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Vasiliev DK, Rudenko BA, Shanoyan AS, Shukurov FB, Feshchenko DA. Predictors of unsuccessful endovascular recanalization of coronary chronic total occlusion. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The prevalence of endovascular interventions for coronary chronic total occlusion (CTO) remains small worldwide. This is due to the complexity of procedure and the risk of intraoperative complications. In this regard, the search for predictors of unsuccessful endovascular intervention in CTO plays a special role. This will allow for a careful selection of patients with the most favorable expectation effect of the operation. Aim. To identify predictors of unsuccessful endovascular recanalization of CTO.Material and methods. This retrospective study included 180 patients with chronic coronary artery disease (CAD) in the period from November 2017 to June 2019, who had multivessel lesion in combination with CTO. In all patients, an attempt was made to achieve complete myocardial revascularization. Depending on the success of procedure, the patients were divided into two groups: complete and incomplete myocardial revascularization. The follow-up period was 12 months.Results. All baseline characteristics of patients in the compared groups were similar. The successful recanalization rate of occlusion was 79,5%. Multivariate regression analysis showed that calcified CTO (p<0,001), baseline SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score >32 (p=0,006), CTO length >30 mm (p=0,046) and CTO of circumflex artery (p<0,01) are significant predictors of unsuccessful endovascular recanalization of CTO. To assess the predictive value of the model, a ROC analysis was carried out, and the area under the curve (AUC) was calculated. The AUC was 0,87, which indicates a high predictive quality of the model. The sensitivity and specificity of the model were 78 and 81%, respectively.Conclusion. The study showed that the presence of calcified CTO, SYNTAX score >32 points, CTO length >30 mm, and CTO of circumflex artery are significant predictors of unsuccessful CTO recanalization.
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Affiliation(s)
- D. K. Vasiliev
- National Medical Research Center for Therapy and Preventive Medicine
| | - B. A. Rudenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. S. Shanoyan
- National Medical Research Center for Therapy and Preventive Medicine
| | - F. B. Shukurov
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. A. Feshchenko
- National Medical Research Center for Therapy and Preventive Medicine
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Vemuri KS, Sihag BK, Sharma Y, Nevali KP, Vijayvergiya R, Kumar RM, Bahl A, Singh P, Mehrotra S, Khanal S, Dahiya N, Gupta A, Gupta H, Naganur S, Basant K, Panda P, Gupta A, Barwad P. Real world perspective of coronary chronic total occlusion in third world countries: A tertiary care centre study from northern India. Indian Heart J 2021; 73:156-160. [PMID: 33865511 PMCID: PMC8065346 DOI: 10.1016/j.ihj.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The aim of this study is to determine the prevalence, clinical characteristics, angiographic profile and predictors of outcome for percutaneous coronary interventions (PCI) of coronary chronic total occlusions (CTO) in a tertiary referral centre of north India. BACKGROUND There is no data on the prevalence and very few reports on clinical characteristics, angiographic profile and outcome of PCI in CTO from India. METHODS Retrospective analysis was done for the data of 12,020 patients undergoing coronary angiography (CAG) between January 2018 to January 2019 at our centre. Detailed baseline clinical, angiographic and revascularization data was collected. Outcome of CTO PCI was also noted. All baseline parameters were analysed for predicting the outcome of CTO PCI. RESULTS CTO was identified in 16.3% (1968) patients undergoing CAG and in 24.4% of patients with hemodynamically significant CAD. CTO was predominantly found in LAD (48%) followed by RCA (42.9%) and LCx (25.3%) arterial distribution. Mean JCTO score was 1.93 ± 0.7. PCI as a management strategy was adopted in 456 of 1968 patients (23.1%) and was successful in 340 of 456 (74.6%) of patients. Almost all CTO PCI were attempted by an antegrade approach only. Increasing age, male sex, CTO in LCx arterial distribution and higher J CTO score were associated with poorer outcome in CTO PCI. CONCLUSIONS CTO's are commonly encountered during CAG procedures. In patients undergoing CTO PCI, a fair success rate can be achieved in a high volume experienced centre.
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Affiliation(s)
- Krishna Santosh Vemuri
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Bhupinder Kumar Sihag
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Yashpaul Sharma
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Krishna Prasad Nevali
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Rajesh Vijayvergiya
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Rohit Manoj Kumar
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Ajay Bahl
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Parminder Singh
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Saurabh Mehrotra
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Suraj Khanal
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Neelam Dahiya
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Ankur Gupta
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Himanshu Gupta
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Sanjeev Naganur
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Kumar Basant
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Prashant Panda
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Ankush Gupta
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India
| | - Parag Barwad
- Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India.
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Oktaviono YH, Rizal A, Al-Farabi MJ, Maghfirah I, Rachmi DA. Coronary Angiography Characteristics as Predictor of Successful Chronic Total Occlusion Recanalization. Int J Angiol 2020; 29:196-201. [PMID: 32904696 DOI: 10.1055/s-0040-1709503] [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] [Indexed: 10/24/2022] Open
Abstract
Although remarkable progress in percutaneous coronary intervention (PCI) has been achieved over the last decade, the success rate of chronic total occlusion (CTO) recanalization varies greatly. Coronary angiography characteristics may affect the success rate of CTO recanalization. This study sought to establish a scoring model to predict successful CTO recanalization based on coronary angiography characteristics. We analyze 287 angiography data from patients who underwent elective PCI. Angiography characteristics being measured were lesion location, blunt stump, calcification, ostial lesion, bridging collateral, bending, side branch, tortuosity, previous stent attempt, and lesion length of >20 mm. Data were analyzed using SPSS 25.0. Multivariate analysis shows that side branch lesion ( p = 0.000), proximal vessels tortuosity ( p = 0.015), calcified lesion ( p = 0.000), lesion length of >20 mm ( p = 0.000), and blunt stump ( p = 0.000) can predict the successful PCI in the CTO. ROC curve analysis of the score ability to predict successful PCI in the CTO showed area under curve of 0.89 (confidence interval 95%), the cutoff point of ≤2 with a sensitivity of 93.33%, and specificity of 88.23%. We concluded that the five angiography characteristics that strongly associate with successful PCI in the CTO are calcified lesion, blunt stump, lesion length >20 mm, proximal vessel tortuosity, and side branch lesion. This score may help cardiologists to predict the success probability of PCI in the CTO.
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Affiliation(s)
- Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Airlangga University, East Java, Indonesia
| | - Ardian Rizal
- Departement of Cardiology and Vascular Medicine, Faculty of Medicine Brawijaya University-Dr. Saiful Anwar General Hospital, East Java, Indonesia
| | | | - Irma Maghfirah
- Department of Cardiology and Vascular Medicine, Airlangga University, East Java, Indonesia
| | - Dita Aulia Rachmi
- Department of Cardiology and Vascular Medicine, Airlangga University, East Java, Indonesia
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