total occlusion intervention-implications of completeness of revascularization. J Interv Cardiol 2018; 31:293-301. [PMID: 29314289 DOI: 10.1111/joic.12480] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/24/2017] [Accepted: 10/29/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Long term clinical outcomes post chronic total occlusion (CTO) intervention may depend not only on CTO success/failure alone but also on Completeness of revascularization. OBJECTIVES To determine long term outcomes post CTO intervention and relate them to both success versus failure and Complete Revascularization (CR) versus Incomplete Revascularization (IR). METHODS Consecutive patients taken up for CTO intervention with at-least one CTO vessel between Jan 2006 to Dec 2015 were included. Clinical, procedural and follow up details were recorded in a pre-specified custom made software. Primary endpoint of the study was survival free of major adverse event individual, death, myocardial infarction (MI), repeat revascularisation (percutaneous coronary intervention [PCI], or coronary artery bypass grafting (CABG) and recurrent or continued angina. Each individual adverse event was considered as a secondary end point. RESULTS A total of 632 patients were enrolled in study with follow up data available in 549 (86%) constituting the study group with 490 (89.3%) success and 59 (11.7%) failure. Complete revascularization (CR) was obtained in 410 (74.7%). Follow up was median 2.9 years with inter-quartile range 1.1-4.8 years. Kaplan Meier survival analysis showed a better EFS with both CTO success versus failure (P = 0.03)and CR versus IR (P = 0.017). Individual adverse outcomes however were not significantly different in CTO success versus failure group but significantly better when analyzed with respect to CR versus IR including death (P = 0.049) and recurrent angina (P = 0.024). Repeat intervention and MI were not different by either analysis. CONCLUSIONS Successful CTO PCI results in a better long term event free survival but the difference between the groups is more if analyzed with respect to completeness of revascularization rather than CTO success/failure alone.
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Affiliation(s)
- Pravin K Goel
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Roopali Khanna
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - C M Pandey
- Department of Biostatistics and Health Informatic, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Fauzia Ashfaq
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Yap SC, Sakhi R, Theuns DA, Yasar YE, Bhagwandien RE, Diletti R, Zijlstra F, Szili-Torok T. Increased risk of ventricular arrhythmias in survivors of out-of-hospital cardiac arrest with chronic total coronary occlusion. Heart Rhythm 2018; 15:124-129. [DOI: 10.1016/j.hrthm.2017.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Indexed: 12/20/2022]
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138
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Vavouranakis E, Kalogeras K, Tousoulis D. Novel Developments in Interventional Strategies. Coron Artery Dis 2018. [DOI: 10.1016/b978-0-12-811908-2.00022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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139
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Effect of changing the duration of keeping sandbag over catheter insertion site on the coronary angiography acute complications: A controlled clinical trial. JOURNAL OF VASCULAR NURSING 2017; 35:193-200. [DOI: 10.1016/j.jvn.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 11/22/2022]
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140
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Midterm Angina-Related Quality of Life Benefits After Percutaneous Coronary Intervention of Chronic Total Occlusions. Can J Cardiol 2017; 33:1668-1674. [DOI: 10.1016/j.cjca.2017.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/28/2017] [Accepted: 08/15/2017] [Indexed: 01/08/2023] Open
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Yamamoto M, Tsuchikane E, Kagase A, Shimura T, Teramoto T, Kimura M, Matsuo H, Kawase Y, Suzuki Y, Kano S, Habara M, Nasu K, Kinoshita Y, Terashima M, Matsubara T, Suzuki T. Novel proctorship effectively teaches interventionists coronary artery chronic total occlusion lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:407-412. [PMID: 29169983 DOI: 10.1016/j.carrev.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Interventionists' experience and skills are essential factors for successful chronic total occlusion-percutaneous coronary intervention (CTO-PCI). However, the construction of theoretical strategy independent from interventionists' procedure may also improve it. We sought to assess the feasibility of CTO-PCI using an educational system supported by a single expert proctor. METHODS A total of 160 patients underwent CTO-PCI between 2009 and 2016 at 92 Japanese centers in the Hands-on proctorship project. The CTO-PCI strategy was discussed with all participants and their specialists, before and during the procedure. We divided patients into 2 groups based on the CTO-PCI experience of their interventionist: (1) the less experienced group (CTO-PCI ≤50 cases, n=65) and (2) the more experienced group (CTO-PCI >50 cases, n=95). Baseline characteristics, procedural complications, and clinical outcomes were compared between groups. RESULTS No significant differences in patient age, sex, prevalence for coronary risk factors, and lesion complexity was observed between groups. The retrograde approach was used equivalently between groups (55.4% vs. 60.0%, p=0.56), and procedural success rates were similar (96.9% vs. 90.5%, p=0.12). The rate of proctor's bailout for recanalization were not frequent between groups (4.6% vs. 5.3%, p=0.85). No procedure-related mortality was noted in either group. In addition, no significant differences in procedural cardiac complications, including coronary dissection, perforation, or tamponade, were observed between groups (10.8% vs. 14.7%, p=0.47). CONCLUSIONS The expert-supported CTO-PCI maintained high success rates regardless of interventionists' experience. This highlights the importance of theoretical strategy for the management patients undergoing CTO-PCI.
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Affiliation(s)
- Masanori Yamamoto
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
| | - Ai Kagase
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Tetsuro Shimura
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Tomohiko Teramoto
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Masashi Kimura
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Yoriyasu Suzuki
- Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Seiji Kano
- Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Maoto Habara
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Kenya Nasu
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Mitsuyasu Terashima
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Tetsuo Matsubara
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Takahiko Suzuki
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
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Hirai T, Grantham JA, Sapontis J, Cohen DJ, Marso SP, Lombardi W, Karmpaliotis D, Moses J, Nicholson WJ, Pershad A, Wyman RM, Spaedy A, Cook S, Doshi P, Federici R, Nugent K, Gosch KL, Spertus JA, Salisbury AC. Impact of subintimal plaque modification procedures on health status after unsuccessful chronic total occlusion angioplasty. Catheter Cardiovasc Interv 2017; 91:1035-1042. [DOI: 10.1002/ccd.27380] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/19/2017] [Accepted: 09/28/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Taishi Hirai
- University of Chicago Medical Center; Chicago Illinois
| | - J. Aaron Grantham
- Saint Luke's Mid America Heart Institute; Kansas City Missouri
- University of Missouri Kansas City; Kansas City Missouri
| | | | - David J. Cohen
- Saint Luke's Mid America Heart Institute; Kansas City Missouri
- University of Missouri Kansas City; Kansas City Missouri
| | | | | | | | - Jeffrey Moses
- Columbia University, New York Presbyterian Hospital; New York New York
| | | | - Ashish Pershad
- Banner Good Samaritan Medical Center, Phoenix, AZ and Banner Heart; Mesa Arizona
| | | | | | - Stephen Cook
- Peacehealth Sacred Heart Medical Center; Springfield Oregon
| | - Parag Doshi
- Alexian Brothers Medical Center; Chicago Illinois
| | | | - Karen Nugent
- University of Missouri Kansas City; Kansas City Missouri
| | | | - John A. Spertus
- Saint Luke's Mid America Heart Institute; Kansas City Missouri
- University of Missouri Kansas City; Kansas City Missouri
| | - Adam C. Salisbury
- Saint Luke's Mid America Heart Institute; Kansas City Missouri
- University of Missouri Kansas City; Kansas City Missouri
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143
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Teeuwen K, van der Schaaf RJ, Adriaenssens T, Koolen JJ, Smits PC, Henriques JPS, Vermeersch PHMJ, Tjon Joe Gin RM, Schölzel BE, Kelder JC, Tijssen JGP, Agostoni P, Suttorp MJ. Randomized Multicenter Trial Investigating Angiographic Outcomes of Hybrid Sirolimus-Eluting Stents With Biodegradable Polymer Compared With Everolimus-Eluting Stents With Durable Polymer in Chronic Total Occlusions: The PRISON IV Trial. JACC Cardiovasc Interv 2017; 10:133-143. [PMID: 28104206 DOI: 10.1016/j.jcin.2016.10.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the efficacy and safety of the hybrid ultrathin-strut sirolimus-eluting stent (SES) with biodegradable polymer compared with the thin-strut everolimus-eluting stent (EES) with durable polymer in successfully recanalized chronic total occlusions (CTOs). BACKGROUND The introduction of drug-eluting stents revolutionized the treatment of CTOs. However, limited data are available on new-generation drug-eluting stents with biodegradable polymer in CTOs. METHODS In this multicenter trial, patients were randomized, after successful CTO recanalization, to either SES or EES. The primary noninferiority endpoint was in-segment late lumen loss (noninferiority margin 0.2 mm). Secondary endpoints included in-stent late lumen loss and clinical endpoints. RESULTS Overall, 330 patients were included. At 9 months, angiography was available in 281 patients (85%). Duration of occlusion ≥3 months was 92.5%, with mean stent length of 52.4 ± 28.1 mm versus 52.3 ± 26.5 mm in the SES and EES groups. The primary noninferiority endpoint, in-segment late lumen loss, was not met for SES versus EES (0.13 ± 0.63 mm vs. 0.02 ± 0.47 mm; p = 0.08, 2-sided; difference 0.11 mm; 95% confidence interval: -0.01 to 0.25 mm; pnoninferiority = 0.11, 1-sided). In-stent late lumen loss was comparable between SES and EES (0.12 ± 0.59 mm vs. 0.07 ± 0.46 mm; p = 0.52). The incidence of in-stent and in-segment binary restenosis was significantly higher with SES compared with EES (8.0% vs. 2.1%; p = 0.028), with comparable rates of reocclusions (2.2% vs. 1.4%; p = 0.68). Clinically indicated target lesion and target vessel revascularization (9.2% vs. 4.0% [p = 0.08] and 9.2% vs. 6.0% [p = 0.33]), target vessel failure (9.9% vs. 6.6%; p = 0.35), and definite or probable stent thrombosis (0.7% vs. 0.7%; p = 1.00) were comparable between the SES and EES groups. CONCLUSIONS This randomized trial failed to show noninferiority of hybrid SES relative to EES in terms of in-segment late lumen loss in successfully recanalized CTOs. Furthermore, a statistically significantly higher rate of binary restenosis was found with SES.
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Affiliation(s)
- Koen Teeuwen
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
| | | | | | - Jacques J Koolen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Pieter C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - José P S Henriques
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | - Johannes C Kelder
- Department of Research and Statistics, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jan G P Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Maarten J Suttorp
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
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144
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Shuvy M, Qiu F, Chee-A-Tow A, Graham JJ, Abuzeid W, Buller C, Strauss BH, Wijeysundera HC. Management of Chronic Total Coronary Occlusion in Stable Ischemic Heart Disease by Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Versus Medical Therapy. Am J Cardiol 2017; 120:759-764. [PMID: 28716335 DOI: 10.1016/j.amjcard.2017.05.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/11/2017] [Accepted: 05/23/2017] [Indexed: 01/24/2023]
Abstract
Coronary chronic total occlusions (CTOs) are found in approximately 20% of angiograms. We sought to assess the variation in the management of patients with CTOs and to compare the clinical outcomes of CTO lesions with those of non-CTO lesions. We conducted a population-based cohort study and included all patients with stable angina who underwent cardiac catheterization from October 1, 2012, to June 30, 2013, in Ontario, Canada. The primary outcome was a composite of mortality and hospitalization for myocardial infarction. A total of 7,864 patients were included, of whom 2,279 (29%) had a CTO. There were substantial differences in revascularization rates for patients with CTOs across hospitals in Ontario (44.9% to 94.1%). Revascularization was associated with improved outcomes in the overall cohort. Although the advantage of coronary artery bypass grafting over medical therapy was consistent in both patients with CTOs and patients without CTOs, the benefit of percutaneous coronary intervention (PCI) was limited to patients without CTOs (hazard ratio 0.56, 95% confidence interval 0.40- to 0.78), with no difference in patients with CTOs. The CTO lesion, however, was revascularized in few of the PCI cases (41.1%), with PCI limited to the non-CTO lesion in most patients.
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145
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Angiographic and clinical outcomes after recanalization of coronary chronic total occlusions with the Orsiro sirolimus-eluting stent compared with the resolute zotarolimus-eluting stent. Coron Artery Dis 2017; 28:376-380. [DOI: 10.1097/mca.0000000000000470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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146
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Leibundgut G, Kaspar M. Chronic Total Occlusions. Interv Cardiol 2017. [DOI: 10.5772/68067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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147
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Valiee S, Fathi M, Hadizade N, Roshani D, Mahmoodi P. Evaluation of feasibility and safety of changing body position after transfemoral angiography: A randomized clinical trial. JOURNAL OF VASCULAR NURSING 2017; 34:106-15. [PMID: 27568318 DOI: 10.1016/j.jvn.2016.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Considering the growing number of patients who suffer from cardiovascular and coronary artery disease and the significant importance of angiography in the diagnosis of coronary artery disease, this study investigated the effects of position change on the acute complications of coronary angiography. METHODS This study was a randomized clinical trial. Sixty patients undergoing coronary angiography, which was performed by a single operator were selected by convenience sampling method and were assigned to intervention or control groups by randomized block design (30 cases in each group). Intervention group patients' position was changed according to schedule, whereas patients in the control group remained in the supine position in complete bed rest. At the entrance hours, 3, 6, 8, and 24 hours after the angiography, patients in both groups were evaluated in terms of vascular complications, urinary retention, low back pain, groin pain, and comfort. Data were analyzed by repeated measures, Friedman, Mann-Whitney, chi-square, independent t-test, and Kolmogorov-Smirnov tests with SPSS-22. RESULTS The two groups did not show any significant difference in terms of demographic, clinical, and preinterventional catheterization characteristics (P > 0.05). There was no significant difference with regard to vascular complications including hematoma (P = 0.149), bleeding (P > 0.01), bruise (P = 0.081), and thrombosis in the two groups of patients during 5 consecutive reviews. However, there was a significant statistical difference regarding low back pain (P < 0.001), groin pain (P < 0.001), urinary retention (P = 0.02), and comfort (P < 0.001). CONCLUSIONS The results of this study showed that changing the positions of patients after angiography based on the provided program created no change in the incidence of vascular complications (hematoma, bleeding, thrombosis, and bruise) but resulted in reduced severity of back pain, groin pain, urinary retention, and increased patients' comfort.
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Affiliation(s)
- Sina Valiee
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Fathi
- Nursing Department, School of Nursing & Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Nooshin Hadizade
- Department of Epidemiology and Biostatistics, Medicine Department, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Daem Roshani
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Parvin Mahmoodi
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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148
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Fam JM, Ojeda S, Garbo R, Latib A, La Manna A, Vaquerizo B, Boukhris M, Vlachojannis GJ, van Geuns RJ, Ezhumalai B, Kawamoto H, van der Sijde J, Felix C, Pan M, Serdoz R, Boccuzzi GG, De Paolis M, Sardella G, Mancone M, Tamburino C, Smits PC, Di Mario C, Seth A, Serra A, Colombo A, Serruys P, Galassi AR, Zijlstra F, Van Mieghem NM, Diletti R. Everolimus-eluting bioresorbable vascular scaffolds for treatment of complex chronic total occlusions. EUROINTERVENTION 2017; 13:355-363. [PMID: 28218604 DOI: 10.4244/eij-d-16-00253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Bioresorbable vascular scaffolds (BVS) represent a novel therapeutic option for the treatment of coronary artery diseases. The objective of this study was to evaluate the feasibility of BVS implantation in complex chronic total occlusions (CTO). METHODS AND RESULTS The present report is a multicentre registry evaluating results after BVS deployment in challenging CTO lesions, defined as J-CTO score ≥2 (difficult or very difficult). A total of 105 patients were included in the present analysis. The mean J-CTO score was 2.61 (difficult 52.4%, very difficult 47.6%). Device success and procedural success rates were 98.1% and 97.1%, respectively. The retrograde approach was used in 25.7% of cases. After wire crossing, predilatation was performed in all cases with a mean predilatation balloon diameter of 2.73±0.43 mm. The mean scaffold length was 59.75±25.85 mm, with post-dilatation performed in 89.5% of the cases and a mean post-dilatation balloon diameter of 3.35±0.44 mm. Post-PCI minimal lumen diameter was 2.50±0.51 mm and percentage diameter stenosis 14.53±10.31%. At six-month follow-up, a total of three events were reported: one periprocedural myocardial infarction, one late scaffold thrombosis and one additional target lesion revascularisation. CONCLUSIONS The present report suggests the feasibility of BVS implantation in complex CTO lesions, given adequate lesion preparation and post-dilatation, with good acute angiographic results and midterm clinical outcomes.
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149
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Coronary Computed Tomographic Angiography Can Predict Chronic Total Occlusion Recanalization Success: Where Do We Go From Here? JACC Cardiovasc Imaging 2017. [PMID: 28624405 DOI: 10.1016/j.jcmg.2017.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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150
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Ng AKY, Shah PB, Williams DO. Percutaneous Revascularization of Chronic Total Coronary Occlusion: For Whom? Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005512. [PMID: 28615235 DOI: 10.1161/circinterventions.117.005512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Andrew Kei-Yan Ng
- From the Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Pinak Bipin Shah
- From the Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David O Williams
- From the Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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