1
|
Blessing RRL, Ahoopai M, Geyer M, Brandt M, Zeiher AM, Vasa-Nicotera M, Münzel T, Wenzel P, Gori T, Dimitriadis Z. Percutaneous coronary intervention for chronic total occlusion in octogenarians: a propensity score study. Sci Rep 2022; 12:3073. [PMID: 35197506 PMCID: PMC8866394 DOI: 10.1038/s41598-022-06994-y] [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: 08/24/2021] [Accepted: 02/09/2022] [Indexed: 11/09/2022] Open
Abstract
Feasibility and efficacy of complex percutaneous coronary intervention (PCI) in the elderly, a more frail population due to more comorbidities is incompletely understood. We therefore set out to compare success and complication rate of PCI for chronic total occlusion (CTO) in octogenarians, in comparison to non-octogenarians. Data from 267 patients (58 patients over 80 years of age and 209 under 80 years of age) who had undergone CTO PCI were analyzed. To compare the results we calculated the propensity score and used inverse probability of treatment weighting. We evaluated demographic, clinical, angiographic, and periprocedural information. The median age of the total collective was 68 (31–90) years (octogenarian collective 82 (80–90) years vs non-octogenarians 65 (31–79) years). We observed a high success rate in both collectives (82.8% vs 90.4%, p = 0.10) and no difference in periprocedural complications or complications in the follow-up period. In our collective restenosis rate at follow-up was comparable to the propensity sore weighted population (11.3% vs 16.3%, p = 0.9). Our results show that CTO PCI in older patients is safe and feasible with comparable in-hospital and follow-up complication rates compared to a younger patient population.
Collapse
Affiliation(s)
- Recha R L Blessing
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany.
| | - Majid Ahoopai
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany
| | - Martin Geyer
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany
| | - Moritz Brandt
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, Mainz, Germany
| | - Andreas M Zeiher
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Philip Wenzel
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Zisis Dimitriadis
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| |
Collapse
|
2
|
Yang T, Fu X, Fu P, Chen J, Xu C, Liu X, Niu T. The value of fragmented QRS in predicting the prognosis of chronic total occlusion patients with myocardial infarction history undergoing percutaneous coronary intervention: A 24-months follow-up study. Clin Cardiol 2021; 44:537-546. [PMID: 33590897 PMCID: PMC8027581 DOI: 10.1002/clc.23573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fragmented QRS (fQRS) is a marker of local myocardial scar. This study aimed to analyze the relationship between fQRS and coronary collateral circulation (CCC) and evaluate the predictive value of fQRS for long-term clinical outcomes among patients with chronic total occlusion (CTO) and prior myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI). METHODS A total of 862 patients with a definite history of MI who had one CTO coronary artery and underwent PCI between 2013 and 2018 were continuously analyzed. Patients were divided into group A (no Q wave and fQRS, n = 206), group B (fQRS, n = 265), group C (Q wave, n = 391). All patients were followed up for 2 years. RESULTS The incidence rate of major adverse cardiovascular events (MACE) in group B was significantly lower than in group C (group B vs. C: 7.2% vs. 11.3%, P = 0.043). The percentage of good CCC was 94.2%, 88.3%, and 82.9% in group A, B, and C (p < .001), respectively. The improvement of cardiac function in group B and A were more significant than in group C. Multivariate Cox regression analysis showed fQRS was an independent protective factor of MACE after PCI within 2 years in CTO patients with prior MI (RR = 0.668, 95% CI [0.422-0.917], p = .001). CONCLUSION fQRS is an independent protective factor of prognosis in patients with prior MI and one CTO vessel who underwent PCI, presenting with a higher rate of good CCC, less occurrence of MACE, and better heart function than in Q wave patients.
Collapse
Affiliation(s)
- Tiangui Yang
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Xi Fu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Peng Fu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Jie Chen
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Changlu Xu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Xiaoxia Liu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Tiesheng Niu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| |
Collapse
|
3
|
Vemmou E, Alaswad K, Patel M, Mahmud E, Choi JW, Jaffer FA, Doing AH, Dattilo P, Karmpaliotis D, Krestyaninov O, Khelimskii D, Nikolakopoulos I, Karacsonyi J, Xenogiannis I, Garcia S, Burke MN, Abi Rafeh N, ElGuindy A, Goktekin O, Abdo A, Rangan BV, Abdullah S, Brilakis ES. Chronic total occlusion percutaneous coronary intervention in octogenarians and nonagenarians. J Am Geriatr Soc 2021; 69:1560-1569. [PMID: 33591578 DOI: 10.1111/jgs.17063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/08/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. METHODS We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. <80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. RESULTS There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p = 0.0201; 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p = 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE. CONCLUSION CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity.
Collapse
Affiliation(s)
- Evangelia Vemmou
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Mitul Patel
- VA San Diego Health Care System and University of California San Diego, La Jolla, California, USA
| | - Ehtisham Mahmud
- VA San Diego Health Care System and University of California San Diego, La Jolla, California, USA
| | - James W Choi
- Baylor Scott & White Heart and Vascular, Dallas, Texas, USA
| | | | - Anthony H Doing
- UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | - Phil Dattilo
- UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | | | - Oleg Krestyaninov
- Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Dmitrii Khelimskii
- Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | | | - Judit Karacsonyi
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | | | - Abir Abdo
- American University of Beirut Medical Center, Lebanon
| | - Bavana V Rangan
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Shuaib Abdullah
- VA North Texas Healthcare System and UT Southewestern Medical Center, Dallas, Texas, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| |
Collapse
|
4
|
Cui C, Sheng Z. Outcomes of percutaneous coronary intervention for chronic total occlusions in the elderly: A systematic review and meta-analysis. Clin Cardiol 2020; 44:27-35. [PMID: 33332739 PMCID: PMC7803357 DOI: 10.1002/clc.23524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/27/2020] [Indexed: 01/16/2023] Open
Abstract
Objective This study aimed to compare outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in the elderly (≥75 years) versus nonelderly and assess the impact of successful CTO‐PCI in the elderly. Methods PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched up to October 1, 2020. Mortality rates and major adverse cardiac events (MACE) were compared between elderly and nonelderly patients and successful versus failed CTO‐PCI in the elderly. Results Eight studies were included. Meta‐analysis indicated no statistically significant difference in the risk of in‐hospital mortality (RR: 1.97 95% CI: 0.78, 4.96 I2 = 0% p = .15) but higher tendency of in‐hospital MACE (RR: 2.30 95% CI: 0.99, 5.35 I2 = 49% p = .05) in the elderly group. Risk of long‐term mortality (RR: 3.79 95% CI: 2.84, 5.04 I2 = 41% p < .00001) and long‐term MACE (RR: 1.53 95% CI: 1.14, 2.04 I2 = 80% p = .004) were significantly increased in the elderly versus nonelderly. Elderly patients had a significantly reduced odds of successful PCI as compared to nonelderly patients (OR: 0.63 95% CI: 0.54, 0.73 I2 = 1% p < .00001). Successful CTO‐PCI was associated with reduction in long‐term mortality (HR: 0.51 95% CI: 0.34, 0.77 I2 = 27% p = .001) and MACE (HR: 0.60 95% CI: 0.37, 0.97 I2 = 53% p = .04) as compared to failed PCI in elderly. Conclusions Elderly patients may have a tendency of higher in‐hospital MACE with significantly increased long‐term mortality and MACE after CTO‐PCI. The success of PCI is significantly lower in the elderly. In elderly patients with successful PCI, the risk of long‐term mortality and MACE is significantly reduced.
Collapse
Affiliation(s)
- Chenmin Cui
- Department of Nephrology, Huzhou Hospital of Traditional Chinese Medicine Affiliated Zhejiang University of Traditional Chinese Medicine, Huzhou, China
| | - Zhichao Sheng
- Department of Cardiovascular Medicine, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing, China
| |
Collapse
|
5
|
Guo L, Lv HC, Huang RC. Percutaneous Coronary Intervention in Elderly Patients with Coronary Chronic Total Occlusions: Current Evidence and Future Perspectives. Clin Interv Aging 2020; 15:771-781. [PMID: 32546995 PMCID: PMC7264026 DOI: 10.2147/cia.s252318] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022] Open
Abstract
The proportion of the elderly in the total population of the world is growing, and the number of elderly patients with coronary chronic total occlusions (CTO) is huge. The elderly patients often have more extensive coronary artery disease, more severe ischemic burden and higher risk of cardiovascular events, as compared to younger patients, and thereby they might greatly benefit from coronary revascularization, even though they may have higher risk of operative complications. Most interventional cardiologists are more likely to be reluctant to operate complex percutaneous coronary intervention (PCI) in elderly patients. The latest refinements in dedicated CTO-PCI equipment and techniques have led to high rates of success and low complications rates and have made the CTO-PCI procedures safe and effective among the elderly patients. However, up to now, there is no widely recognized consensus or guideline on treatment strategy of elderly CTO patients, and the prognosis in this population is unknown. In this review, we aim to provide an overview of the current evidence and future perspectives on PCI in elderly patients with CTOs.
Collapse
Affiliation(s)
- Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Hai-Chen Lv
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Rong-Chong Huang
- Department of Cardiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People’s Republic of China
| |
Collapse
|
6
|
Lateef N, Ahsan MJ, Fazeel HM, Haseeb A, Latif A, Kousa O, Mirza M, Holmberg M. Percutaneous coronary intervention for chronic total occlusion in patients aged <75 years versus ≥75 years: a systematic review. J Community Hosp Intern Med Perspect 2020; 10:25-31. [PMID: 32128055 PMCID: PMC7034474 DOI: 10.1080/20009666.2020.1719731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/02/2020] [Indexed: 02/04/2023] Open
Abstract
Objective: To examine the effect of age on procedural and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) lesions. Methods: Literature search was conducted across PubMed, Google Scholar and Web of science, databases till March 2019. Results: Seven studies including 7671 patients with an overall follow-up period of 1.5 to 5 years were included in our review. A total of 6299/1372 patients were included in non-elderly and elderly groups, respectively, with mean age and 67%/61% male patients. CTO-PCI was similarly successful in younger and older patients (82.8%, n = 5070 vs. 78.1%, n = 1010). The incidence of short-term outcomes was low across the studies and comparable between the two groups (all-cause mortality: 0.4% younger vs. 0.85% elderly, cerebrovascular accidents: 0.3% vs. 0.4%, major adverse cardiovascular events (MACE): 1.53% vs. 3.72% and major bleeding: 0.57% vs. 2.18%). Long-term outcomes including all-cause mortality (8.89% vs. 29.5%), cardiac mortality (3.72% vs. 15%) and MACE (24.9% vs. 40%) occurred with a higher incidence in elderly patients. When results were segregated according to the success of CTO-PCI, reduced clinical events were noted with successful revascularization in either age group. Conclusion: Compared with the younger age group, CTO-PCI in elderly patients is safe and feasible with a comparable incidence of short-term outcomes. In either population, the incidence of long-term outcomes including survival remains a concern but when successful, CTO-PCI may be associated with improvement in terms of multiple patient-important clinical end-points.
Collapse
Affiliation(s)
- Noman Lateef
- Internal Medicine, Creighton University, Omaha, Nebraska, USA
| | | | | | - Abdul Haseeb
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Azka Latif
- Internal Medicine, Creighton University, Omaha, Nebraska, USA
| | - Omar Kousa
- Internal Medicine, Creighton University, Omaha, Nebraska, USA
| | - Mohsin Mirza
- Internal Medicine, Creighton University, Omaha, Nebraska, USA
| | - Mark Holmberg
- Department of Cardiology, Creighton University, Omaha, Nebraska, USA
| |
Collapse
|
7
|
Guo L, Lv H, Zhong L, Wu J, Ding H, Xu J, Huang R. Comparison of long-term outcomes of medical therapy and successful recanalisation for coronary chronic total occlusions in elderly patients: a report of 1,294 patients. Cardiovasc Diagn Ther 2019; 9:586-595. [PMID: 32038948 DOI: 10.21037/cdt.2019.11.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Little is known about the long-term outcomes of medical therapy (MT) versus successful percutaneous coronary intervention (PCI) in elderly patients with coronary chronic total occlusions (CTOs). Methods There were 1,294 consecutive patients with 1,520 CTOs included (2007 to 2016) and were divided into the younger group (age <65 years; n=664, 51.3%) and the older group (age ≥65 years; n=630, 48.7%). In the older group, 630 patients were divided into MT group (n=421) and successful CTO-PCI group (n=209) according to the initial treatment strategy. In the younger group, they were divided into two groups: 379 patients in the MT group and 285 patients in the successful CTO-PCI group. We performed propensity score matching to minimize any selection bias. The primary end point was cardiac mortality. The secondary end point was major adverse cardiac event (MACE). Results After 3.6 (IQR, 2.1-5.0) years follow-up, no significant difference was observed between the MT and successful CTO-PCI groups in terms of cardiac mortality (MT vs. successful CTO-PCI: 9.3% vs. 5.0%, P=0.378) and MACE (28.3% vs. 15.1%, P=0.070) in the older group. After propensity score matching analysis (120 pairs), the risk of cardiac mortality (6.7% vs. 8.3%, P=0.624) was found to be comparable between the two groups. In the younger group, the occurrence of cardiac death (MT vs. successful CTO-PCI: 3.7% vs. 1.4%, P=0.072) was similar, whereas the MACE rate (27.7% vs. 17.9%, P=0.003) was significantly higher in MT group. After multivariate analysis, previous myocardial infarction (MI) [hazard ratio (HR) 1.70, 95% confidence interval (CI): 1.16-2.49, P=0.006], CTO in right coronary artery (HR 1.55, 95% CI: 1.07-2.25, P=0.020), multivessel disease (HR 2.02, 95% CI: 1.10-3.72, P=0.024) and calcification (HR 1.61, 95% CI: 1.07-2.42, P=0.023) were independent predictors of MACE in elderly. Conclusions In the treatment of elderly patients with CTOs, successful CTO-PCI compared with MT alone didn't reduce the risk of cardiac death or MACE.
Collapse
Affiliation(s)
- Lei Guo
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Haichen Lv
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Lei Zhong
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Jian Wu
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Huaiyu Ding
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Jiaying Xu
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Rongchong Huang
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| |
Collapse
|
8
|
Valenti R, Migliorini A, De Gregorio MG, Martone R, Berteotti M, Bernardini A, Carrabba N, Vergara R, Marchionni N, Antoniucci D. Impact of complete percutaneous revascularization in elderly patients with chronic total occlusion. Catheter Cardiovasc Interv 2019; 95:145-153. [PMID: 31430034 DOI: 10.1002/ccd.28452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/10/2019] [Accepted: 08/01/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of the study was to assess the prognostic impact of successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and completeness of revascularization in the elderly. BACKGROUND Successful CTO-PCI is associated with clinical benefit. Notwithstanding elderly patients are currently underrepresented in CTO-PCI randomized controlled trials and registries. METHODS From the Florence CTO-PCI registry 1,405 patients underwent CTO-PCI between 2004 and 2015; out of these, 460 consecutive patients were ≥75 years. End point of the study was long-term cardiac survival. The prognostic impact of successful CTO-PCI and complete revascularization on survival was assessed by Kaplan-Meier estimation and by Cox multivariable regression analysis. RESULTS Patients were stratified according to success (72%) or failure of CTO-PCI. Completeness of revascularization was achieved in 57% of patients. Five-year cardiac survival was significantly higher in the successful CTO-PCI group (84 ± 3% vs. 72 ± 6%; p = .006) and it was further improved if complete coronary revascularization was achieved (90 ± 3% vs. 68 ± 5%; p < .001). At multivariable analysis, increasing age (hazard ratio [HR] 1.08; p = .001), diabetes (HR 1.55; p = .033), chronic kidney disease (HR 1.96, p = .002), left ventricular ejection fraction <0.40 (HR 2.10; p < .001), and completeness of revascularization (HR 0.58; p < .005) resulted independently associated with long-term cardiac survival. CONCLUSIONS In the elderly successful CTO-PCI is associated with a long-term survival benefit. The results of this study suggest that, even in the elderly, a CTO-PCI attempt should be considered to achieve complete coronary revascularization.
Collapse
Affiliation(s)
- Renato Valenti
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Angela Migliorini
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Maria Grazia De Gregorio
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Raffaele Martone
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Martina Berteotti
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Bernardini
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Nazario Carrabba
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Ruben Vergara
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Niccolò Marchionni
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - David Antoniucci
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| |
Collapse
|
9
|
Choo EH, Koh YS, Seo SM, Lee JM, Kim HY, Park HJ, Kim PJ, Chang K, Jeon DS, Kim DB, Her SH, Park CS, Yoo KD, Chung WS, Seung KB. Comparison of successful percutaneous coronary intervention versus optimal medical therapy in patients with coronary chronic total occlusion. J Cardiol 2019; 73:156-162. [DOI: 10.1016/j.jjcc.2018.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/16/2018] [Accepted: 08/28/2018] [Indexed: 01/04/2023]
|
10
|
Impact of Coronary Artery Chronic Total Occlusion on Arrhythmic and Mortality Outcomes: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol 2018; 4:1214-1223. [PMID: 30236396 DOI: 10.1016/j.jacep.2018.06.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/03/2018] [Accepted: 06/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to examine the relationship between chronic coronary artery total occlusion (CTO) status and the occurrence of ventricular tachycardia (VT)/ventricular fibrillation (VF) or appropriate implantable cardioverter-defibrillator (ICD) therapy. BACKGROUND CTO is a significant problem in patients with ischemic heart disease. However, the extent to which it predisposes affected individuals to VT/VF and whether these arrhythmic events could be prevented by revascularization are unclear. Therefore, a systematic review and meta-analysis were conducted to examine the relationship between CTO status and the occurrence of VT/VF or appropriate ICD therapy. METHODS PubMed and Embase databases were searched until November 16, 2017, identifying 137 studies. RESULTS Seventeen studies involving 54,594 subjects (mean age, 61 ± 21 years of age, 81% male) with a mean follow-up of 43 ± 31 months were included. The presence of CTO was associated with higher risk of VT/VF or appropriate ICD therapy (adjusted hazard ratio [aHR]: 1.99; 95% confidence interval (CI): 1.53 to 2.59; p < 0.0001, I2 = 3%) but not in cardiac mortality (aHR: 2.59; 95% CI: 0.64 to 10.59; p = 0.18, I2 = 86%) or in all-cause mortality (aHR: 1.70; 95% CI: 0.84 to 3.46; p = 0.14; I2 = 64%). Compared to patients with non-infarct-related CTOs, those with infarct-related CTOs have a higher risk of VT/VF or appropriate ICD therapy (aHR: 2.47; 95% CI: 1.76 to 3.46; p < 0.0001; I2 = 14%), cardiac mortality (aHR: 2.73; 95% CI: 1.02 to 7.30; p < 0.05; I2 = 79%) and higher all-cause mortality (aHR: 1.69; 95% CI: 1.19 to 2.40; p < 0.01; I2 = 40%). Nonrevascularization of CTOs tended to be associated with an increased risk of all-cause mortality compared to successful revascularization (unadjusted HR: 1.52; 95% CI: 0.96 to 2.43; p = 0.08; I2 = 76). CONCLUSIONS CTOs, especially infarct-related, are associated with high risk of VT/VF or appropriate ICD therapy and mortality. ICD implantation could be beneficial. However, it is not clear that revascularization has an impact on the outcome of patients with CTOs.
Collapse
|
11
|
Mitomo S, Demir OM, Colombo A, Nakamura S, Chieffo A. What the surgeon needs to know about percutaneous coronary intervention treatment of chronic total occlusions. Ann Cardiothorac Surg 2018; 7:533-545. [PMID: 30094219 DOI: 10.21037/acs.2018.06.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chronic total occlusion (CTO) accounts for 10-20% of lesions identified in coronary artery disease (CAD) patients. CTO percutaneous coronary intervention (PCI) is one of the most challenging of lesion subsets due to its technical difficulty, requiring specific operator expertise and equipment. There has been increased interest on CTO PCI evolving with the development of novel techniques and dedicated devices. Furthermore, in order to effectively and systematically utilize these techniques and devices, CTO PCI algorithms have been established. All of these developments have resulted in procedural success rates increasing to approximately 90%. In this review, we outline the evidence base for CTO PCI, conventional and contemporary CTO PCI techniques, CTO algorithms and outline integrated management strategies between cardiac surgeons and interventional cardiologists.
Collapse
Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Ozan M Demir
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
12
|
Abstract
Chronic total occlusions (CTOs) are routinely encountered during coronary angiography, but subsequent revascularization rates are low. This has likely been driven by a historical belief that there is minimal clinical benefit and poor success rates with a percutaneous coronary intervention (PCI). However, in the current era, with the development of new techniques and tools, experienced operators can perform CTO-PCI successfully in the majority of patients. The current indications and benefit of CTO-PCI remain a topic of controversy and debate. There is a growing body of predominantly nonrandomized studies reporting both short-term and long-term outcomes of CTO-PCI. Recent and upcoming randomized-controlled trials in this area will also potentially expand indications in both stable and patients with acute coronary syndrome. In this review, we will discuss the current evidence for CTO-PCI and also future directions in this field.
Collapse
|
13
|
Toma A, Gebhard C, Gick M, Ademaj F, Stähli BE, Mashayekhi K, Ferenc M, Neumann FJ, Buettner HJ. Survival after percutaneous coronary intervention for chronic total occlusion in elderly patients. EUROINTERVENTION 2017; 13:e228-e235. [PMID: 27867143 DOI: 10.4244/eij-d-16-00499] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Few data are available on outcomes of percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) in very elderly patients in the drug-eluting stent (DES) era. We aimed to investigate long-term survival in a single-centre cohort of elderly patients following CTO PCI using DES. METHODS AND RESULTS A total of 2,002 consecutive patients who underwent PCI of a CTO at our centre between January 2005 and December 2013 were followed for a median of 2.6 years (interquartile range 1.1-3.1 years). Four hundred and nine (409) patients were older than 75 years. The absolute reduction in all-cause mortality by successful CTO PCI was numerically greater in elderly patients as compared to younger patients (22.1% vs. 7.2% at three years). In multivariate models, successful CTO PCI was significantly associated with improved survival in both elderly (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI]: 0.39 to 0.87; p=0.009) and younger patients (adjusted HR 0.59, 95% CI: 0.40 to 0.86; p=0.006). CONCLUSIONS In the DES era, elderly patients (≥75 years) derive a similar survival benefit from successful CTO PCI to younger patients. These findings suggest that CTO PCI, when indicated, should not be withheld from the elderly.
Collapse
Affiliation(s)
- Aurel Toma
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Wolff R, Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Sparkes JD, Wright GA, Wijeysundera HC, Strauss BH. Gender differences in the prevalence and treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv 2015; 87:1063-70. [DOI: 10.1002/ccd.26330] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 10/24/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Rafael Wolff
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
| | - Paul Fefer
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
- Department of Cardiology; Sheba Medical Center, Tel Aviv University; Tel Aviv Israel
| | - Merril L. Knudtson
- Division of Cardiology; Libin Cardiovascular Institute of Alberta; Calgary Alberta Canada
| | - Asim N. Cheema
- Division of Cardiology; St. Michael's Hospital; Toronto Ontario Canada
- Department of Medicine; University of Toronto, Division of Cardiology; Toronto Ontario Canada
| | - P. Diane Galbraith
- Division of Cardiology; Libin Cardiovascular Institute of Alberta; Calgary Alberta Canada
| | - John D. Sparkes
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
| | - Graham A. Wright
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
| | - Harindra C. Wijeysundera
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
- Department of Medicine; University of Toronto, Division of Cardiology; Toronto Ontario Canada
- Management and Evaluation (IHPME); University of Toronto, Institute of Health Policy; Toronto, Ontario Canada
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | - Bradley H. Strauss
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
- Department of Medicine; University of Toronto, Division of Cardiology; Toronto Ontario Canada
| |
Collapse
|
15
|
Lee SH, Yang JH, Choi SH, Song YB, Hahn JY, Choi JH, Kim WS, Lee YT, Gwon HC. Long-Term Clinical Outcomes of Medical Therapy for Coronary Chronic Total Occlusions in Elderly Patients (≥75 Years). Circ J 2015; 79:1780-6. [DOI: 10.1253/circj.cj-15-0041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Seung Hwa Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| |
Collapse
|