1
|
Zheng J, Li T, Hu F, Chen B, Xu M, Yan S, Lu C. Predictive value of peripheral neutrophil count on admission for young patients with acute coronary syndrome. Am J Med Sci 2024:S0002-9629(24)01389-2. [PMID: 39084522 DOI: 10.1016/j.amjms.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE The present study aimed to explore the relationship between neutrophil count on admission and major adverse cardiovascular and cerebrovascular events (MACCE) and left ventricular ejection fraction (LVEF) during hospitalization in young ACS patients, which have rarely been investigated in previous studies. METHODS This study included 400 young ACS patients (<45 years old) who underwent coronary angiography. According to the median neutrophil count at admission, the patients were divided into two groups. The relationship between neutrophil count and MACCE and LVEF during hospitalization was analyzed by regression analysis. The receiver operating characteristic (ROC) curve and the Youden index was used to determine the optimal cut-off value of neutrophil count. RESULTS Neutrophil count at admission was an independent risk factor of in-hospital MACCE (OR: 1.33, 95 % CI: 1.13-1.56, P<0.001) and LVEF <50 % (OR: 1.28, 95 % CI: 1.12-1.47, P<0.001) in young ACS patients.The cutoff value of neutrophil count for predicting the occurrence of in-hospital MACCE was 6.935 × 10^9/L with a sensitivity of 92.1 %, specificity of 59.4 %, and AUC is 0.820 (95 % CI: 0.7587-0.8804, P<0.001), and for identifying the LVEF <50 % was 8.660 × 10^9/L with a sensitivity of 69.8 %, specificity of 76.8 %, and AUC is 0.775 (95 % CI: 0.6997-0.8505, P<0.001). CONCLUSION The neutrophil count upon admission is an independent predictor of in-hospital MACCE and LVEF in young ACS patients, giving important information for predicting the poor prognosis of young ACS patients.
Collapse
Affiliation(s)
- Jia Zheng
- The First Central Clinical School, Tianjin Medical University, Tianjin, China; Department of Cardiology, Tianjin First Center Hospital, Tianjin, China
| | - Tingting Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Fang Hu
- Department of Cardiology, Tianjin First Center Hospital, Tianjin, China
| | - Bingwei Chen
- Department of Cardiology, Tianjin First Center Hospital, Tianjin, China
| | - Mengping Xu
- Department of Cardiology, Tianjin First Center Hospital, Tianjin, China
| | - Shuangbing Yan
- Department of Cardiology, Tianjin First Center Hospital, Tianjin, China
| | - Chengzhi Lu
- Department of Cardiology, Tianjin First Center Hospital, Tianjin, China.
| |
Collapse
|
2
|
Mansouri P, Jazi ZA, Mansouri MH, Dehghan H, Zavar R, Hashemi SM, Sattar F, Sadeghi M, Amirpour A, Abdar M. Evaluation of the efficacy and safety of rivaroxaban compared to warfarin in patients with left ventricular apical thrombus: a randomized clinical trial. Thromb J 2024; 22:66. [PMID: 39030573 PMCID: PMC11264466 DOI: 10.1186/s12959-024-00632-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/01/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION This research is one of the pioneering randomized clinical trials (RCTs) aimed at assessing the effectiveness and safety of rivaroxaban in treating left ventricular thrombus (LVT) in patients who have experienced acute coronary syndrome (ACS). MATERIALS AND METHODS This is a randomized, controlled, interventional, open-label study. The patients were randomly divided into warfarin and rivaroxaban groups. We performed transthoracic echocardiography at the start of the study and again after three months to measure the thrombus area in square millimeters. The morphology of the thrombus was categorized into mural and round, and the mobility was classified into immobile, semi-mobile and hypermobile. We also monitored for adverse events including bleeding, systemic embolic occurrences, rehospitalization, and major adverse cardiac events (MACE). RESULTS The study included fifty-two patients in the intention-to-treat analysis, with an equal split between the rivaroxaban and warfarin groups (26 patients each). The average follow-up duration was three months. The thrombus resolution rates in the rivaroxaban (76.9%) and warfarin (69.2%) groups, as well as the thrombus size reduction, did not show statistical significance between groups. All semi-mobile or hypermobile thrombi transformed into immobile and all of the round LVTs changed into a mural in both rivaroxaban and warfarin groups. No significant difference was observed in bleeding complications and rehospitalization between the two groups. CONCLUSION The trial demonstrated that rivaroxaban is as effective as warfarin in terms of thrombus resolution rate, reduction in thrombus size, bleeding risk, and rehospitalization rate. Our findings suggest that rivaroxaban is a viable alternative to warfarin for managing left ventricular thrombus.
Collapse
Affiliation(s)
- Pejman Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Azamian Jazi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hadi Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hooman Dehghan
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reihaneh Zavar
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Fereshteh Sattar
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac rehabilitation research center, cardiovascular research institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Amirpour
- Cardiac rehabilitation research center, cardiovascular research institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Morteza Abdar
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
3
|
Azzalini L, Lombardi WL. Chronic Total Occlusion Percutaneous Coronary Intervention: Mindset, Culture, and Continuous Improvement. Am J Cardiol 2024; 222:141-148. [PMID: 38705253 DOI: 10.1016/j.amjcard.2024.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/26/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
The development of complex and higher-risk indicated procedures (CHIP) and chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has brought new challenges in terms of operator training. Although the technical aspects of learning CHIP/CTO PCI have been described in detail, very little has been discussed concerning the mental skills that the operator must possess or develop to be successful. Moreover, an at least equally important aspect of CHIP/CTO PCI program development is the professional culture of the institution where these complex procedures are performed, because this can mark the difference between a thriving and long-lasting program and one that is quickly bound to fail. This article analyzes the mental attributes of the CHIP/CTO PCI operator and outlines several leadership principles that can be applied to foster a growth culture and develop a thriving program.
Collapse
Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
| | - William L Lombardi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
4
|
Pacheco C, Coutinho T, Bastiany A, Beanlands R, Boczar KE, Gulati M, Liu S, Luu J, Mulvagh SL, Paquin A, Saw J, Sedlak T. Canadian Cardiovascular Society/Canadian Women's Heart Health Alliance Clinical Practice Update on Myocardial Infarction With No Obstructive Coronary Artery Disease (MINOCA). Can J Cardiol 2024; 40:953-968. [PMID: 38852985 DOI: 10.1016/j.cjca.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 06/11/2024] Open
Abstract
Myocardial infarction with no obstructive coronary artery disease (MINOCA) represents 6%-15% of all acute coronary syndromes, and women are disproportionately represented. MINOCA is an encompassing preliminary diagnosis, and emerging evidence supports a more expansive comprehensive diagnostic and therapeutic clinical approach. The current clinical practice update summarizes the latest evidence regarding the epidemiology, clinical presentation, and diagnostic evaluation of MINOCA. A cascaded approach to diagnostic workup is outlined for clinicians, for noninvasive and invasive diagnostic pathways, depending on clinical setting and local availability of diagnostic modalities. Evidence concerning the nonpharmacological and pharmacological treatment of MINOCA are presented and summarized according to underlying cause of MINOCA, with practical tips on the basis of expert opinion, outlining a real-life, evidence-based, comprehensive approach to management of this challenging condition.
Collapse
Affiliation(s)
- Christine Pacheco
- Department of Medicine, Hôpital Pierre-Boucher, Centre de santé et de services sociaux de la Montérégie-Est, Longueuil, Québec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
| | - Thais Coutinho
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexandra Bastiany
- Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Rob Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kevin E Boczar
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shuangbo Liu
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Judy Luu
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sharon L Mulvagh
- Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amelie Paquin
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Sedlak
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Doolub G, Mamas MA, Dziewierz A, Malinowski KP, Oleś I, Kuleta M, Zdzierak B, Siudak Z. Do two operators improve outcomes in left main percutaneous coronary intervention? Insights from the ORPKI Registry. Minerva Cardiol Angiol 2024; 72:79-86. [PMID: 37870423 DOI: 10.23736/s2724-5683.23.06364-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Significant left main coronary artery (LMCA) disease is prevalent in 7% of patients undergoing angiography. Limited data exists on the impact of double scrubbing in LMCA PCI. We sought to assess periprocedural outcomes in two-operator LMCA percutaneous coronary intervention (PCI). METHODS Using data from the Polish National Registry of PCI (ORPKI), we collected data on 28,745 patients undergoing LMCA PCI from 154 centers. Patients were divided into two groups based on the number of operators performing PCI (one vs. two operators). RESULTS LMCA PCI was performed by a single operator in 86% of the cases and by two operators in 14% of cases. Patients treated by two operators had a greater comorbidity burden including diabetes mellitus, arterial hypertension, previous myocardial infarction, and previous revascularization. In addition, these were more likely to be treated in high-volume centers, by operators with higher volume of LMCA PCIs. The risk of periprocedural death (2.37% vs. 2.44%; P=0.78), as well as cardiac arrest, coronary artery perforation, no-reflow, and puncture site bleeding was comparable between the two groups. On multivariable analysis, we found that a two-operator strategy was an independent predictor of periprocedural death, with this effect being much more profound in an elective setting (OR=5.13 [1.37-19.26]; P=0.015), compared to an urgent (ACS) setting (OR=1.32 [1.00-1.73]; P=0.047). CONCLUSIONS Our study suggests that a two-operator approach is not necessarily routinely recommended for LMCA interventions, although it can be considered for more complex cases.
Collapse
Affiliation(s)
- Gemina Doolub
- Center for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
- Unit of Translational Health Sciences, University of Bristol, Bristol, UK
| | - Mamas A Mamas
- Center for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Artur Dziewierz
- Jagiellonian University Medical College, Second Department of Cardiology, Institute of Cardiology, Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital of Krakow, Krakow, Poland
| | - Krzysztof P Malinowski
- Jagiellonian University Medical College, Department of Bioinformatics and Telemedicine, Krakow, Poland
- Jagiellonian University Medical College, Digital Medicine and Robotics Center, Krakow, Poland
| | - Izabela Oleś
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Martyna Kuleta
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Barbara Zdzierak
- Jagiellonian University Medical College, Second Department of Cardiology, Institute of Cardiology, Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland -
| |
Collapse
|
6
|
Shi J, Levett JY, Lv H, Zhang G, Wang S, Wei T, Wang Z, Zhang X, Feng D, Wang K, Liu Q, Shum-Tim D. Surgical repair of post myocardial infarction ventricular septal defect: a retrospective analysis of a single institution experience. J Cardiothorac Surg 2023; 18:313. [PMID: 37950265 PMCID: PMC10638688 DOI: 10.1186/s13019-023-02418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Ventricular septal defect (VSD) is a mechanical complication of acute myocardial infarction (MI) with a very high mortality, despite advances in surgical and circulatory support. The tremendous hemodynamic disturbance and the severely fragile myocardium render surgical repair a great challenge. The optimal time of surgical repair with or without circulatory support is still controversial. OBJECTIVE The aim of this study is to review our experience with early surgical repair of post-MI VSD in a single major cardiac institution in China. METHODS From January 2013 to October 2020, 9consecutive patients presented to our emergency department with a diagnosis of post-MI VSD. Among them, 8 were male, and the mean age was 58 ± 7years. The mean VSD size was 22.5 ± 5.7 mm. In all patients, an intra-aortic balloon pump (IABP)was inserted immediately after admission to cardiac surgery service. All patients were operated at a mean of 3.3 ± 2.9 days, and 4 within 24 h of the rupture (range 1 to 9 days post-VSD). In 5 cases, the VSD was located superiorly, and 4 cases in the posterior septum. RESULTS The overall 30-day mortality was 11% (1/9). Coronary angiography was performed in all nine patients, four with single vessel disease had coronary stents implanted, and the other five received concomitant coronary artery bypass grafting during VSD repair surgery. There was no death in all 5 patients with anterior septal perforation. One patient with posterior septal perforation died in the operating room due to bleeding from the ventriculotomy site. Three survived patients were diagnosed with a small residual defect and mild left to right shunt post-repair. However, no further intervention was required, and patients remained asymptomatic (Killip II in 1 and III in 2). CONCLUSION In our experience, immediate insertion of IABP and hemodynamic stabilization with early surgical intervention of VSD repair and concomitant coronary revascularization provided an 89% survival rate.
Collapse
Affiliation(s)
- Jian Shi
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, China.
| | - Jeremy Y Levett
- Division of Cardiac Surgery, Department of Surgery, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Haiyu Lv
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Guoan Zhang
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Sha Wang
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Tao Wei
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Zhikun Wang
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xi Zhang
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Dawei Feng
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Kan Wang
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Qiang Liu
- Department of Cardiac Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Dominique Shum-Tim
- Division of Cardiac Surgery, Department of Surgery, McGill University Health Centre, McGill University, Montreal, QC, Canada
| |
Collapse
|
7
|
Abdelaziz A, Elsayed H, Atta K, Mechi A, Kadhim H, Aboutaleb AM, Elaraby A, Hafez A, Bakr A, Mohamed Rzk F, Elshahat A, Bakr M, Zawaneh EA, Ezzat M, Abdelaziz M, Fadel S, Ghaith HS, Singer E, Suppah M. Short- and Long-term Outcomes of Percutaneous Coronary Interventions in Chronic and Non-chronic Total Occlusions: A Meta-analysis of 690,123 Patients. Curr Probl Cardiol 2023; 48:101890. [PMID: 37336307 DOI: 10.1016/j.cpcardiol.2023.101890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
The use of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is still a subject of debate, with conflicting outcomes reported in different studies when compared to non-CTO lesions. This meta-analysis aims to clarify the clinical outcomes of PCI in CTO cases compared to non-CTO lesions, both in the short and long-term. PubMed, Scopus, Web of Science, Ovid, and Cochrane Central were searched until March 2023 for relevant studies addressing short- and long-term outcomes of PCI in CTO vs non-CTO lesions. Dichotomous data were pooled as odds ratio (OR) with its 95% confidence interval (CI) in a random Der-Simonian lair effect model using STATA 17 MP. Eight studies with a total of 690,123 patients were included. In terms of short-term outcomes, CTO PCI was associated with higher rates of vessel perforation (OR = 2.16, 95% CI: 1.31-3.57) and cardiac tamponade (OR = 5.19, 95% CI: 4.29-6.28). Additionally, CTO PCI showed lower rates of procedural success (OR = 0.84, 95% CI: 0.73-0.96). Moreover, in the long-term, CTO PCI had higher rates of MACE (OR = 1.02, 95% CI: 1.01-1.04), however, it showed lower rates of cardiac death (OR = 0.61, 95% CI: 0.38-0.98), with no significant difference in other reported outcomes. Our findings underscore the challenges and adverse outcomes associated with using PCI to treat CTO lesions in the short term. This suggests that interventional cardiologists should carefully evaluate the risks and benefits before proceeding with PCI in CTO lesions.
Collapse
Affiliation(s)
- Ahmed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Hanaa Elsayed
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Karim Atta
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Ahmed Mechi
- Department of Internal Medicine, University of Kufa, Medicine College, Najaf, Iraq
| | | | - Aya Moustafa Aboutaleb
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elaraby
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman Hafez
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali Bakr
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fayed Mohamed Rzk
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Elshahat
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Bakr
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Emad Addin Zawaneh
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of medicine, Jordan university of science and technology, Irbid, Jordan
| | - Mahmoud Ezzat
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Shaimaa Fadel
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hazem S Ghaith
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Emad Singer
- University of Texas MD Anderson, Houston, TX
| | - Mustafa Suppah
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ
| |
Collapse
|
8
|
Al-Lamee RK, Khan SA, Davies J. Reconsidering the evidence for CTO PCI: the devil is in the detail. EUROINTERVENTION 2023; 19:537-538. [PMID: 37720966 PMCID: PMC10493770 DOI: 10.4244/eij-e-23-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Rasha K Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sarosh A Khan
- Essex Cardiothoracic Centre, Basildon, Essex, UK
- Anglia Ruskin University, Chelmsford, Essex, UK
| | - John Davies
- Essex Cardiothoracic Centre, Basildon, Essex, UK
- Anglia Ruskin University, Chelmsford, Essex, UK
| |
Collapse
|
9
|
Januszek R, De Luca G, Siłka W, Bryniarski L, Malinowski KP, Surdacki A, Wańha W, Bartuś S, Piotrowska A, Bartuś K, Pytlak K, Siudak Z. Single versus Dual-Operator Approaches for Percutaneous Coronary Interventions within Chronic Total Occlusion-An Analysis of 27,788 Patients. J Clin Med 2023; 12:4684. [PMID: 37510798 PMCID: PMC10380720 DOI: 10.3390/jcm12144684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Since the treatment of chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) is associated with high procedural complexity, it has been suggested to use a multi-operator approach. This study was aimed at evaluating the procedural outcomes of single (SO) versus dual-operator (DO) CTO-PCI approaches. (2) Methods: This retrospective analysis included data from the Polish Registry of Invasive Cardiology Procedures (ORPKI), collected between January 2014 and December 2020. To compare the DO and SO approaches, propensity score matching was introduced with equalized baseline features. (3) Results: The DO approach was applied in 3604 (13%) out of 27,788 CTO-PCI cases. Patients undergoing DO CTO-PCI experienced puncture-site bleeding less often than the SO group (0.1% vs. 0.3%, p = 0.03). No differences were found in the technical success rate (successful revascularization with thrombolysis in myocardial infarction flow grade 2/3) of the SO (72.4%) versus the DO approach (71.2%). Moreover, the presence of either multi-vessel (MVD) or left main coronary artery disease (LMCA) (odds ratio (OR), 1.67 (95% confidence interval (CI), 1.20-2.32); p = 0.002), as well as lower annual and total operator volumes of PCI and CTO-PCI, could be noted as factors linked with the DO approach. (4) Conclusions: Due to the retrospective character, the findings of this study have to be considered only as hypothesis-generating. DO CTO-PCI was infrequent and was performed on patients who were more likely to have LMCA lesions or MVD. Operators collaboratively performing CTO-PCIs were more likely to have less experience. Puncture-site bleeding occurred less often in the dual-operator group; however, second-operator involvement had no impact on the technical success of the intervention.
Collapse
Affiliation(s)
- Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
| | - Giuseppe De Luca
- Division of Cardiology, AOU Policlinico G. Martino, University of Messina, 98166 Messina, Italy
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
| | - Wojciech Siłka
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
| | - Krzysztof Piotr Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Aleksandra Piotrowska
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Kraków, Poland
| | - Kamil Pytlak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
| |
Collapse
|
10
|
Seto AH, Tehrani DM. Better together? Maybe not with CTO-PCI. Catheter Cardiovasc Interv 2023; 101:828-829. [PMID: 36861737 DOI: 10.1002/ccd.30606] [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: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Arnold H Seto
- Department of Medicine, VA Long Beach Healthcare System, Long Beach, California, USA.,Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA.,Department of Medicine, University of California, Irvine, California, USA
| | - David M Tehrani
- Department of Medicine, University of California, Los Angeles, California, USA
| |
Collapse
|
11
|
Karacsonyi J, Alaswad K, Krestyaninov O, Karmpaliotis D, Kirtane A, Ali Z, McEntegart M, Masoumi A, Poomipanit P, Jaffer FA, Khatri J, Choi J, Patel M, Koutouzis M, Tsiafoutis I, Gorgulu S, Sheikh AM, Elbarouni B, Jaber W, ElGuindy A, Yeh R, Kostantinis S, Simsek B, Rangan B, Mastrodemos OC, Vemmou E, Nikolakopoulos I, Ungi I, Rafeh NA, Goktekin O, Burke MN, Brilakis ES, Sandoval Y. Single vs. multiple operators for chronic total occlusion percutaneous coronary interventions: From the PROGRESS-CTO Registry. Catheter Cardiovasc Interv 2023; 101:543-552. [PMID: 36695421 DOI: 10.1002/ccd.30564] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is limited data on the impact of a second attending operator on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) outcomes. METHODS We analyzed the association between multiple operators (MOs) (>1 attending operator) and procedural outcomes of 9296 CTO PCIs performed between 2012 and 2021 at 37 centers. RESULTS CTO PCI was performed by a single operator (SO) in 85% of the cases and by MOs in 15%. Mean patient age was 64.4 ± 10 years and 81% were men. SO cases were more complex with higher Japan-CTO (2.38 ± 1.29 vs. 2.28 ± 1.20, p = 0.005) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention scores (1.13 ± 1.01 vs. 0.97 ± 0.93, p < 0.001) compared with MO cases. Procedural time (131 [87, 181] vs. 112 [72, 167] min, p < 0.001), fluoroscopy time (49 [31, 76] vs. 42 [25, 68] min, p < 0.001), air kerma radiation dose (2.32 vs. 2.10, p < 0.001), and contrast volume (230 vs. 210, p < 0.001) were higher in MO cases. Cases performed by MOs and SO had similar technical (86% vs. 86%, p = 0.9) and procedural success rates (84% vs. 85%, p = 0.7), as well as major adverse complication event rates (MACE 2.17% vs. 2.42%, p = 0.6). On multivariable analyses, MOs were not associated with higher technical success or lower MACE rates. CONCLUSION In a contemporary, multicenter registry, 15% of CTO PCI cases were performed by multiple operators. Despite being more complex, SO cases had lower procedural and fluoroscopy times, and similar technical and procedural success and risk of complications compared with MO cases.
Collapse
Affiliation(s)
- Judit Karacsonyi
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | | | - Dimitri Karmpaliotis
- Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, New Jersey, USA
| | | | - Ziad Ali
- St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | | | - Amirali Masoumi
- Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, New Jersey, USA
| | - Paul Poomipanit
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Farouc A Jaffer
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - James Choi
- Baylor Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas, USA
| | - Mitul Patel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Michalis Koutouzis
- 2nd Department of Cardiology, Red Cross Hospital of Athens, Athens, Greece
| | | | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | | | - Basem Elbarouni
- Department of Internal Medicine, Section of Cardiology, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Wissam Jaber
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ahmed ElGuindy
- Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Robert Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana Rangan
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Evangelia Vemmou
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Imre Ungi
- Division of Invasive Cardiology, Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | | | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| |
Collapse
|
12
|
Xu J, Patel A, Meraj P. Impact of chronic total occlusions on outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention: A propensity-score matched analysis using the National Inpatient Sample database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:14-18. [PMID: 35739013 DOI: 10.1016/j.carrev.2022.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is limited data on the impact of chronic total occlusions (CTOs) on the outcomes of patients presenting with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) in the contemporary era. METHODS We queried the National Inpatient Sample between October 2015 and December 2017 using the International Classification of Diseases, Tenth revision codes to identify hospitalized AMI patients undergoing PCI. A 1:1 propensity-score matched analysis was performed to compare in-hospital outcomes of patients with and without CTOs. RESULTS Among 576,760 admissions identified during the study period, 51,225(8.8 %) had CTO and 525,535 (91.1 %) did not. After 1:1 propensity-score matching, each matched group contained 51,210 admissions. In-hospital mortality was significantly higher in the CTO group compared with the non-CTO group (4.7 % vs 3 %, p < 0.0001). In the CTO group, hospital length of stay was longer (median 3 vs 2 days, p = 0.001) and lower percentage of patients were discharged to home (78.8 % vs 81.1 %, p < 0.0001), compared with the non-CTO group. Median cost of hospital stay was also higher in the CTO group compared with the non-CTO group ($20,921 vs $19,856, p < 0.0001). CONCLUSIONS In this propensity-score matched analysis of a large US inpatient database, the presence of CTOs in AMI patients undergoing PCI identified a higher risk cohort with in higher in-hospital mortality, longer hospital length of stay and higher hospitalization cost.
Collapse
Affiliation(s)
- James Xu
- Department of Cardiology, North Shore University Hospital, Northwell Health, Hofstra Northwell School of Medicine, Manhasset, NY, United States of America; Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Amitkumar Patel
- Department of Cardiology, North Shore University Hospital, Northwell Health, Hofstra Northwell School of Medicine, Manhasset, NY, United States of America
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Hofstra Northwell School of Medicine, Manhasset, NY, United States of America.
| |
Collapse
|
13
|
Holck EN, Winther NS, Mogensen LJH, Christiansen EH. Cost-Effectiveness in Patients Undergoing Revascularization of Chronic Total Occluded Coronary Arteries—A Cohort Study. Front Cardiovasc Med 2022; 9:849942. [PMID: 35694673 PMCID: PMC9177990 DOI: 10.3389/fcvm.2022.849942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Revascularization of patients with chronic total occluded coronary arteries (CTO) is recommended if they have symptoms despite medical treatment. The cost-effectiveness of treatment with percutaneous coronary intervention (PCI) was investigated in this cohort study. Materials and Methods The study was designed as a cohort study enrolling all patients undergoing PCI for a CTO in the Central Region of Denmark and recorded in the EUROCTO database. Major adverse cardio- and cerebrovascular events (MACCE) and admissions for cardiac symptoms were collected in the Western Denmark Heart Registry and through medical Journal Audits. Exposure was defined as successful revascularization of all CTO lesions compared with having one or more remaining CTOs after PCI attempt(s). Cost-effectiveness was evaluated as the net benefit (NB) at the patient level 3 years after treatment and through cost-effectiveness planes. The cost was defined as the cumulative cost of the index procedure and admissions due to MACCE and cardiac symptoms. Effectiveness was defined as the difference in MACCE for the primary analysis and the difference in death and symptomatic admissions for the secondary. Results Between 2009 and 2019, 441 patients with ≥ 3 years of follow-up were treated with PCI for at least one CTO lesion (342 in the successful arm and 99 in the unsuccessful arm). The technical success rate was 85.4%. In total, 155 MACCE and 184 symptomatic admissions occurred in the follow-up period. The mean total cost was EUR 11.719 (11.034; 12.406) in the successful group vs. EUR 13.565 (11.899; 15,231) (p = 0.02) in the unsuccessful group. Net-benefit was EUR 1.846 (64; 3,627) after successful revascularization for MACCE. The adjusted analysis found an NB of EUR 1,481 (–118; 3,079). Bootstrap estimates showed cost-effectiveness planes in favor of successful revascularization. Conclusion Patients fully revascularized for all CTO lesions had a more cost-efficient treatment. However, results need confirmation in a randomized controlled trial due to the risk of residual confounding after adjustment.
Collapse
Affiliation(s)
- Emil Nielsen Holck
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Emil Nielsen Holck,
| | - Naja Stausholm Winther
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Juul Hune Mogensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
14
|
Azzalini L, Karmpaliotis D, Santiago R, Mashayekhi K, Di Mario C, Rinfret S, Nicholson WJ, Carlino M, Yamane M, Tsuchikane E, Brilakis ES. Contemporary Issues in Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022; 15:1-21. [PMID: 34991814 DOI: 10.1016/j.jcin.2021.09.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 12/18/2022]
Abstract
Remarkable progress has been achieved in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in recent years, with refinement of the indications and technical aspects of the procedure, imaging, and complication management. Randomized controlled trials and rigorous prospective registries have provided high-quality data on the benefits and risks of CTO PCI. Global collaboration has led to an agreement on nomenclature, indications, endpoint definition, and principles of clinical trial design that have been distilled in global consensus documents such as the CTO Academic Research Consortium. Increased use of preprocedural coronary computed tomography angiography and intraprocedural intravascular imaging, as well as development of novel techniques and structured CTO crossing and complication management algorithms, allow a systematic, stepwise approach to this difficult lesion subset. This state-of-the-art review provides a comprehensive discussion about the most recent developments in the indications, preprocedural planning, technical aspects, complication management, and future directions of CTO PCI.
Collapse
Affiliation(s)
- Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
| | - Dimitri Karmpaliotis
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Ricardo Santiago
- PCI Cardiology Group, Bayamon Heart and Lung Institute, Bayamon, Puerto Rico, USA
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Department of Clinical & Experimental Medicine, Florence, Italy
| | | | | | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Masahisa Yamane
- Cardiovascular Division, Saitama-Sekishinkai Hospital, Saitama, Japan
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| |
Collapse
|
15
|
Kovach CP, Hebbe A, Barón AE, Strobel A, Plomondon ME, Valle JA, Waldo SW. Clinical Characteristics and Outcomes Among Patients Undergoing High-Risk Percutaneous Coronary Interventions by Single or Multiple Operators: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. J Am Heart Assoc 2021; 10:e022131. [PMID: 34775783 PMCID: PMC9075385 DOI: 10.1161/jaha.121.022131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background High-risk percutaneous coronary intervention (HR-PCI) is increasingly common among contemporary patients with coronary artery disease. Experts have advocated for a collaborative 2-operator approach to support intraprocedural decision-making for these complex interventions. The impact of a second operator on patient and procedural outcomes is unknown. Methods and Results Patients who underwent HR-PCI from 2015 to 2018 within the Veterans Affairs Healthcare System were identified. Propensity-matched cohorts were generated to compare the outcomes following HR-PCI performed by a single or multiple (≥2) operators. The primary end point was the 12-month rate of major adverse cardiovascular events. We identified 6672 patients who underwent HR-PCI during the study period; 6211 (93%) were treated by a single operator, and 461 (7%) were treated by multiple operators, with a nonsignificant trend toward increased multioperator procedures over time. A higher proportion of patients treated by multiple operators underwent left main (10% versus 7%, P=0.045) or chronic total occlusion intervention (11% versus 5%, P<0.001). Lead interventionalists participating in multioperator procedures practiced at centers with higher annual HR-PCI volumes (124±71.3 versus 111±69.2; standardized mean difference, 0.197; P<0.001) but otherwise performed a similar number of HR-PCI procedures per year (34.4±35.3 versus 34.7±30.7; standardized mean difference, 0.388; P=0.841) compared with their peers performing single-operator interventions. In a propensity-matched cohort, there was no significant difference in major adverse cardiovascular events (32% versus 30%, P=0.444) between patients who underwent single-operator versus multioperator HR-PCI. Adjusted analyses accounting for site-level variance showed no significant differences in outcomes. Conclusions Patients who underwent multioperator HR-PCI had similar outcomes compared with single-operator procedures. Further studies are needed to determine if the addition of a second operator offers clinical benefits to a subset of HR-PCI patients undergoing left main or chronic total occlusion intervention.
Collapse
Affiliation(s)
| | - Annika Hebbe
- Department of Biostatistics and Informatics University of Colorado Aurora CO.,CART Program Office of Quality and Patient Safety Veterans Health Administration Washington DC
| | - Anna E Barón
- Department of Biostatistics and Informatics University of Colorado Aurora CO
| | - Aaron Strobel
- Division of Cardiology Department of Medicine University of Colorado Aurora CO
| | - Mary E Plomondon
- CART Program Office of Quality and Patient Safety Veterans Health Administration Washington DC
| | - Javier A Valle
- Division of Cardiology Department of Medicine University of Colorado Aurora CO.,Department of Medicine, Michigan Heart and Vascular Institute Ann Arbor MI
| | - Stephen W Waldo
- Division of Cardiology Department of Medicine University of Colorado Aurora CO.,CART Program Office of Quality and Patient Safety Veterans Health Administration Washington DC
| |
Collapse
|
16
|
Popp LM, Lowell LM, Ashburn NP, Stopyra JP. Adverse events after prehospital nitroglycerin administration in a nationwide registry analysis. Am J Emerg Med 2021; 50:196-201. [PMID: 34390902 PMCID: PMC9029256 DOI: 10.1016/j.ajem.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Nitroglycerin (NTG) is a vasodilator used in the prehospital setting with chest pain patients. Potential adverse effects include hypotension, bradycardia or tachycardia, and mental status change. However, it is unclear which factors, if any, are associated with patients having an adverse event after receiving NTG. The objective of this study was to determine demographic and clinical factors associated with adverse events after prehospital NTG administration. METHODS The ESO Data Collaborative (Austin, TX), containing records from 1322 EMS agencies, was queried for 911 encounters where NTG was administered to patients ≥18 years old by EMS. Adverse event outcomes were defined as a new systolic blood pressure (SBP) < 90, heart rate (HR) < 50 or > 120, mean arterial pressure (MAP) < 65, or change in mental status following NTG administration. Descriptive statistics and logistic regression models adjusting for age, sex, race, ethnicity, intravenous (IV) access, and initial vital signs were used to assess for adverse event-related factors. RESULTS Among 80,760 encounters, the mean age was 61 (IQR 50-72), with 52% males, 71% white race, and 7% Hispanic ethnicity. Adverse events occurred in 7% of encounters. Adverse events were found to be less common among Black patients (OR = 0.74, 95%CI:0.69-0.80). IV access obtained prior to NTG administration was associated with fewer adverse events (OR = 0.92, 95%CI:0.85-0.99). Increasing age (OR = 1.02, 95%CI:1.01-1.02) and HR (OR = 1.03, 95%CI:1.02-1.03) were associated with increased odds of adverse events while SBP (OR = 0.99, 95%CI:0.98-0.99) was inversely associated. CONCLUSIONS Adverse events following prehospital NTG administration were rare, especially in patients with an SBP > 110 and a HR < 100, and less frequent in those with existing IV access. Demographics were not found to be clinically significant.
Collapse
Affiliation(s)
- Lucas M Popp
- Department of Emergency Medicine, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Luke M Lowell
- Department of Emergency Medicine, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Nicklaus P Ashburn
- Department of Emergency Medicine, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Jason P Stopyra
- Department of Emergency Medicine, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| |
Collapse
|
17
|
Kandzari DE, Lembo NJ, Carlson HD, Kalynych A, Spertus JA, Gibson CM, Chi G, Morgan J, Rinehart S, Yehya A, Qian Z, Ajose B, Karmpaliotis D. Procedural, clinical, and health status outcomes in chronic total coronary occlusion revascularization: Results from the PERSPECTIVE study. Catheter Cardiovasc Interv 2020; 96:567-576. [PMID: 31512377 DOI: 10.1002/ccd.28494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Limited research has detailed the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with independent core laboratory and event adjudication. This study examined procedural, clinical, and patient-reported health status outcomes among patients undergoing CTO PCI with specific focus on outcomes for those treated with zotarolimus-eluting stents (ZES). METHODS Among 500 consecutive patients undergoing attempted CTO PCI, procedural and in-hospital clinical outcomes were examined in addition to the 1-year composite endpoint of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events, MACE). In a pre-specified cohort of 250 patients, health status measures were ascertained at baseline and 1 year. A powered secondary endpoint was 1-year MACE among patients treated with ZES compared with a performance goal. RESULTS Demographic, lesion, and procedural characteristics for the overall population included prior bypass surgery, 29.8%; diabetes, 35.2%; occlusion length >20 mm, 71.3%; J-CTO score, 2.5 ± 1.1; and primary retrograde strategy, 30.8%. Overall guidewire crossing was 90.9%; clinical success following guidewire crossing, 94.3%; and 1-year MACE rate, 12.1%. One-year health status significantly improved from baseline with successful CTO-PCI (angina frequency, 72.7 ± 26.5 at baseline to 96.0 ± 10.8, p < .0001). Compared with a performance goal derived from prior CTO DES trials (1-year hierarchal MACE, 25.2%), treatment with ZES was associated with significantly lower MACE (18.2%, one-sided upper CI, 23.6%, p = .017). CONCLUSIONS Favorable procedural success, health status improvements and late-term clinical outcomes inform the relative risks and benefits of CTO PCI when performed in a clinically indicated, complex patient population representative of those treated in clinical practice.
Collapse
Affiliation(s)
- David E Kandzari
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Nicholas J Lembo
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Harold D Carlson
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Anna Kalynych
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - John A Spertus
- Cardiovascular Research, Department of Biomedical and Health Informatics, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, Missouri
| | - C Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gerald Chi
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jayne Morgan
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Sarah Rinehart
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Amin Yehya
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Zhen Qian
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Bola Ajose
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | | |
Collapse
|
18
|
Kaul P, Kandzari DE. Chronic Total Occlusions: Practice Makes Perfect-Implications for Standardizing Performance and Training. Circ Cardiovasc Interv 2020; 13:e009724. [PMID: 32791952 DOI: 10.1161/circinterventions.120.009724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Prashant Kaul
- Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA
| | - David E Kandzari
- Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA
| |
Collapse
|
19
|
Doll JA, Hira RS, Kearney KE, Kandzari DE, Riley RF, Marso SP, Grantham JA, Thompson CA, McCabe JM, Karmpaliotis D, Kirtane AJ, Lombardi W. Management of Percutaneous Coronary Intervention Complications: Algorithms From the 2018 and 2019 Seattle Percutaneous Coronary Intervention Complications Conference. Circ Cardiovasc Interv 2020; 13:e008962. [PMID: 32527193 DOI: 10.1161/circinterventions.120.008962] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Complications of percutaneous coronary intervention (PCI) may have significant impact on patient survival and healthcare costs. PCI procedural complexity and patient risk are increasing, and operators must be prepared to recognize and treat complications, such as perforations, dissections, hemodynamic collapse, no-reflow, and entrapped equipment. Unfortunately, few resources exist to train operators in PCI complication management. Uncertainty regarding complication management could contribute to the undertreatment of patients with high-complexity coronary disease. We, therefore, coordinated the Learning From Complications: How to Be a Better Interventionalist courses to disseminate the collective experience of high-volume PCI operators with extensive experience in chronic total occlusion and high-risk PCI. From these conferences in 2018 and 2019, we developed algorithms that emphasize early recognition, effective treatment, and team-based care of PCI complications. We think that an algorithmic approach will result in a logical and systematic response to life-threatening complications. This construct may be useful for operators who plan to perform complex PCI procedures.
Collapse
Affiliation(s)
- Jacob A Doll
- University of Washington, Seattle, WA (J.A.D., R.S.H., K.E.K., J.M.M., W.L.).,VA Puget Sound Health Care System, Seattle, WA (J.A.D.)
| | - Ravi S Hira
- University of Washington, Seattle, WA (J.A.D., R.S.H., K.E.K., J.M.M., W.L.)
| | - Kathleen E Kearney
- University of Washington, Seattle, WA (J.A.D., R.S.H., K.E.K., J.M.M., W.L.)
| | | | - Robert F Riley
- The Christ Hospital Health Network, Cincinnati, OH (R.F.R.)
| | - Steven P Marso
- HCA Midwest Health Heart and Vascular Institute, Overland Park, KS (S.P.M.)
| | - James A Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.G.).,University of Missouri-Kansas City, Kansas City, MO (J.A.G.)
| | | | - James M McCabe
- University of Washington, Seattle, WA (J.A.D., R.S.H., K.E.K., J.M.M., W.L.)
| | | | - Ajay J Kirtane
- Columbia University Medical Center, New York, NY (D.K., A.J.K.)
| | - William Lombardi
- University of Washington, Seattle, WA (J.A.D., R.S.H., K.E.K., J.M.M., W.L.)
| |
Collapse
|
20
|
|
21
|
Riley RF, Henry TD, Kong JA, Reginelli JP, Kereiakes DJ, Grantham JA, Lombardi WL. A CHIP fellow's transition into practice: Building a complex coronary therapeutics program. Catheter Cardiovasc Interv 2019; 96:1058-1064. [DOI: 10.1002/ccd.28599] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/09/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Robert F. Riley
- Lindner Center for Research and Education, The Christ Hospital Network Cincinnati Ohio
| | - Timothy D. Henry
- Lindner Center for Research and Education, The Christ Hospital Network Cincinnati Ohio
| | - James A. Kong
- Lindner Center for Research and Education, The Christ Hospital Network Cincinnati Ohio
| | - Joel P. Reginelli
- Lindner Center for Research and Education, The Christ Hospital Network Cincinnati Ohio
| | - Dean J. Kereiakes
- Lindner Center for Research and Education, The Christ Hospital Network Cincinnati Ohio
| | - J. Aaron Grantham
- Saint Luke's Mid America Heart Institute, University of Missouri Columbia Missouri
| | | |
Collapse
|
22
|
Brilakis ES, Mashayekhi K, Tsuchikane E, Abi Rafeh N, Alaswad K, Araya M, Avran A, Azzalini L, Babunashvili AM, Bayani B, Bhindi R, Boudou N, Boukhris M, Božinović NŽ, Bryniarski L, Bufe A, Buller CE, Burke MN, Büttner HJ, Cardoso P, Carlino M, Christiansen EH, Colombo A, Croce K, Damas de Los Santos F, De Martini T, Dens J, Di Mario C, Dou K, Egred M, ElGuindy AM, Escaned J, Furkalo S, Gagnor A, Galassi AR, Garbo R, Ge J, Goel PK, Goktekin O, Grancini L, Grantham JA, Hanratty C, Harb S, Harding SA, Henriques JPS, Hill JM, Jaffer FA, Jang Y, Jussila R, Kalnins A, Kalyanasundaram A, Kandzari DE, Kao HL, Karmpaliotis D, Kassem HH, Knaapen P, Kornowski R, Krestyaninov O, Kumar AVG, Laanmets P, Lamelas P, Lee SW, Lefevre T, Li Y, Lim ST, Lo S, Lombardi W, McEntegart M, Munawar M, Navarro Lecaro JA, Ngo HM, Nicholson W, Olivecrona GK, Padilla L, Postu M, Quadros A, Quesada FH, Prakasa Rao VS, Reifart N, Saghatelyan M, Santiago R, Sianos G, Smith E, C Spratt J, Stone GW, Strange JW, Tammam K, Ungi I, Vo M, Vu VH, Walsh S, Werner GS, Wollmuth JR, Wu EB, Wyman RM, Xu B, Yamane M, Ybarra LF, Yeh RW, Zhang Q, Rinfret S. Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation 2019; 140:420-433. [PMID: 31356129 DOI: 10.1161/circulationaha.119.039797] [Citation(s) in RCA: 236] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.
Collapse
Affiliation(s)
- Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (E.S.B., M.N.B.)
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II University Heart Center Freiburg Bad Krozingen, Germany (K.M., H.J.B.)
| | | | - Nidal Abi Rafeh
- St. George Hospital University Medical Center, Beirut, Lebanon (N.A.R.)
| | | | - Mario Araya
- Clínica Alemana and Instituto Nacional del Tórax, Santiago, Chile (M.A.)
| | - Alexandre Avran
- Arnault Tzank Institut St. Laurent Du Var Nice, France (A.A.)
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (L.A., M.C.)
| | - Avtandil M Babunashvili
- Department of Cardiovascular Surgery, Center for Endosurgery and Lithotripsy, Moscow, Russian Federation (A.M.B.)
| | - Baktash Bayani
- Cardiology Department, Mehr Hospital, Mashhad, Iran (B.B.)
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Australia (R.B.)
| | | | - Marouane Boukhris
- Cardiology department, Abderrahment Mami Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia (M.B.)
| | - Nenad Ž Božinović
- Department of Interventional Cardiology Clinic for Cardiovascular Diseases University Clinical Center Nis, Serbia (N.Z.B.)
| | - Leszek Bryniarski
- II Department of Cardiology and Cardiovascular Interventions Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland (L.B.)
| | - Alexander Bufe
- Department of Cardiology, Heartcentre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany, Institute for Heart and Circulation Research, University of Cologne, Germany, and University of Witten/Herdecke, Witten, Germany (A.B.)
| | | | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (E.S.B., M.N.B.)
| | - Heinz Joachim Büttner
- Department of Cardiology and Angiology II University Heart Center Freiburg Bad Krozingen, Germany (K.M., H.J.B.)
| | - Pedro Cardoso
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre (CAML) and Centro Cardiovascular da Universidade de Lisboa (CCUL), Portugal (P.C.)
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (L.A., M.C.)
| | | | - Antonio Colombo
- San Raffaele Hospital and Columbus Hospital, Milan, Italy (A.C.)
| | - Kevin Croce
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (K.C.)
| | - Felix Damas de Los Santos
- Interventional Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez Mexico City, Mexico (F.D.d.l.S.)
| | - Tony De Martini
- SIU School of Medicine, Memorial Medical Center, Springfield, IL (T.D.M.)
| | - Joseph Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium (J.D.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.)
| | - Kefei Dou
- Center for Coronary Heart Disease, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (K.D.)
| | - Mohaned Egred
- Freeman Hospital and Newcastle University, Newcastle upon Tyne, United Kingdom (M.E.)
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Egypt (A.M.E.).,National Heart and Lung Institute, Imperial College London, United Kingdom (A.M.E.)
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Spain (J.E.)
| | - Sergey Furkalo
- Department of Endovascular Surgery and Angiography, National Institute of Surgery and Transplantology of AMS of Ukraine, Kiev (S.F.)
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy (A.G.)
| | - Alfredo R Galassi
- Chair of Cardiology, Department of PROMISE, University of Palermo, Italy (A.R.G.)
| | - Roberto Garbo
- Director of Interventional Cardiology, San Giovanni Bosco Hospital, Turin, Italy (R.G.)
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China (J.G.)
| | - Pravin Kumar Goel
- Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow, India (P.K.G.)
| | | | - Luca Grancini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy (L.G.)
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.G.)
| | - Colm Hanratty
- Belfast Health and Social Care Trust, United Kingdom (C.H., S.W.)
| | - Stefan Harb
- LKH Graz II, Standort West, Kardiologie, Teaching Hospital of the University of Graz, Austria (S.H.)
| | - Scott A Harding
- Wellington Hospital, Capital and Coast District Health Board, New Zealand (S.A.H.)
| | - Jose P S Henriques
- Academic Medical Centre of the University of Amsterdam, The Netherlands (J.P.S.H.)
| | | | - Farouc A Jaffer
- Cardiology Division, Massachusetts General Hospital, Boston (F.A.J.)
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea (Y.J.)
| | | | - Artis Kalnins
- Department of Cardiology, Eastern Clinical University Hospital, Riga, Latvia (A. Kalnins)
| | | | | | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei(H.-L.K.)
| | | | - Hussien Heshmat Kassem
- Cardiology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Egypt(H.H.K.).,Fujairah Hospital, United Arab Emirates (H.H.K.)
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (P.K.)
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, "Sackler" School of Medicine, Tel Aviv University, Petach Tikva, Israel (R.K.)
| | | | - A V Ganesh Kumar
- Department of Cardiology, Dr LH Hiranandani Hospital, Mumbai, India (A.V.G.K.)
| | - Peep Laanmets
- North Estonia Medical Center Foundation, Tallinn, Estonia(P. Laanmets)
| | - Pablo Lamelas
- Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular de Buenos Aires, Argentina (P. Lamelas).,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada (P. Lamelas)
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (S.-W.L.)
| | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud Hopital prive Jacques Cartier, Massy, France (T.L.)
| | - Yue Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, China (Y.L.)
| | - Soo-Teik Lim
- Department of Cardiology, National Heart Centre Singapore (S.-T.L.)
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital and The University of New South Wales, Sydney, Australia (S.L.)
| | | | | | | | - José Andrés Navarro Lecaro
- Médico Cardiólogo Universitario - Hemodinamista en Hospital de Especialidades Eugenio Espejo y Hospital de los Valles, Ecuador (J.A.N.L.)
| | | | | | | | - Lucio Padilla
- Department of Interventional Cardiology and Endovascular Therapeutics, ICBA, Instituto Cardiovascular, Buenos Aires, Argentina (L.P.)
| | - Marin Postu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases "Prof. Dr. C.C. Iliescu," Bucharest, Romania (M.P.)
| | - Alexandre Quadros
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil (A.Q.)
| | - Franklin Hanna Quesada
- Interventional Cardiology Department, Clinica Comfamiliar Pereira City, Colombia (F.H.Q.)
| | | | - Nicolaus Reifart
- Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany (N.R.)
| | | | - Ricardo Santiago
- Hospital Pavia Santurce, PCI Cardiology Group, San Juan, Puerto Rico (R.S.T.)
| | - George Sianos
- AHEPA University Hospital, Thessaloniki, Greece (G.S.)
| | - Elliot Smith
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (E.S.)
| | - James C Spratt
- St George's University Hospital NHS Trust, London, United Kingdom (J.S.)
| | - Gregg W Stone
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (G.W.S.)
| | - Julian W Strange
- Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J.W.S.)
| | - Khalid Tammam
- Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia (K.T.)
| | - Imre Ungi
- 2nd Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary (I.U.)
| | - Minh Vo
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada (M.V.)
| | - Vu Hoang Vu
- Interventional Cardiology Department, Heart Center, University Medical Center at Ho Chi Minh City, and University of Medicine and Pharmacy, Vietnam (H.V.)
| | - Simon Walsh
- Belfast Health and Social Care Trust, United Kingdom (C.H., S.W.)
| | - Gerald S Werner
- Medizinische Klinik I Klinikum Darmstadt GmbH, Germany (G.W.)
| | | | | | | | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing (B.X.)
| | - Masahisa Yamane
- Saitima St. Luke's International Hospital, Tokyo, Japan (M.Y.)
| | - Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (L.F.Y.)
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.)
| | - Qi Zhang
- Shanghai East Hospital, Tongji University, China (Q.Z.)
| | - Stephane Rinfret
- McGill University Health Centre, McGill University, Montreal, QC, Canada (S.R.)
| |
Collapse
|
23
|
Stojanovic I, Schneider JE, Cooper J. Cost-impact of cardiac magnetic resonance imaging with Fast-SENC compared to SPECT in the diagnosis of coronary artery disease in the U.S. J Med Econ 2019; 22:430-438. [PMID: 30732489 DOI: 10.1080/13696998.2019.1580713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS The purpose of this study is to assess the economic cost differences and the associated treatment resource changes between the developing coronary artery disease (CAD) diagnostic tool fast strain-encoded cardiac imaging (Fast-SENC) and the current commonly used stress test single-photon emission computed tomography (SPECT). MATERIALS AND METHODS A "payer perspective" model was created first, consisting of long-term and short-term components that used a hypothetical cohort of patients of average age (60.8 years) presenting with chest pain and suspected CAD to assess cost-impact. A cost impact model was then built that assessed likely savings from a "hospital perspective" from substituting Fast-SENC for a portion of SPECTs assuming an average number of annual SPECT tests performed in US hospitals. RESULTS In the payer model, using Fast-SENC followed by coronary angiography (CA) and percutaneous coronary intervention (PCI) treatment when necessary is less costly than the SPECT method when considering both direct and indirect costs of testing. Expected costs of the Fast-SENC were between $2,510 and $2,632 per correct diagnosis, while expected costs for the SPECT were between $3,157 and $4,078. Fast-SENC reduced false positives by 50% and false negatives by 86%, generating additional cost savings. The hospital model showed total costs per CAD patient visit of $825 for SPECT and $376 for Fast-SENC. LIMITATIONS Limitations of this study are that clinical data are sourced from other published clinical trials on how CAD diagnostic strategies impact clinical outcome, and that necessary assumptions were made which impact health outcomes. CONCLUSION The lower cost, higher sensitivity and specificity rates, and faster, less burdensome process for detecting CAD patients make Fast-SENC a more capable and economically beneficial stress test than SPECT. The payer model and hospital model demonstrate an alignment between payer and provider economics as Fast-SENC provides monetary savings for patients and resource benefits for hospitals.
Collapse
Affiliation(s)
| | | | - Jacie Cooper
- a Avalon Health Economics , Morristown , NJ , USA
| |
Collapse
|
24
|
The Cost of Percutaneous Coronary Intervention for Chronic Total Occlusions in Our Current Cost-Conscious Environment. JACC Cardiovasc Interv 2019; 12:332-334. [DOI: 10.1016/j.jcin.2018.10.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 11/20/2022]
|
25
|
Salisbury AC, Karmpaliotis D, Grantham JA, Sapontis J, Meng Q, Magnuson EA, Gada H, Lombardi W, Moses J, Li H, Arnold SV, Baron SJ, Spertus JA, Cohen DJ. In-Hospital Costs and Costs of Complications of Chronic Total Occlusion Angioplasty. JACC Cardiovasc Interv 2019; 12:323-331. [DOI: 10.1016/j.jcin.2018.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/27/2018] [Accepted: 10/09/2018] [Indexed: 11/28/2022]
|
26
|
|
27
|
Hirai K, Sakakura K, Watanabe Y, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H. Determinants of high device cost in current percutaneous coronary interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:607-612. [PMID: 29358042 DOI: 10.1016/j.carrev.2017.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/17/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Percutaneous coronary interventions (PCI), especially medical devices, consume large amounts of medical resources. It is important to know which type of lesions requires high device costs among current PCI. The purpose of this study was to investigate the association between lesion characteristics and medical device costs in current PCI. METHODS We identified 593 coronary artery lesions in our PCI database between January 1, 2015 and December 31, 2015. The total PCI cost was calculated for each lesion. The highest quartile (Q1) of total PCI costs was defined as the highest cost group, whereas the other quartiles (Q2, Q3, Q4) were defined as the low-intermediate cost group. RESULTS The mean PCI cost in the highest cost and low-intermediate cost groups was ¥1,032,943 ± 211,912 and ¥532,547 ± 112,127, respectively. In a multivariate logistic regression analysis, lesion length (10 mm increase: OR 2.93, 95% CI 2.25-3.82, P < 0.001), left main lesion (OR 2.96, 95% CI 1.02-8.60, P = 0.046), moderate to severe calcification (OR 16.43, 95% CI 7.97-33.88, P < 0.001), chronic total occlusion (CTO) (OR 5.83, 95% CI 2.07-16.39, P = 0.001), and bifurcation (OR 2.01, 95% CI 1.08-3.75, P = 0.027) were significantly associated with the highest cost group. CONCLUSIONS Lesion characteristics including CTO, diffuse long lesion, calcification, and bifurcation were significantly associated with the highest device cost. Non-CTO complex lesions including bifurcation and calcification as well as CTO lesions require higher PCI device costs than non-complex lesions.
Collapse
Affiliation(s)
- Keisuke Hirai
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan.
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| |
Collapse
|
28
|
Tanguay A, Lebon J, Lau L, Hébert D, Bégin F. Detection of STEMI Using Prehospital Serial 12-Lead Electrocardiograms. PREHOSP EMERG CARE 2018; 22:419-426. [PMID: 29336652 DOI: 10.1080/10903127.2017.1399185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Repeated or serial 12-lead electrocardiograms (ECGs) in the prehospital setting may improve management of patients with subtle ST-segment elevation (STE) or with a ST-segment elevation myocardial infarction (STEMI) that evolves over time. However, there is a minimal amount of scientific evidence available to support the clinical utility of this method. Our objective was to evaluate the use of serial 12-lead ECGs to detect STEMI in patients during transport in a Canadian emergency medical services (EMS) jurisdiction. METHODS We performed a retrospective study of suspected STEMI patients transported by EMS in the Chaudière-Appalaches region (Québec, Canada) between August 2006 and December 2013. Patients were monitored by a serial 12-lead ECG system where an averaged ECG was transmitted every 2 minutes. Following review by an emergency physician, ECGs were grouped as having either a persistent STE or a dynamic STE that evolved over time. RESULTS A total of 754 suspected STEMI patients were transported by EMS during the study period. Of these, 728 patients met eligibility criteria and were included in the analysis. A persistent STE was observed in 84.3% (614/728) of patients, while the remaining 15.7% (114/728) had a dynamic STE. Among those with dynamic STE, 11.1% (81/728) had 1 ST-segment change (41 no-STEMI to STEMI; 40 STEMI to no-STEMI) and 4.5% (33/728) had ≥ 2 ST-segment changes (17 no-STEMI to STEMI; 16 STEMI to no-STEMI). Overall, in 8.0% (58/728) of the cohort, STEMI was identified on a subsequent ECG following an initial no-STEMI ECG. CONCLUSIONS Through recognition of transient ST-segment changes during transport via the prehospital serial 12-lead ECG system, STEMI was identified in 8% of suspected STEMI patients who had an initial no-STEMI ECG. Key words: electrocardiography; emergency medical services; ST-elevation myocardial infarction; prehospital dynamic ECG.
Collapse
|
29
|
Balter S, Brinkman M, Kalra S, Nazif T, Parikh M, Kirtane A, Moses J, Leon M, Feri A, Green P, Ali Z, Liao M, Karmpaliotis D. Novel radiation dose reduction fluoroscopic technology facilitates chronic total occlusion percutaneous coronary interventions. EUROINTERVENTION 2017; 13:e1468-e1474. [DOI: 10.4244/eij-d-16-00216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
30
|
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.
| |
Collapse
|
31
|
O'connor CT, Kiernan TJ, Yan BP. The genetic basis of antiplatelet and anticoagulant therapy: A pharmacogenetic review of newer antiplatelets (clopidogrel, prasugrel and ticagrelor) and anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban). Expert Opin Drug Metab Toxicol 2017; 13:725-739. [PMID: 28571507 DOI: 10.1080/17425255.2017.1338274] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The study of pharmacogenomics presents the possibility of individualised optimisation of drug therapy tailored to each patients' unique physiological traits. Both antiplatelet and anticoagulant drugs play a key role in the management of cardiovascular disease. Despite their importance, there is a substantial volume of literature to suggest marked person-to-person variability in their effect. Areas covered: This article reviews the data available for the genetic cause for this inter-patient variability of antiplatelet and anticoagulant drugs. The genetic basis for traditional antiplatelets (i.e. aspirin) is compared with the newly available antiplatelet medicines (clopidogrel, prasugrel and ticagrelor). Similarly, the pharmacogenetics of warfarin is compared with the newer direct oral anticoagulants (DOACs) in detail. Expert Opinion: We identify strengths and weaknesses in the research thus far; including shortcomings in trial design and a review of newer analytical techniques. The direction of this research and its real-world implications are discussed.
Collapse
Affiliation(s)
- Cormac T O'connor
- a Cardiology Department , University Hospital Limerick , Limerick , Ireland
| | - Thomas J Kiernan
- a Cardiology Department , University Hospital Limerick , Limerick , Ireland
| | - Bryan P Yan
- b Division of Cardiology, Department of Medicine and Therapeutics , The Chinese University of Hong Kong, Prince of Wales Hospital , Hong Kong SAR , China
| |
Collapse
|
32
|
Azzalini L, Torregrossa G, Puskas JD, Brilakis ES, Lombardi WL, Karmpaliotis D, Nakamura S, Colombo A, Carlino M. Percutaneous revascularization of chronic total occlusions: Rationale, indications, techniques, and the cardiac surgeon's point of view. Int J Cardiol 2017; 231:90-96. [DOI: 10.1016/j.ijcard.2017.01.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 01/03/2017] [Indexed: 11/24/2022]
|
33
|
The Outcomes, Patient Health Status, and Efficiency IN Chronic Total Occlusion Hybrid Procedures registry. Coron Artery Dis 2017; 28:110-119. [DOI: 10.1097/mca.0000000000000439] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
BoganaShanmugam V, Psaltis PJ, Wong DT, Seneviratne S, Cameron J, Meredith IT, Malaiapan Y. Chronic Total Occlusion – Percutaneous Coronary Intervention (CTO-PCI) Experience in a Single, Multi-operator Australian Centre: Need for dedicated CTO-PCI programs. Heart Lung Circ 2016; 25:676-82. [DOI: 10.1016/j.hlc.2015.12.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 12/14/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022]
|
35
|
Epstein M, Pitt B. Recent advances in pharmacological treatments of hyperkalemia: focus on patiromer. Expert Opin Pharmacother 2016; 17:1435-48. [DOI: 10.1080/14656566.2016.1190333] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
36
|
Hwang JW, Yang JH, Choi SH, Hwang JK, Jang WJ, Hahn JY, Song YB, Choi JH, Lee SH, Gwon HC. Optimal medical therapy may be a better initial strategy in patients with chronic total occlusion of a single coronary artery. Int J Cardiol 2016; 210:56-62. [DOI: 10.1016/j.ijcard.2016.02.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 02/11/2016] [Accepted: 02/14/2016] [Indexed: 11/25/2022]
|
37
|
Kaliyadan AG, Savage MP, Ruggiero N, Fischman DL. An update on management of the patient presenting with non-ST-elevation acute coronary syndromes. Hosp Pract (1995) 2016; 44:173-8. [PMID: 27098650 DOI: 10.1080/21548331.2016.1179119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Over 780,000 patients in the United States are diagnosed with an acute coronary syndrome (ACS) each year. As physicians, it is our responsibility to provide prompt workup, diagnosis and management of these patients. After identification of the patient with ACS and confirming there is not ST-segment elevation MI requiring immediate revascularization, physicians should pursue a work-up for non-ST-elevation acute coronary syndrome (NSTE-ACS). It is important to understand the latest best practice guidelines in the treatment and management of patients with NSTE-ACS who carry high rates of in-hospital mortality. Physicians must integrate the clinical history and examination, electrocardiogram and laboratory findings in order to properly diagnose an NSTE-ACS. Early treatment with guideline directed medical therapy is imperative even in the setting of an early invasive strategy with cardiac catheterization and percutaneous coronary intervention. The focus of this review is to discuss the appropriate strategies for evaluation and management of patients with NSTE-ACS based on the most recent ACC/AHA practice guidelines.
Collapse
Affiliation(s)
- Antony G Kaliyadan
- a Division of Cardiology , Thomas Jefferson University Hospital , Philadelphia , PA , USA
| | - Michael P Savage
- a Division of Cardiology , Thomas Jefferson University Hospital , Philadelphia , PA , USA
| | - Nicholas Ruggiero
- a Division of Cardiology , Thomas Jefferson University Hospital , Philadelphia , PA , USA
| | - David L Fischman
- a Division of Cardiology , Thomas Jefferson University Hospital , Philadelphia , PA , USA
| |
Collapse
|
38
|
Christopoulos G, Wyman RM, Alaswad K, Karmpaliotis D, Lombardi W, Grantham JA, Yeh RW, Jaffer FA, Cipher DJ, Rangan BV, Christakopoulos GE, Kypreos MA, Lembo N, Kandzari D, Garcia S, Thompson CA, Banerjee S, Brilakis ES. Clinical Utility of the Japan-Chronic Total Occlusion Score in Coronary Chronic Total Occlusion Interventions: Results from a Multicenter Registry. Circ Cardiovasc Interv 2016; 8:e002171. [PMID: 26162857 DOI: 10.1161/circinterventions.114.002171] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The performance of the Japan-chronic total occlusion (J-CTO) score in predicting success and efficiency of CTO percutaneous coronary intervention has received limited study. METHODS AND RESULTS We examined the records of 650 consecutive patients who underwent CTO percutaneous coronary intervention between 2011 and 2014 at 6 experienced centers in the United States. Six hundred and fifty-seven lesions were classified as easy (J-CTO=0), intermediate (J-CTO=1), difficult (J-CTO=2), and very difficult (J-CTO≥3). The impact of the J-CTO score on technical success and procedure time was evaluated with univariable logistic and linear regression, respectively. The performance of the logistic regression model was assessed with the Hosmer-Lemeshow statistic and receiver operator characteristic curves. Antegrade wiring techniques were used more frequently in easy lesions (97%) than very difficult lesions (58%), whereas the retrograde approach became more frequent with increased lesion difficulty (41% for very difficult lesions versus 13% for easy lesions). The logistic regression model for technical success demonstrated satisfactory calibration and discrimination (P for Hosmer-Lemeshow =0.743 and area under curve =0.705). The J-CTO score was associated with a 2-fold increase in the odds of technical failure (odds ratio 2.04, 95% confidence interval 1.52-2.80, P<0.001). Procedure time increased by ≈20 minutes for every 1-point increase of the J-CTO score (regression coefficient 22.33, 95% confidence interval 17.45-27.22, P<0.001). CONCLUSIONS J-CTO score was strongly associated with final success and efficiency in this study, supporting its expanded use in CTO interventions. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.
Collapse
Affiliation(s)
- Georgios Christopoulos
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - R Michael Wyman
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Khaldoon Alaswad
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Dimitri Karmpaliotis
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - William Lombardi
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - J Aaron Grantham
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Robert W Yeh
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Farouc A Jaffer
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Daisha J Cipher
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Bavana V Rangan
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Georgios E Christakopoulos
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Megan A Kypreos
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Nicholas Lembo
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - David Kandzari
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Santiago Garcia
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Craig A Thompson
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Subhash Banerjee
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Emmanouil S Brilakis
- From the VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., B.V.R., G.E.C., S.B., E.S.B.); Torrance Memorial Medical Center, Torrance, CA (R.M.W.); Henry Ford Hospital, Detroit, MI (K.A.); Columbia University, New York, NY (D.K.); University of Washington, Seattle, WA (W.L.); Mid America Heart Institute, Kansas City, MO (J.A.G.); Massachusetts General Hospital, Boston, MA (R.W.Y., F.A.J.); College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); Texas Tech University Health Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX (M.A.K.); Piedmont Heart Institute, Atlanta, GA (N.L., D.K.); Minneapolis VA Medical Center, Minneapolis, MN (S.G.); and Boston Scientific, Natick, MA (C.A.T.).
| |
Collapse
|
39
|
Brilakis ES, Vo MN. How to develop a successful chronic total occlusion percutaneous coronary intervention program. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:3-4. [PMID: 26831900 DOI: 10.1016/j.carrev.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Minh N Vo
- University of Manitoba, Section of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba
| |
Collapse
|
40
|
Karmpaliotis D, Green P. Chronic total occlusion percutaneous coronary intervention in 2014 beyond the J-CTO score (Japanese Multicenter CTO Registry): chance favors the prepared mind. JACC Cardiovasc Interv 2016; 8:268-270. [PMID: 25700749 DOI: 10.1016/j.jcin.2014.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 08/28/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Dimitrios Karmpaliotis
- Center for Interventional Vascular Therapy, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
| | - Philip Green
- Center for Interventional Vascular Therapy, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| |
Collapse
|
41
|
Brilakis ES, Banerjee S, Karmpaliotis D, Lombardi WL, Tsai TT, Shunk KA, Kennedy KF, Spertus JA, Holmes DR, Grantham JA. Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv 2016; 8:245-253. [PMID: 25700746 DOI: 10.1016/j.jcin.2014.08.014] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to describe contemporary frequency, predictors, and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in the United States. BACKGROUND CTO PCI can provide significant clinical benefits, yet there is limited information on its success and safety in unselected patient populations. METHODS We analyzed the frequency and outcomes of CTO PCI compared with non-CTO PCI in elective patients, and of successful versus failed CTO PCI between July 1, 2009, and March 31, 2013, in the National Cardiovascular Data Registry CathPCI Registry. Generalized estimating equations logistic regression modeling was used to generate independent variables associated with procedural success and procedural complications. RESULTS During the study period, CTO PCI represented 3.8% of the total PCI volume for stable coronary artery disease (22,365 of 594,510). Overall, patients undergoing CTO PCI required greater contrast volume and longer fluoroscopy time and had lower procedural success (59% vs. 96%, p < 0.001) and higher major adverse cardiac event (1.6% vs. 0.8%, p < 0.001) rates than non-CTO PCI patients. On multivariable analysis, several parameters (including older age, current smoking, previous myocardial infarction, previous coronary artery bypass graft, previous peripheral arterial disease, previous cardiac arrest, right coronary artery CTO target vessel, and less operator experience) were associated with a lower likelihood of CTO PCI procedural success, whereas operators' annual CTO PCI volume was associated with improved success without a significant increase in major complications. CONCLUSIONS CTO PCI is currently performed infrequently in the United States for stable coronary artery disease and is associated with lower procedural success and higher complication rates compared with non-CTO PCI. Procedural success was associated with several patient factors and operator experience.
Collapse
Affiliation(s)
- Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
| | - Subhash Banerjee
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | | | | | - Thomas T Tsai
- Institute for Health Research, Kaiser Permanente Colorado, and University of Colorado Denver, Denver, Colorado
| | - Kendrick A Shunk
- University of California San Francisco and VA Medical Center, San Francisco, California
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | | | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| |
Collapse
|
42
|
Myths to Debunk to Improve Management, Referral, and Outcomes in Patients With Chronic Total Occlusion of an Epicardial Coronary Artery. Am J Cardiol 2015; 116:1774-80. [PMID: 26434510 DOI: 10.1016/j.amjcard.2015.08.050] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/25/2015] [Accepted: 08/25/2015] [Indexed: 02/05/2023]
Abstract
A chronic total occlusion (CTO) is defined as an occlusive (100% stenosis) coronary lesion with anterograde Thrombolysis In Myocardial Infarction 0 flow for at least 3 months. CTOs are common in patients referred for coronary angiography (up to 33%) and are associated with angina, impaired quality of life, and reduced survival. Unfortunately, CTO percutaneous coronary intervention continues to be underperformed worldwide (10% to 15% at most institutions, ∼30% where expert operators are available). The aim of this study was to address common fallacies pertaining to CTOs among cardiologists by providing a concise review of pertinent previously published reports along with an update on safety and efficacy of state-of-the-art CTO percutaneous coronary intervention techniques.
Collapse
|
43
|
Vo MN, Karmpaliotis D, Brilakis ES. “Move the cap” technique for ambiguous or impenetrable proximal cap of coronary total occlusion. Catheter Cardiovasc Interv 2015; 87:742-8. [DOI: 10.1002/ccd.26079] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/06/2015] [Accepted: 05/23/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Minh N. Vo
- Section of Cardiology; University of Manitoba, St. Boniface Hospital; Winnipeg Manitoba Canada
| | - Dimitri Karmpaliotis
- Division of Cardiology, Department of Medicine, Columbia University Medical Center; New York New York
| | - Emmanouil S. Brilakis
- Division of Cardiology, Department of Medicine, VA North Texas Healthcare System and University of Texas Southwestern Medical Center; Dallas Texas
| |
Collapse
|
44
|
Werner GS, Hecht H, Stone GW. Utility of CT Angiography to Guide Coronary Intervention of CTO. JACC Cardiovasc Imaging 2015; 8:814-6. [DOI: 10.1016/j.jcmg.2015.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/10/2015] [Accepted: 04/16/2015] [Indexed: 12/01/2022]
|
45
|
Christopoulos G, Karmpaliotis D, Alaswad K, Yeh RW, Jaffer FA, Wyman RM, Lombardi WL, Menon RV, Grantham JA, Kandzari DE, Lembo N, Moses JW, Kirtane AJ, Parikh M, Green P, Finn M, Garcia S, Doing A, Patel M, Bahadorani J, Tarar MNJ, Christakopoulos GE, Thompson CA, Banerjee S, Brilakis ES. Application and outcomes of a hybrid approach to chronic total occlusion percutaneous coronary intervention in a contemporary multicenter US registry. Int J Cardiol 2015; 198:222-8. [PMID: 26189193 DOI: 10.1016/j.ijcard.2015.06.093] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND A hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) prioritizing and combining all available crossing techniques was developed to optimize procedural efficacy, efficiency, and safety, but there is limited published data on its outcomes. METHODS We examined the procedural techniques and outcomes of 1036 consecutive CTO PCIs performed using a hybrid approach between 2012 and 2015 at 11 US centers. RESULTS Mean age was 65 ± 10 years and 86% of the patients were men, with a high prevalence of diabetes mellitus (43%) and prior coronary artery bypass graft surgery (34%). Most target CTOs were located in the right coronary artery (59%), followed by the left anterior descending artery (23%) and the circumflex (19%). Dual injection was used in 71%. Technical success was achieved in 91% and a major procedural complication occurred in 1.7% of cases. The final successful crossing technique was antegrade wire escalation in 46%, antegrade dissection/re-entry in 26%, and retrograde in 28%. The initial crossing strategy was successful in 58% of the lesions, whereas 39% required an additional approach. Overall, antegrade wire escalation was used in 71%, antegrade dissection/re-entry in 36%, and the retrograde approach in 42% of procedures. Median contrast volume, fluoroscopy time, and air kerma radiation dose were 260 (200-360) ml, 44 (27-72) min, and 3.4 (2.0-5.4) Gray, respectively. CONCLUSION Application of a hybrid approach to CTO crossing resulted in high success and low complication rates across a varied group of operators and hospital practice structures, supporting its expanding use in CTO PCI.
Collapse
Affiliation(s)
- Georgios Christopoulos
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | | | | | - Robert W Yeh
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Farouc A Jaffer
- Torrance Memorial Medical Center, Torrance, CA, United States
| | - R Michael Wyman
- Torrance Memorial Medical Center, Torrance, CA, United States
| | | | - Rohan V Menon
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | | | | | | | | | | | | | - Philip Green
- Columbia University, New York, NY, United States
| | - Matthew Finn
- Columbia University, New York, NY, United States
| | - Santiago Garcia
- Minneapolis VA Healthcare System, Minneapolis, MN, United States; University of Minnesota, Minneapolis, MN, United States
| | - Anthony Doing
- Medical Center of the Rockies, Loveland, CO, United States
| | - Mitul Patel
- VA San Diego Healthcare System, San Diego, CA, United States; University of California San Diego, San Diego, CA, United States
| | - John Bahadorani
- VA San Diego Healthcare System, San Diego, CA, United States; University of California San Diego, San Diego, CA, United States
| | - Muhammad Nauman J Tarar
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | | | | | - Subhash Banerjee
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States
| | - Emmanouil S Brilakis
- VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, United States.
| |
Collapse
|
46
|
Complete Versus Incomplete Coronary Revascularization of Patients With Multivessel Coronary Artery Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:366. [DOI: 10.1007/s11936-015-0366-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
47
|
Touma G, Ramsay D, Weaver J. Chronic total occlusions - Current techniques and future directions. IJC HEART & VASCULATURE 2015; 7:28-39. [PMID: 28785642 PMCID: PMC5497190 DOI: 10.1016/j.ijcha.2015.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/28/2014] [Accepted: 02/01/2015] [Indexed: 11/24/2022]
Abstract
Chronic total occlusions (CTOs) of coronary arteries represent a common and significant challenge to interventional cardiology. Medical therapy is often regarded as an adequate long term strategy in the management of these lesions with surgical intervention for refractory symptoms. Extensive collateralisation is used as a marker of distal coronary perfusion, further reinforcing non-invasive strategies. This together with relatively low percutaneous success rates outside of specialised centres has meant that rates of percutaneous intervention have remained low. Increasing evidence suggests that CTOs are not a benign entity. Further, symptom control and quality of life improve significantly with successful percutaneous revascularisation. Both factors have reignited interest in percutaneous modalities. The Japanese have been pioneers in the field of CTO intervention although their success rates have been difficult to replicate. New techniques and equipment developed in North America offer an alternative to the Japanese approach. These techniques focus on time, radiation and contrast minimisation. This review will assess the histopathology of CTO and shifting paradigms in CTO treatment strategies. Chronic total occlusions are common and prognostically important. Strategies for chronic occlusions are pioneered by Japanese, adapted by North American operators. Japanese and North American strategies appear divergent, both add considerable expertise.
Collapse
Affiliation(s)
- George Touma
- Department of Cardiology, The St George Hospital, Kogarah, Sydney, Australia
| | - David Ramsay
- Department of Cardiology, The St George Hospital, Kogarah, Sydney, Australia
| | - James Weaver
- Department of Cardiology, The St George Hospital, Kogarah, Sydney, Australia
| |
Collapse
|
48
|
Carlino M, Magri CJ, Uretsky BF, Brilakis ES, Walsh S, Spratt JC, Hanratty C, Grantham JA, Rinfret S, Thompson CA, Lombardi WL, Galassi AR, Sianos G, Latib A, Garbo R, Karmpaliotis D, Kandzari DE, Colombo A. Treatment of the chronic total occlusion: A call to action for the interventional community. Catheter Cardiovasc Interv 2014; 85:771-8. [DOI: 10.1002/ccd.25736] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 11/07/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Barry F. Uretsky
- University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Emmanouil S. Brilakis
- VA North Texas Health Care System, and University of Texas Southwestern Medical Center; Dallas Texas
| | - Simon Walsh
- Department of Cardiology; Belfast Health and Social Care Trust; Belfast United Kingdom
| | | | - Colm Hanratty
- Department of Cardiology; Belfast Health and Social Care Trust; Belfast United Kingdom
| | | | - Stéphane Rinfret
- Quebec Heart and Lung Institute, Laval University; Quebec City Canada
| | | | | | - Alfredo R. Galassi
- Department of Medical Sciences and Pediatrics; Clinical Division of Cardiology, Cannizzaro Hospital, University of Catania; Italy
| | - George Sianos
- Department of Cardiology; AHEPA University Hospital; Thessaloniki Greece
| | - Azeem Latib
- San Raffaele Scientific Institute; Milan Italy
| | | | | | | | - Antonio Colombo
- San Raffaele Scientific Institute; Milan Italy
- EMO-GVM Centro Cuore Columbus; Milan Italy
| |
Collapse
|
49
|
Sapontis J, Grantham JA. Chronic total occlusion angioplasty: no more excuses. Interv Cardiol 2014. [DOI: 10.2217/ica.14.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
50
|
Application of the "hybrid approach" to chronic total occlusions in patients with previous coronary artery bypass graft surgery (from a Contemporary Multicenter US registry). Am J Cardiol 2014; 113:1990-4. [PMID: 24793678 DOI: 10.1016/j.amjcard.2014.03.039] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 11/23/2022]
Abstract
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been traditionally associated with lower success rates in patients with previous coronary artery bypass graft surgery (CABG). We sought to examine the success and complication rates of CTO PCI using the "hybrid" crossing algorithm among patients with a history of previous CABG. The procedural outcomes of 496 consecutive CTO PCIs performed at 5 high-volume PCI centers in the United States from January 2012 to August 2013 were assessed. The outcomes of patients with previous CABG were compared with those of patients without previous CABG. Compared with patients without previous CABG (n = 320), patients with previous CABG (n = 176, 35%) were older, had more coronary artery disease risk factors, and had less favorable baseline angiographic CTO characteristics. Technical and procedural success was slightly lower among patients with previous CABG (88.1% vs 93.4%, p = 0.044 and 87.5 vs 92.5%, p = 0.07, respectively). Patients with previous CABG more commonly underwent CTO PCI using the retrograde approach (39% vs 24%, respectively, p <0.001) and received higher air kerma radiation exposure (4.8 [interquartile range 3.0 to 6.4] vs 3.1 [1.9 to 5.3] Gray, p <0.001) and fluoroscopy time (59 [38 to 77] vs 34 [21 to 55] minutes, p <0.001). Major procedural complications were similar in the 2 groups: 2 of 176 (1.1%) patients with previous CABG versus 7 of 320 (2.1%) patients without previous CABG (p = 0.40). In conclusion, with application of the "hybrid" approach to CTO PCI, success was slightly lower, and complication rates were similar between patients with and without previous CABG.
Collapse
|