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Liao R, Li Z, Wang Q, Lin H, Sun H. Revascularization of chronic total occlusion coronary artery and cardiac regeneration. Front Cardiovasc Med 2022; 9:940808. [PMID: 36093131 PMCID: PMC9455703 DOI: 10.3389/fcvm.2022.940808] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary chronic total occlusion (CTO) contributes to the progression of heart failure in patients with ischemic cardiomyopathy. Randomized controlled trials demonstrated that percutaneous coronary intervention (PCI) for CTO significantly improves angina symptoms and quality of life but fails to reduce clinical events compared with optimal medical therapy. Even so, intervening physicians strongly support CTO-PCI. Cardiac regeneration therapy after CTO-PCI should be a promising approach to improving the prognosis of ischemic cardiomyopathy. However, the relationship between CTO revascularization and cardiac regeneration has rarely been studied, and experimental studies on cardiac regeneration usually employ rodent models with permanent ligation of the coronary artery rather than reopening of the occlusive artery. Limited early-stage clinical trials demonstrated that cell therapy for cardiac regeneration in ischemic cardiomyopathy reduces scar size, reverses cardiac remodeling, and promotes angiogenesis. This review focuses on the status quo of CTO-PCI in ischemic cardiomyopathy and the clinical prospect of cardiac regeneration in this setting.
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Affiliation(s)
- Ruoxi Liao
- Department of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Zhihong Li
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiancheng Wang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hairuo Lin
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Hairuo Lin, ,
| | - Huijun Sun
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China
- Huijun Sun,
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2
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Lin S, Guan C, Wu F, Xie L, Zou T, Shi Y, Chen S, He L, Xu B, Zheng Z. Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion and Multivessel Disease. Circ Cardiovasc Interv 2022; 15:e011312. [PMID: 35167333 DOI: 10.1161/circinterventions.121.011312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) has been used increasingly as an alternative means of revascularization for patients with chronic total occlusion and multivessel disease. We investigated 5-year clinical outcomes following coronary artery bypass grafting (CABG) and PCI in patients with chronic total occlusion and multivessel disease. METHODS In this single-center, retrospective cohort study, 4324 consecutive patients with ≥1 chronic total occlusion and multivessel disease were treated with either CABG (n=2264) or PCI (n=2060) between 2010 and 2013. The primary outcome was 5-year composite of death, myocardial infarction, or stroke. An inverse-probability-of-treatment weighting method was used adjusting for both patient and lesion characteristics. RESULTS The unadjusted 5-year composite outcomes were similar between CABG group and PCI group (12.1% [258/2264] versus 11.4% [218/2060]; P=0.52). After adjustment for baseline variables, PCI was associated with significantly higher risk of composite outcomes (adjusted hazard ratio: 1.21 [95% CI, 1.02-1.44]; P=0.03). The inferiority of PCI in 5-year composite outcome was significant in patients with CABG recommendation according to SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score II (adjusted hazard ratio: 1.55 [95% CI, 1.14-2.09]; P=0.005) but not evident in patients with PCI or PCI/CABG equipoise recommendation according to SYNTAX score II (adjusted hazard ratio: 0.94 [95% CI, 0.75-1.17]; P=0.56). A similar risk of 5-year composite outcomes was observed between CABG and PCI with residual SYNTAX score ≤8. CONCLUSIONS In this single-center retrospective study among patients with chronic total occlusion and multivessel disease, PCI was associated with higher risk of 5-year composite death, myocardial infarction, or stroke.
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Affiliation(s)
- Shen Lin
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiovascular Surgery (S.L., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changdong Guan
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Catheterization Laboratories (C.G., F.W., L.X., T.Z., Y.S., B.X.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Wu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Catheterization Laboratories (C.G., F.W., L.X., T.Z., Y.S., B.X.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihua Xie
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Catheterization Laboratories (C.G., F.W., L.X., T.Z., Y.S., B.X.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tongqiang Zou
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Catheterization Laboratories (C.G., F.W., L.X., T.Z., Y.S., B.X.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanpu Shi
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Catheterization Laboratories (C.G., F.W., L.X., T.Z., Y.S., B.X.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sipeng Chen
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Information Center (S.C.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li He
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Catheterization Laboratories (C.G., F.W., L.X., T.Z., Y.S., B.X.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiovascular Surgery (S.L., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,National Health Commission Key Laboratory of Cardiovascular Regenerative Medicine, Fuwai Central-China Hospital, Central-China Branch of National Center for Cardiovascular Diseases, Zhengzhou, China (Z.Z.)
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3
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Aljabbary T, Katyukha A, Elbaz-Greener G, Gressmann K, Bagai A, Graham JJ, Vijayaraghavan R, Kalra S, Vo M, Wijeysundera HC. Overview of Contemporary Chronic Total Occlusion Percutaneous Coronary Intervention Techniques: A Narrative Systematic Review. CJC Open 2021; 3:1273-1281. [PMID: 34888507 PMCID: PMC8636234 DOI: 10.1016/j.cjco.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/31/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite the abundance of coronary chronic total occlusions (CTO) percutaneous coronary intervention (PCI) studies, the literature is not easy to digest for both general PCI operators and CTO PCI specialists because of the many varied terms used for approaches and inconsistency in terminology. This inconsistency makes it challenging to understand the advantages and disadvantages of these different approaches and, most importantly, their downstream clinical outcomes. Accordingly, we conducted a systematic review of all published studies on CTO PCI to describe techniques and algorithms used in the last decade to provide an overview on the efficacy and safety of contemporary CTO PCI techniques. METHODS We performed a comprehensive search of the PubMed, EMBASE, and the Cochrane library databases for manuscripts about PCI of CTOs. We included studies published between the years 2005 and 2019. We categorized studies into those using a single approach (antegrade, retrograde) and those with a prespecified algorithm (ie, hybrid approach). RESULTS Fifty-five observational studies including 28,907 patients who underwent CTO were included in this review. CTO PCI generally carries low risk of major procedural complications, with angiographic success rates being higher in studies that used an algorithmic vs single technical approach. CONCLUSIONS This systematic review highlights the wide variation in definitions and practices in CTO PCI and calls for standardization in terminology and practice.
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Affiliation(s)
- Talal Aljabbary
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Andriy Katyukha
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Akshay Bagai
- Terrence Donnelly Heart Center, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - John J. Graham
- Terrence Donnelly Heart Center, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | | | - Sanjog Kalra
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Minh Vo
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Harindra C. Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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4
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Abunassar J, Dave P, Alturki M, Abuzeid W. Preprocedural computed tomography angiography in differentiating chronic total from subtotal coronary occlusions. J Cardiovasc Med (Hagerstown) 2021; 22:371-377. [PMID: 32941329 DOI: 10.2459/jcm.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Differentiation of chronic total occlusion (CTO) from subtotal coronary occlusions (STOs) is often difficult to make from coronary angiography. These differences are very important, as the technical expertise and tools required are significantly different for revascularization of these lesions. We sought to determine if preprocedural computed tomography angiography (CTA) can help better diagnose and differentiate CTO from STO. METHODS We searched three databases (Ovid MEDLINE, EMBASE, EBM reviews) from 1 January 1946 to 1 March 2019. Studies reporting on the use of computed tomography (CT) to aid in CTO revascularization were included. Case reports and case series were excluded. RESULTS We identified 577 articles, and using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method, 4 articles met prespecified inclusion criteria. A total of 669 patients were included. The statistically significant CT-derived parameters determined to help differentiate CTO from STO were found to include longer lesion length (four out of four studies), larger contrast density difference (one out of four studies), presence of collaterals (two out of four studies) and the presence of the reverse attenuation gradient sign (two out of four studies). CONCLUSION This systematic review shows the utility of preprocedural CTA to help differentiate CTO from STO using a number of CT-derived parameters as above. Further, this study highlights the need for further research to develop specific validated parameters for differentiation of CTO and STO.
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Affiliation(s)
- Joseph Abunassar
- Division of Cardiology, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | | | - Mohammad Alturki
- Division of Cardiology, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Wael Abuzeid
- Division of Cardiology, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
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5
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Ybarra LF, Buller CE, Rinfret S. The Canadian Contribution to Science, Techniques, Technology, and Education in Chronic Total Occlusion Percutaneous Coronary Intervention. CJC Open 2021; 3:22-27. [PMID: 33458629 PMCID: PMC7801209 DOI: 10.1016/j.cjco.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/02/2020] [Indexed: 12/29/2022] Open
Abstract
Chronic total occlusions are considered the most complex coronary lesions in interventional cardiology. This article reviews the Canadian clinical and academic contributions to this field, including innovative procedural techniques, teaching and proctoring, clinical research, and the development of novel tools and therapies.
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Affiliation(s)
- Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Stéphane Rinfret
- Division of Cardiology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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6
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Khan AA, Khalid MF, Ayub MT, Murtaza G, Sardar R, White CJ, Mukherjee D, Nanjundappa A, Paul TK. Outcomes of Percutaneous Coronary Intervention Versus Optimal Medical Treatment for Chronic Total Occlusion: A Comprehensive Meta-analysis. Curr Probl Cardiol 2020; 46:100695. [PMID: 33010951 DOI: 10.1016/j.cpcardiol.2020.100695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/15/2020] [Indexed: 01/11/2023]
Abstract
The presence of concurrent chronic total occlusion (CTO) is a strong predictor for both short-term and long-term mortality. Successful percutaneous coronary intervention (PCI) of CTO has been associated with clinical benefit. We sought to perform a meta-analysis comparing CTO-PCI versus optimal medical therapy. PubMed, ClinicalTrials.gov, Google scholar and the Cochrane Central Register of Controlled Trials were searched for studies published from 2006 to 2019. A total of 16 studies, with 11,314 patients were included. We analyzed data on mortality, cardiac deaths, myocardial re-infarction, major adverse cardiac events, stroke, and repeat CTO-PCI using random-effects models. The odds ratios (OR) with 95% confidence interval (CI) were computed and P < 0.05 was considered as a level of significance. Compared with medical therapy alone, CTO-PCI was associated with lower mortality (OR: 0.45, CI: 0.32-0.63, P < 0.00001) and cardiac deaths (OR: 0.58, CI: 0.38-0.89, P = 0.01). These results were primarily driven by observational studies with no difference observed in randomized controlled trials. There was no significant difference in the incidence of major adverse cardiac events (OR: 0.71, CI: 0.48-1.05, P = 0.54), myocardial re-infarction (OR: 0.71, CI: 0.48-1.05, P = 0.54), stroke (OR: 0.61, CI: 0.32-1.17, P = 0.14, and repeat PCI (OR: 1.28, CI: 0.91-1.78, P = 0.16). This meta-analysis shows lower long-term mortality and cardiac deaths in CTO-PCI group as compared to OMT driven by observational studies with no difference observed in randomized controlled trials. Further randomized trials are needed to confirm these findings and evaluate long term results.
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7
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One-year clinical outcomes of coronary chronic total occlusion intervention in patients with acute coronary syndrome versus stable angina: from the Korean chronic total occlusion registry. Coron Artery Dis 2020; 31:430-437. [PMID: 32168045 DOI: 10.1097/mca.0000000000000880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic total occlusion intervention remains challenging and detailed real-world data on the safety and efficacy of which are limited. This study sought to determine whether there are differences in the 1-year clinical outcomes between chronic total occlusion patients with acute coronary syndrome and stable angina following chronic total occlusion intervention. PATIENTS AND METHODS Data from the Korean chronic total occlusion registry were collected from May 2003 to September 2012, and a total of 3268 patients who underwent chronic total occlusion intervention were enrolled. Cardiovascular outcomes up to 12 months in the acute coronary syndrome group were compared with stable angina group. RESULTS The acute coronary syndrome group consisted of 1657 patients, and stable angina group consisted of 1264 patients. In the acute coronary syndrome group, patients with successful chronic total occlusion intervention had a lower incidence of total death and cardiac death compared to patients with failed intervention. However, there were no significant differences in cardiovascular events in the stable angina group. The successful chronic total occlusion intervention was a significant prognostic factor for lower total death (P = 0.006, hazard ratio = 0.46) and cardiac death (P = 0.003, hazard ratio = 0.36) within acute coronary syndrome group. On the other hand, successful chronic total occlusion intervention was not a prognostic factor for cardiovascular events within stable angina group. CONCLUSIONS Successful chronic total occlusion intervention in acute coronary syndrome patients was associated with a lower incidence of cardiovascular outcome compared to patients with failed chronic total occlusion intervention.
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8
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Iannaccone G, Scarparo P, Wilschut J, Daemen J, Den Dekker W, De Jaegere P, Zijlstra F, Van Mieghem NM, Diletti R. Current approaches for treatment of coronary chronic occlusions. Expert Rev Med Devices 2019; 16:941-954. [PMID: 31594416 DOI: 10.1080/17434440.2019.1676729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Coronary chronic total occlusions (CTO) represent a challenging subset in interventional cardiology.Areas covered: During the last decade, improvements in materials, techniques, and meticulous pre-procedural lesion assessment have increased the success rate in CTO lesions. Several scores have been developed to address overall lesion evaluation and help select the most appropriate treatment strategy. In addition, specific algorithms such as the hybrid algorithm have been introduced to provide a framework for CTO operators and a rapid management of the various challenging aspects of the procedure. The hybrid approach requires operator's ability to switch from one treatment strategy to another when the first one appears to be unsuccessful. Adequate training and operators' experience remain crucial to improve the likelihood of success.Expert opinion: The aim of this review is to provide insights and guidance for operators on current approaches for treatment of CTO and complication management.
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Affiliation(s)
- Giulia Iannaccone
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paola Scarparo
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Peter De Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Li KHC, Wong KHG, Gong M, Liu T, Li G, Xia Y, Ho J, Nombela-Franco L, Sawant AC, Eccleshall S, Tse G, Vassiliou VS. Percutaneous Coronary Intervention Versus Medical Therapy for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis. Curr Atheroscler Rep 2019; 21:42. [PMID: 31399762 PMCID: PMC6689032 DOI: 10.1007/s11883-019-0804-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose of Review Chronic total occlusion (CTO) of the coronary arteries is a significant clinical problem and has traditionally been treated by medical therapy or coronary artery bypass grafting. Recent studies have examined percutaneous coronary intervention (PCI) as an alternative option. Recent Findings This systematic review and meta-analysis compared medical therapy to PCI for treating CTOs. Summary PubMed and Embase were searched from their inception to March 2019 for studies that compared medical therapy and PCI for clinical outcomes in patients with CTOs. Quality of the included studies was assessed by Newcastle–Ottawa scale. The results were pooled by DerSimonian and Laird random- or fixed-effect models as appropriate. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger’s regression, respectively. Of the 703 entries screened, 17 studies were included in the final analysis. This comprised 11,493 participants. Compared to PCI, medical therapy including randomized and observational studies was significantly associated with higher risk of all-cause mortality (risk ratio (RR) 1.99, 95% CI 1.38–2.86), cardiac mortality (RR 2.36 (1.97–2.84)), and major adverse cardiac event (RR 1.25 (1.03–1.51)). However, no difference in the rate of myocardial infarction and repeat revascularization procedures was observed between the two groups. Univariate meta-regression demonstrated multiple covariates as independent moderating factors for myocardial infarction and repeat revascularization but not cardiac death and all-cause mortality. However, when only randomized studies were included, there was no difference in overall mortality or cardiac death. In CTO, when considering randomized and observational studies, medical therapy might be associated with a higher risk of mortality and myocardial infarction compared to PCI treatment. Electronic supplementary material The online version of this article (10.1007/s11883-019-0804-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ka Hou Christien Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Ka Hei Gabriel Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jeffery Ho
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Luis Nombela-Franco
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Abhishek C Sawant
- Division of Interventional Cardiology, Banner University Medical Center, Phoenix, AZ, USA
| | - Simon Eccleshall
- Norfolk and Norwich University Hospital and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Vassilios S Vassiliou
- Norfolk and Norwich University Hospital and Norwich Medical School, University of East Anglia, Norwich, UK. .,Royal Brompton Hospital and Imperial College London, London, UK. .,Bob Champion Research and Education, Second Floor, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
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10
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Abo-Aly M, Misumida N, Backer N, ElKholey K, Kim SM, Ogunbayo GO, Abdel-Latif A, Ziada KM. Percutaneous Coronary Intervention With Drug-Eluting Stent Versus Optimal Medical Therapy for Chronic Total Occlusion: Systematic Review and Meta-Analysis. Angiology 2019; 70:908-915. [PMID: 31256614 DOI: 10.1177/0003319719858823] [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: 11/15/2022]
Abstract
The optimal treatment strategy for coronary chronic total occlusion (CTO) has not been well established. The benefit of percutaneous coronary intervention (PCI) was inferred mainly from observational studies comparing successful versus failed PCI without a control group receiving optimal medical therapy (OMT). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing PCI using drug-eluting stent (DES) versus OMT alone in patients with CTO. Eight studies were identified: 3 RCTs and 5 observational studies. Among a total of 4784 included patients, 2461 patients underwent PCI and 2323 patients received OMT. There was a significant association between PCI and lower cardiac mortality (odds ratio = 0.62; 95% confidence interval 0.42-0.93; P = .02). There was no significant difference between PCI and OMT regarding major adverse cardiac events, recurrent myocardial infarction (MI), repeat revascularization, or stroke. In the RCT subset (1399 patients), there was no significant difference between PCI and OMT regarding clinical outcomes. Compared with OMT alone, PCI with DES for CTO was associated with lower cardiac mortality, mainly driven by observational studies, without significant difference in recurrent MI or repeated revascularization. Further RCTs are needed to investigate the role of PCI for management of patients with CTO.
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Affiliation(s)
- Mohamed Abo-Aly
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Naoki Misumida
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Neil Backer
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Khaled ElKholey
- 2 Heart Rhythm Institute, Oklahoma University Health Science Center, Oklahoma City, OK, USA
| | - Sun Moon Kim
- 3 University of North Carolina Heart and Vascular Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gbolahan O Ogunbayo
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Ahmed Abdel-Latif
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Khaled M Ziada
- 1 Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
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11
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Flores‐Umanzor EJ, Vázquez S, Cepas‐Guillen P, Ivey‐Miranda J, Caldentey G, Jimenez‐Britez G, Regueiro A, Freixa X, Andrea R, Ferreira‐González I, Sabaté M, Martin‐Yuste V. Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients. Catheter Cardiovasc Interv 2019; 94:527-535. [DOI: 10.1002/ccd.28163] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/09/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - Sara Vázquez
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Pedro Cepas‐Guillen
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Juan Ivey‐Miranda
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Guillem Caldentey
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Gustavo Jimenez‐Britez
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Ander Regueiro
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Xavier Freixa
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Rut Andrea
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Ignacio Ferreira‐González
- Cardiology DepartmentVall d'hebron Hospital, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Manel Sabaté
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Victoria Martin‐Yuste
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
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12
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Iantorno M, Weintraub WS. Cost-Effectiveness and Economic Burden of PCI. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:561-563. [PMID: 30146118 DOI: 10.1016/j.carrev.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Micaela Iantorno
- Section of Interventional Cardiology, MedStar Heart & Vascular Institute, Georgetown University, Washington, DC
| | - William S Weintraub
- Section of Interventional Cardiology, MedStar Heart & Vascular Institute, Georgetown University, Washington, DC.
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13
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Chen F, Liu F, Lu J, Yang X, Xiao B, Jin Y, Zhang J. Coenzyme Q10 combined with trimetazidine in the prevention of contrast-induced nephropathy in patients with coronary heart disease complicated with renal dysfunction undergoing elective cardiac catheterization: a randomized control study and in vivo study. Eur J Med Res 2018; 23:23. [PMID: 29776437 PMCID: PMC5960150 DOI: 10.1186/s40001-018-0320-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/24/2018] [Indexed: 02/01/2023] Open
Abstract
Background Contrast-induced nephropathy (CIN) is one of the common hospital-acquired acute renal failures. The purpose of this study was to investigate whether Coenzyme Q10 (CoQ10) and trimetazidine (TMZ) can prevent the occurrence of CIN after elective cardiac catheterization in patients with coronary artery disease complicated with renal dysfunction. Methods Consecutive coronary artery disease patients with renal insufficiency scheduled for coronary angiography were enrolled in randomized, paralleled, double-blind, controlled trial. The development of CIN was occurrence at the 48 or 72 h after the procedure. The changes of serum creatinine (SCr), eGFR, and Cys-C within 72 h after the procedure were measured and compared. In vivo contrast medium (CM)-induced acute kidney injury (AKI) animal model was established, and CoQ10 plus TMZ was orally administrated to evaluate its renal protective effect. Results 150 patients with renal insufficiency were enrolled finally. CIN occurred in 21 (14.00%) of the 150 patients. 72 h after the procedure, the incidence of CIN was significantly lower in CoQ10 plus TMZ group compared with control group (6.67 vs. 21.3%, p = 0.01). No cardiac death occurred in this study. No side effects were observed after administration of CoQ10 and TMZ. In vivo test demonstrated that CoQ10 and TMZ could significantly reduce the concentration of blood urea nitrogen (BUN) and SCR induced by CM i.v. injection, as well as tubular pathological injuries. Meanwhile, CoQ10 and TMZ could significantly reduce the oxidation stress in kidneys from CM-AKI animals. Conclusion CoQ10 plus TMZ could decrease the incidence of CIN in patients with renal insufficiency undergoing elective cardiac catheterization, and their effect may be due to its strong anti-oxidation effect.
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Affiliation(s)
- Fei Chen
- Department of Cardiology, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Xinhua District, Shijiazhuang, 050005, Hebei, China
| | - Fan Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Xinhua District, Shijiazhuang, 050005, Hebei, China.
| | - Jingchao Lu
- Department of Cardiology, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Xinhua District, Shijiazhuang, 050005, Hebei, China
| | - Xiuchun Yang
- Department of Cardiology, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Xinhua District, Shijiazhuang, 050005, Hebei, China
| | - Bing Xiao
- Department of Cardiology, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Xinhua District, Shijiazhuang, 050005, Hebei, China
| | - Yaqiong Jin
- Department of Cardiology, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Xinhua District, Shijiazhuang, 050005, Hebei, China
| | - Jie Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Xinhua District, Shijiazhuang, 050005, Hebei, China
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14
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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.
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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
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15
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Elbaz-Greener G, Wijeysundera HC. Coronary Chronic Total Occlusions: Time to Abandon a Culture of Therapeutic Nihilism? Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.004295. [PMID: 29237747 DOI: 10.1161/circoutcomes.117.004295] [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: 11/16/2022]
Affiliation(s)
- Gabby Elbaz-Greener
- From the Division of Cardiology and Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (G.E.G., H.C.W.); University of Toronto, Ontario, Canada (G.E.G., H.C.W.); Institute for Clinical Evaluative Sciences, Ontario, Canada (H.C.W.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (H.C.W.)
| | - Harindra C Wijeysundera
- From the Division of Cardiology and Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (G.E.G., H.C.W.); University of Toronto, Ontario, Canada (G.E.G., H.C.W.); Institute for Clinical Evaluative Sciences, Ontario, Canada (H.C.W.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (H.C.W.).
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