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Qafoud F, Kunji K, Elshrif M, Althani A, Salam A, Al Suwaidi J, Darbar D, Asaad N, Saad M. Correlations between Resting Electrocardiogram Findings and Disease Profiles: Insights from the Qatar Biobank Cohort. J Clin Med 2024; 13:276. [PMID: 38202283 PMCID: PMC10779868 DOI: 10.3390/jcm13010276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Resting electrocardiogram (ECG) is a valuable non-invasive diagnostic tool used in clinical medicine to assess the electrical activity of the heart while the patient is resting. Abnormalities in ECG may be associated with clinical biomarkers and can predict early stages of diseases. In this study, we evaluated the association between ECG traits, clinical biomarkers, and diseases and developed risk scores to predict the risk of developing coronary artery disease (CAD) in the Qatar Biobank. METHODS This study used 12-lead ECG data from 13,827 participants. The ECG traits used for association analysis were RR, PR, QRS, QTc, PW, and JT. Association analysis using regression models was conducted between ECG variables and serum electrolytes, sugars, lipids, blood pressure (BP), blood and inflammatory biomarkers, and diseases (e.g., type 2 diabetes, CAD, and stroke). ECG-based and clinical risk scores were developed, and their performance was assessed to predict CAD. Classical regression and machine-learning models were used for risk score development. RESULTS Significant associations were observed with ECG traits. RR showed the largest number of associations: e.g., positive associations with bicarbonate, chloride, HDL-C, and monocytes, and negative associations with glucose, insulin, neutrophil, calcium, and risk of T2D. QRS was positively associated with phosphorus, bicarbonate, and risk of CAD. Elevated QTc was observed in CAD patients, whereas decreased QTc was correlated with decreased levels of calcium and potassium. Risk scores developed using regression models were outperformed by machine-learning models. The area under the receiver operating curve reached 0.84 using a machine-learning model that contains ECG traits, sugars, lipids, serum electrolytes, and cardiovascular disease risk factors. The odds ratio for the top decile of CAD risk score compared to the remaining deciles was 13.99. CONCLUSIONS ECG abnormalities were associated with serum electrolytes, sugars, lipids, and blood and inflammatory biomarkers. These abnormalities were also observed in T2D and CAD patients. Risk scores showed great predictive performance in predicting CAD.
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Affiliation(s)
- Fatima Qafoud
- College of Health Sciences, Qatar University, Doha P.O. Box 2713, Qatar; (F.Q.); (A.A.)
| | - Khalid Kunji
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha P.O. Box 5825, Qatar; (K.K.); (M.E.)
| | - Mohamed Elshrif
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha P.O. Box 5825, Qatar; (K.K.); (M.E.)
| | - Asma Althani
- College of Health Sciences, Qatar University, Doha P.O. Box 2713, Qatar; (F.Q.); (A.A.)
| | - Amar Salam
- Department of Cardiology, Al-Khor Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Jassim Al Suwaidi
- Heart Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Dawood Darbar
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Nidal Asaad
- Heart Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Mohamad Saad
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha P.O. Box 5825, Qatar; (K.K.); (M.E.)
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Shokry KAA, Farag ESM, Salem AM, Ibrahim IM, Abel-Aziz M, El Zayat A. Original Article--Value of Pathological Q Waves and Angiographic Collateral Grade in Patients Undergoing Coronary Chronic Total Occlusion Recanalization: Cardiac Magnetic Resonance Study. J Saudi Heart Assoc 2021; 33:41-50. [PMID: 33880327 PMCID: PMC8051329 DOI: 10.37616/2212-5043.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background/aim Successful coronary chronic total occlusion (CTO) revascularization was found by many studies to be associated with improved left ventricular (LV) systolic function and survival if evidence of viability is present. Little is known about the association of CTO revascularization in patients with electrocardiographic Q waves and improvement in angina burden as a measurement of health-related quality of life (HRQOL) afterwards. Methods In this study, 100 patients with single vessel CTO were included. Myocardial viability was tested by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and 50 patients showed evidence of viability. Seattle Angina Questionnaire (SAQ) scores were used as a measure of HRQOL. Results Pathological Q waves were present in 48 patients (including 19 patients with viable CTO territory) out of 100 patients. Patients with Q waves tended to have worse Seattle Angina Questionnaire (SAQ) scores compared to those with no Q waves (31.2 ± 11.7 vs 45.3 ± 13.9 respectively, p = 0.002), worse LV systolic function and wall motion score index (WMSI) on CMR. They also had significantly less prevalence of viability (p < 0.001). Patients with Q waves and positive viability had lower SAQ scores (37.2 ± 10.1 vs 52.7 ± 13.2 respectively, p = 0.02), higher LVEF and lower WMSI. They also had well developed collateral grade (2.1 ± 1.03 vs 0.7 ± 0.82 respectively, p < 0.001). After successful percutaneous coronary intervention (PCI), in the viable LV group, presence of Q waves was not associated with better LV functional recovery, while those with higher collateral grades were more likely to have better LV functional recovery post CTO-PCI. Patients with Q waves and viable CTO territory showed significantly better SAQ scores compared to pre-PCI (87.3 ± 12.2 vs 37.2 ± 10.1 respectively, p < 0.001). For angina frequency, post–PCI score was 80.2 ± 7.9 compared to 39.2 ± 7.1 before PCI, p < 0.001). Multivariate regression analysis showed that pathological Q waves, Rentrop's collateral grade and the Canadian Cardiovascular Society (CCS) angina class before PCI were the most significant independent predictors of improved HRQOL as reflected by SAQ (OR for Q waves 7.83, 95% CI 1.62–18.91,p 0.003), (OR for Rentrop's collateral grade 8.31,95% CI 2.21–26.33, p < 0.001), (OR for CCS class 8.39, 95% CI 1.21–20.8, p 0.01). Conclusion Well-developed collateral circulation could independently predict LV functional recovery after CTO-PCI. Patients with Q waves and viable CTO territory tend to have higher CCS class before revascularization and get significant improvement of HRQOL after PCI. Other predictors of improved HRQOL are Rentrop's collateral grade and worse CCS class before PCI.
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Affiliation(s)
| | | | - Ahmed Mohamed Salem
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Ahmed El Zayat
- Department of Cardiology, Zagazig University, Zagazig, Egypt
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Hu Y, Jiang S, Lu S, Xu R, Huang Y, Zhao Z, Qu Y. Echocardiography and Electrocardiography Variables Correlate With the New York Heart Association classification: An Observational Study of Ischemic Cardiomyopathy Patients. Medicine (Baltimore) 2017; 96:e7071. [PMID: 28658100 PMCID: PMC5500022 DOI: 10.1097/md.0000000000007071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of our study was to determine whether combinations of ultrasound echocardiography (UCG) and electrocardiography (EKG) parameters correlated with the functional status of ischemic cardiomyopathy (ICM) patients according to the New York Heart Association (NYHA) classification system.We assessed 536 elderly Chinese ICM patients according to the NYHA criteria, which included 196 patients with type 2 diabetes mellitus (T2DM). All of the patients underwent UCG. Transmural dispersion of ventricular repolarization was examined using EKG. Cumulative odds logistic regression was performed to evaluate associations between NYHA class and the demographic, clinical, UCG, and EKG variables based on the odds ratio (OR) and 95% confidence interval (CI). A Pearson analysis was also performed to examine correlations between the NYHA classification and the UCG and EKG variables.Based on the NYHA assessment, 140, 147, 138, and 111 patients were identified as class I, II, III and IV, respectively. A comparison of UCG and EKG variables based on T2DM status showed that CO and Tp-e differed significantly between all NYHA classes (P < .05 for all), with values of each increasing with increasing NYHA class regardless of T2DM status. Multivariate logistic regression analysis showed that the disease course (OR: 1.30; 95% CI: 1.20-1.40), heart rate (OR: 1.16; 95% CI: 1.12-1.21), T wave peak to endpoint (Tp-e; OR: 1.22; 95% CI: 1.18-1.27), dispersion of the QT interval (OR: 0.98; 95% CI: 0.95-1.22), left ventricular fractional shortening (OR: 0.82; 95% CI: 0.78-0.87), cardiac output (CO; OR: 5.58; 95% CI: 3.08-10.13) were significantly associated with the NYHA class (P < .0001 for all). A Pearson correlation analysis showed that Tp-e (r = 0.75982, P < .0001), CO (r = 0.56072, P < .0001), and stroke volume (r = -0.14839, P = .0006) significantly correlated with the NYHA class.An index consisting of Tp-e and CO will be useful for corroborating the results of the NYHA assessment of ICM patients.
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Affiliation(s)
- Ying Hu
- Department of Geriatrics, Xuhui District Central Hospital
| | - Shifeng Jiang
- Department of Geriatrics, Qingpu Branch of Zhongshan Hospital, Fudan University
| | - Siyuan Lu
- Department of Geriatrics, Xuhui District Central Hospital
| | - Rong Xu
- Department of Geriatrics, Xuhui District Central Hospital
| | - Yunping Huang
- Department of Geriatrics, Xuhui District Central Hospital
| | - Zongliang Zhao
- Geriatric Nursing Services, Xuhui District Tianlin Street Community Health Service Center General, Shanghai, China
| | - Yi Qu
- Department of Geriatrics, Xuhui District Central Hospital
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Scarsini R, Zivelonghi C, Pesarini G, Vassanelli C, Ribichini FL. Repeat revascularization: Percutaneous coronary intervention after coronary artery bypass graft surgery. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:272-8. [PMID: 27215852 DOI: 10.1016/j.carrev.2016.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/14/2016] [Accepted: 04/22/2016] [Indexed: 01/25/2023]
Abstract
Repeat myocardial revascularization procedures are markedly different from de novo interventions, with increased procedural risk and technical-demanding complexity. However the number of patients previously treated with coronary artery bypass graft (CABG) that need a repeat revascularization due to graft failure is increasing consistently. Late graft failure, usually caused by saphenous vein grafts (SVG) attrition, is certainly not uncommon. However PCI on degenerated SVG presents higher complication rate and worse clinical outcome compared with native arteries interventions. In acute graft failure setting, PCI represents a valuable option to treat postoperative myocardial infarction.
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Affiliation(s)
- Roberto Scarsini
- University of Verona, Department of Medicine, Section of Cardiology, Italy.
| | - Carlo Zivelonghi
- University of Verona, Department of Medicine, Section of Cardiology, Italy
| | - Gabriele Pesarini
- University of Verona, Department of Medicine, Section of Cardiology, Italy
| | - Corrado Vassanelli
- University of Verona, Department of Medicine, Section of Cardiology, Italy
| | - Flavio L Ribichini
- University of Verona, Department of Medicine, Section of Cardiology, Italy
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Sun H, He Y, Yang P. CTO, A Challenge Not Only for PCI, But Also for EP. J Cardiovasc Electrophysiol 2015. [PMID: 26222763 DOI: 10.1111/jce.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Huan Sun
- Cardiology Department, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuquan He
- Cardiology Department, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ping Yang
- Cardiology Department, China-Japan Union Hospital of Jilin University, Changchun, China
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Nassar Y, Boudou N, Carrie D. Radial approach and single wiring as first intentional strategies in chronic total occlusions of the left anterior descending coronary artery. J Saudi Heart Assoc 2013; 25:67-73. [PMID: 24174849 DOI: 10.1016/j.jsha.2013.02.003] [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] [Received: 11/30/2012] [Revised: 02/11/2013] [Accepted: 02/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the left anterior descending coronary artery (LAD) specifically is associated with improved long-term 5 years survival as compared to PCI failure. Simpler PCI techniques may be successful and safer than complex techniques which are perceived to have high failure rates and technical complexity. We aimed to describe the safety and effectiveness of first intentional single wiring and radial approach in the treatment of patients with a CTO of the native LAD coronary artery at Toulouse Rangueil university hospitals. PATIENTS AND METHODS The study was a single center prospective registry. All patients showed evidence of myocardial viability in LAD territory. The operators' initial strategy was to start by a radial access as a first choice whenever feasible; if not, a femoral access was chosen. The initial strategy for lesion crossing in either antegrade or retrograde approaches was single wiring by lesion crossing using one guidewire (GW) as a simple technique. RESULTS A total of 30 patients with 30 LAD CTO lesions (100%) were recorded. Mean age was 71.6 + 15 years, 77% were males and 23% were females. The access route was radial 66% of the time and femoral 54% of the time and with double access for contralateral injection in 40% of the patients. Sheaths and catheters sizes 6F were used in 53% of the patients, and 7F in 73% of the patients. Overall lesion success rate was 83% of lesions. Single wiring was the prevailing technique used in 97% of successful lesions (83% of total cases), while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% of our total study cases with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% of our cases with a GW success rate of 67%. Q-wave myocardial infarction (MI), stent thrombosis, stroke, emergency coronary artery bypass graft (CABG), major bleeding, radiation dermatitis, cardiac tamponade or clinical perforation requiring any hemostatic maneuvers did not occur. There was a post-procedural Troponin rise of 3x normal levels in 30% of patients, and contrast induced nephropathy in 7%. Intra-aortic balloon counterpulsation (IABCP) was used in 3% of patients and cardiac death occurred in 3% of patients. CONCLUSION Single wiring and radial access as initial strategies in PCI for LAD-CTO lesions in either approaches antegrade or retrograde are associated with a high procedural success rate and an acceptable incidences of adverse events.
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Abstract
Chronic total occlusion percutaneous coronary intervention (CTO PCI) procedural planning involves much thought and deliberation before one actually attempts to cross the CTO lesion in the cardiac catheterization laboratory. Careful preprocedural angiographic assessment is a key to successful CTO PCI. CTO PCI represents the most complex PCI one can perform, and thus operator and staff training as well as the concept of CTO days are all essential for a successful CTO PCI program.
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Affiliation(s)
- Nicholas J Lembo
- Piedmont Heart Institute, 275 Collier Road North West, Suite 300, Atlanta, GA 30309, USA.
| | - Dimitri Karmpaliotis
- Piedmont Heart Institute, 275 Collier Road North West, Suite 300, Atlanta, GA 30309, USA
| | - David E Kandzari
- Piedmont Heart Institute, 275 Collier Road North West, Suite 300, Atlanta, GA 30309, USA
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Nombela-Franco L, Mitroi CD, Fernández-Lozano I, García-Touchard A, Toquero J, Castro-Urda V, Fernández-Diaz JA, Perez-Pereira E, Beltrán-Correas P, Segovia J, Werner GS, Javier G, Luis AP. Ventricular Arrhythmias Among Implantable Cardioverter-Defibrillator Recipients for Primary Prevention. Circ Arrhythm Electrophysiol 2012; 5:147-54. [PMID: 22205684 DOI: 10.1161/circep.111.968008] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
An implantable cardioverter-defibrillator (ICD) is the therapy of choice for primary prevention in patients with ischemia who are at risk for sudden cardiac death (SCD). One third of patients with significant coronary disease have chronic total coronary occlusion (CTO), which is associated with long-term mortality in patients with previous myocardial infarction. However, the impact of CTO on the occurrence of ventricular arrhythmias and long-term mortality in ICD recipients remains unknown.
Methods and Results—
All consecutive patients with coronary artery disease receiving ICD therapy for the prevention of SCD were included in the study. Among other characteristics, the existence of CTO was assessed. During follow-up, the occurrence of appropriate device delivery because of ventricular arrhythmias as well as mortality were noted. A total of 162 patients (mean age, 62±9 years; 93% men) with an ICD were included and followed for a median of 26 months (interquartile range, 12–42). At least 1 CTO was present in 71 (44%) patients. Appropriate device therapy was detected in 18% of the patients during the follow-up. The presence of CTO was associated with higher ventricular arrhythmia and mortality rates (log-rank test, <0.01). Multivariable analysis revealed that CTO was independently associated with appropriate ICD intervention (hazard ratio, 3.5;
P
=0.003).
Conclusions—
In patients with ischemic heart disease receiving ICDs for primary prevention of SCD, CTO is an independent predictor for the occurrence of ventricular arrhythmias and has an adverse impact on long-term mortality.
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Affiliation(s)
- Luis Nombela-Franco
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Cristina D. Mitroi
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Ignacio Fernández-Lozano
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Arturo García-Touchard
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Jorge Toquero
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Victor Castro-Urda
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Jose A. Fernández-Diaz
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Elena Perez-Pereira
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Paula Beltrán-Correas
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Javier Segovia
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Gerald S. Werner
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Goicolea Javier
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Alonso-Pulpón Luis
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
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Werner GS. Outcomes following successful recanalization of chronic total coronary occlusions. Interv Cardiol 2011. [DOI: 10.2217/ica.11.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
The present article discusses the current status of treatment strategies for chronic total occlusion (CTO) and the prospects offered by new therapies. The indication for revascularisation recognized in the current European guidelines includes the presence of typical symptoms and evidence of ischemia of over 10% of the total myocardium, while in patients with multiple vascular diseases the aim is complete revascularisation. Although the vast majority of patients with CTO fulfil these criteria, they are currently not receiving interventional treatment as frequently as expected. The reasons often given for this include the low success rates and high recurrence rates. However, both problems have been improved by drug-eluting stents (DES) on the one hand and by wire techniques and strategies on the other, such that results almost comparable with non-occluded coronary lesions can be achieved. While more advanced approaches like retrograde recanalization should be restricted to specialized centres, marked improvements can be achieved even without these special techniques by means of consistent further training and the application of modern techniques. Despite the aggressiveness of these approaches to pass through an occluded artery, the complication rate is not higher than with non-occluded lesions when the specific complications of recanalization are avoided in a careful approach. Further technical improvements are expected with the use of modern imaging techniques such as intravascular ultrasound and high-resolution CT imaging of coronary arteries.
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Lexis CP, van der Horst IC, Rahel BM, Lexis MA, Kampinga MA, Gu YL, de Smet BJ, Zijlstra F. Impact of chronic total occlusions on markers of reperfusion, infarct size, and long-term mortality: A substudy from the TAPAS-trial. Catheter Cardiovasc Interv 2011; 77:484-91. [DOI: 10.1002/ccd.22664] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Leone AM, Giubilato S, De Caterina AR. Recanalization of a chronic total occlusion in ST-segment elevation myocardial infarction patients: why and when? Interv Cardiol 2010. [DOI: 10.2217/ica.10.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Park CS, Kim HY, Park HJ, Ihm SH, Kim DB, Lee JM, Kim PJ, Park CS, Moon KW, Yoo KD, Jeon DS, Chung WS, Seung KB, Kim JH. Clinical, electrocardiographic, and procedural characteristics of patients with coronary chronic total occlusions. Korean Circ J 2009; 39:111-5. [PMID: 19949597 PMCID: PMC2771804 DOI: 10.4070/kcj.2009.39.3.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 12/10/2008] [Accepted: 01/05/2009] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Percutaneous coronary intervention for chronic total occlusion lesions is technically difficult despite equipment advances. Changes in electrocardiographic patterns, such as Q and T waves, during chronic total occlusion can provide information about procedural success and myocardial viability. In this study, we investigated clinical, electrocardiographic, and procedural characteristics of chronic total occlusions. Subjects and Methods Patients (2,635) who underwent coronary angiography between January 2006 and July 2007 at six Catholic University Hospitals were identified using a dedicated Internet database. Results A total of 195 patients had total occlusion lesions (7.4%). Percutaneous coronary interventions were attempted in 136 total occlusion lesions (66.0%) in 134 patients. Successful recanalization with stent implantation was accomplished in 89 lesions, with a procedural success rate of 66.4%. One procedure-related death occurred because of no-reflow phenomenon. After excluding 8 patients with bundle branch block, Q and T wave inversions were observed in 60 (32.1%) and 78 patients (41.7%), respectively. The presence of Q waves was associated with severe angina, decreased left ventricular ejection fraction, regional wall motion abnormality, and T wave inversion, but was not related to procedural success. Conclusion Percutaneous coronary intervention is a safe and useful procedure for the revascularization of coronary chronic total occlusion lesions. The procedural success rate was not related to the presence of pathologic Q waves, which were associated with severe angina and decreased left ventricular function.
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Affiliation(s)
- Chan Seok Park
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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