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Vaduganathan M, Kornowski R, Vaknin-Assa H, Greenberg G, Bental T, Lev EI, Assali AR. Coronary stenting approaches in the treatment of chronic total occlusion: contemporary registry-based experience. J Cardiovasc Med (Hagerstown) 2015; 17:673-9. [PMID: 25806471 DOI: 10.2459/jcm.0000000000000231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This 'real-world' investigation attempted to determine the long-term prognoses of patients who have undergone successful revascularization of chronic total occlusion (CTO) lesions. METHODS All consecutive unselected patients from January 2006 to June 2011, undergoing stenting for CTO (n = 272), were retrospectively identified through an institutional registry. Procedural failure was defined as final diameter stenosis greater than 30% or postdilatation thrombolysis in myocardial infarction flow less than 3. Outcomes were assessed based on stenting type [bare metal stent (BMS), drug-eluting stent (DES), or mixed] in the successful procedural cohort. Multiple logistic regression analyses were used to account for known baseline cardiovascular risk imbalances. The primary endpoint was 2-year target vessel revascularization. RESULTS Overall procedural failure occurred in 55 (20.2%) patients presenting with CTO lesions. Failed revascularization was independently associated with multivessel disease, lesion lengths greater than 15 mm, tortuous segments, and presence of calcifications. Major complications included coronary dissection (10%) and perforation (2%). Of the successful procedures, 141 (64%) underwent pure DES, 46 (21%) pure BMS, and 34 (15%) mixed stenting. At 2-year follow-up, fewer patients in the DES group required repeat revascularization compared to the mixed stenting group (6 vs. 26%; P = 0.002). Mixed stenting was an independent predictor of long-term target vessel revascularization (adjusted odds ratio 2.1, 95% confidence interval 1.1-4.1, P = 0.02) compared to DES. CONCLUSIONS Failed revascularization of CTO lesions occurs in a fifth of patients and appears to be associated with complex vessel anatomy. Our data suggest that DES use in this setting are associated with improved 2-year clinical endpoints compared with pure BMS or mixed stenting approaches.
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Affiliation(s)
- Muthiah Vaduganathan
- aDepartment of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA bDepartment of Cardiology, Rabin Medical Center, Petah-Tikva, Tel-Aviv University, Tel-Aviv, Israel
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Younan H, Ragab T, El-Khashab K, Farag N. Impact of gender difference on PCI outcome in Egyptian diabetic patients: Prospective two center registry study. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Advances in the management of coronary chronic total occlusions. J Cardiovasc Transl Res 2014; 7:426-36. [PMID: 24634196 DOI: 10.1007/s12265-014-9556-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/24/2014] [Indexed: 12/16/2022]
Abstract
Chronic total occlusions (CTOs) have been called "the last frontier" of percutaneous coronary intervention (PCI) due to traditionally low success rates and high risk for restenosis and re-occlusion. Recent advances in equipment and crossing techniques have significantly increased CTO PCI success rates while maintaining low risk of complications. Specifically, the retrograde approach and controlled antegrade dissection and re-entry in conjunction with advanced guidewires and microcatheters have significantly improved procedural success rates. Moreover, the introduction of the "hybrid" approach has created a unified framework for operators to approach CTOs in a systematic and efficient fashion. Finally, drug-eluting stents, especially second generation, have improved long-term patency after CTO PCI.
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Brilakis ES, Kotsia A, Luna M, Garcia S, Abdullah SM, Banerjee S. The role of drug-eluting stents for the treatment of coronary chronic total occlusions. Expert Rev Cardiovasc Ther 2014; 11:1349-58. [DOI: 10.1586/14779072.2013.838142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shrestha R, Xu J, Xie D, Liu Z, Xu T, Ye F, Din S, Qian X, Yang S, Liu Y, Li F, Zhang A, Chen S. Comparison of clinical outcomes of Chinese men and women after coronary stenting for coronary artery disease: a multi-center retrospective analysis of 4,334 patients. J Biomed Res 2013; 28:368-75. [PMID: 25332708 PMCID: PMC4197387 DOI: 10.7555/jbr.28.20120127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 05/16/2013] [Accepted: 07/28/2013] [Indexed: 11/24/2022] Open
Abstract
The outcome differences between Chinese male and female patients within one-year follow-up after percutaneous coronary intervention (PCI) with stent remain unclear. The present study was aimed to compare clinical outcomes in such two populations. From May 1999 to December 2009, 4,334 patients with acute myocardial infarction (MI), unstable angina, stable angina, or silent ischemia, who underwent PCI, were registered at our centers. Among these, 3,089 were men and 1,245 were women. We compared these groups with respect to the primary outcomes of MI and secondary outcomes including a composite of major adverse cardiac events (MACE) including cardiac death, MI, target lesion revascularization, target vessel revascularization (TVR), stent thrombosis (ST), definite ST and probable ST at one-year follow-up. Chinese male patients had a higher MACE rate (13% vs. 10.7%, P = 0.039), mainly led by TVR (9.09% vs. 6.98%, P = 0.024) at one year, which was significantly different than female patients. Chinese male and female patients showed a significant difference on MACEs. However, there was no significant difference with respect to MI between these groups.
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Affiliation(s)
- Rajiv Shrestha
- Department of Cardiology, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jing Xu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Dujiang Xie
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Zhizhong Liu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Tian Xu
- Department of Cardiology, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Shiqing Din
- Department of Cardiology, Huainan Xinhua Hospital, Huainan, Anhui 232038, China
| | - Xuesong Qian
- Department of Cardiology, Zhangjiagang People's Hospital, Zhangjiagang, Jiangsu 215600, China
| | - Song Yang
- Department of Cardiology, Yixin People's Hospital, Yixin, Jiangsu 214200, China
| | - Yueqiang Liu
- Department of Cardiology, Jintan People's Hospital, Jintan, Jiangsu 213200, China
| | - Feng Li
- Department of Cardiology, Huainan Oriental General Hospital, Huainan, Anhui 235056, China
| | - Aiping Zhang
- Department of Cardiology, Huainan People's Hospital, Huainan, Anhui 340016, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
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Freixa X, Džavík V, Forman SA, Rankin JM, Buller CE, Cantor WJ, Ruzyllo W, Reynolds HR, Lamas GA, Hochman JS. Long-term outcomes after a strategy of percutaneous coronary intervention of the infarct-related artery with drug-eluting stents or bare metal stents vs medical therapy alone in the Occluded Artery Trial (OAT). Am Heart J 2012; 163:1011-8. [PMID: 22709754 DOI: 10.1016/j.ahj.2012.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 03/12/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND The OAT, a randomized study of routine percutaneous coronary intervention or optimal medical therapy (MED) alone for the treatment of a totally occluded infarct-related artery in the subacute phase after myocardial infarction, showed similar rates of death, reinfarction and congestive heart failure (CHF) between study groups. Although most percutaneous coronary intervention patients were treated with bare metal stents (BMS), drug-eluting stents (DES) were also implanted in the latter part of the study. The aim of the study was to conduct an exploratory analysis of long-term outcomes for DES vs. BMS deployment vs. MED in the OAT. METHODS Patients enrolled after February 2003 (when first DES was implanted) were followed (DES n = 79, BMS n = 393, MED n = 552) up to a maximum of 6 years (mean survivor follow-up 5.1 years). RESULTS The 6-year occurrence of the composite end point of death, reinfarction and class IV CHF was similar [20.4% of DES, 18.9% of BMS and 18.4% of MED (P = .66)] as were the rates of the components of the primary end point. During the follow-up period, 33.4% of DES, 44.4% of BMS and 48.1% of MED patients, developed angina (P = .037). The rate of revascularization during follow up was 11.3%, 20.5% and 22.5% among these groups, respectively (P = .045). CONCLUSIONS There is no suggestion of reduced long-term risk of death, reinfarction or class IV CHF with DES usage compared to BMS or medical treatment alone. An association between DES use and freedom from angina and revascularization relative to medical therapy is suggested.
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