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Soriano K, Jiang GY, Balkan L, Tamez H, Yeh RW. Who Should Undergo Chronic Total Occlusions Percutaneous Coronary Intervention and When?: An Evidence-Based Approach to the Patient Referred for Percutaneous Coronary Intervention of Chronic Total Occlusion. Am J Cardiol 2024; 227:18-28. [PMID: 39032587 DOI: 10.1016/j.amjcard.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
Chronic total occlusions (CTO) of the coronary arteries are common among patients presenting to the cardiac catheterization laboratory, and data suggests a worse overall prognosis in patients with CTOs. Percutaneous coronary intervention (PCI) of CTOs has been shown to improve anginal symptoms in observational studies and in a limited number of randomized trials. However, CTO PCI has not been shown to lead to a reduction in other important end points such as myocardial infarction or death. Furthermore, despite recent advances in the field, CTO PCI still carries higher risks and a lower likelihood of success compared with non-CTO PCI. Thus, determining which patients may be appropriate for CTO PCI is challenging and must involve a comprehensive risk-benefit analysis and discussion with the patient. Therefore, we review the currently available data regarding CTO PCI, including the clinical outcomes, the role of preprocedural ischemia testing, and various procedural success and risk stratification scores. Finally, we present our approach to the patient referred for CTO PCI.
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Affiliation(s)
- Kevin Soriano
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ginger Y Jiang
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lauren Balkan
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Hector Tamez
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Robert W Yeh
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Gold DA, Sandesara PB, Jain V, Gold ME, Vatsa N, Desai SR, Elhage Hassan M, Yuan C, Ko YA, Liu C, Ejaz K, Alvi Z, Alkhoder A, Rahbar A, Murtagh G, Varounis C, Jaber WA, Nicholson WJ, Quyyumi AA. N terminal pro-brain natriuretic peptide level and benefits of chronic total occlusion revascularization. Int J Cardiol 2024; 409:132196. [PMID: 38782069 DOI: 10.1016/j.ijcard.2024.132196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/28/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The management of revascularization of chronic total occlusions (CTOs) remains controversial. Whether specific patients gain survival benefit from CTO revascularization remains unknown. OBJECTIVES We investigated whether (i) patients with CTO have higher N terminal pro-brain natriuretic peptide (NT pro-BNP) levels than patients without CTO, (ii) in patients with CTO, NT pro-BNP levels predict adverse events, and (iii) those with elevated levels benefit from revascularization. METHODS In 392 patients with stable, significant coronary artery disease (CAD) and CTO undergoing coronary angiography, rates of all-cause mortality, cardiovascular death, and a composite (cardiovascular death, myocardial infarction and heart failure hospitalizations) were investigated. Unadjusted and adjusted Cox proportional and Fine and Gray sub-distribution hazard models were performed to determine the association between NT pro-BNP levels and incident event rates in patients with CTO. RESULTS NT pro-BNP levels were higher in patients with, compared to those without CTO (median 230.0 vs. 177.7 pg/mL, p ≤0.001). Every doubling of NT pro-BNP level in patients with CTO was associated with a > 25% higher rate of adverse events. 111 (28.5%) patients underwent CTO revascularization. In patients with elevated NT pro-BNP levels (> 125 pg/mL), those who underwent CTO revascularization had substantially lower adverse event rates compared to patients without CTO revascularization (adjusted cardiovascular death hazard ratio 0.29, 95% confidence interval (0.09-0.88). However, in patients with low NT pro-BNP levels (≤ 125 pg/mL), event rates were similar in those with and without CTO revascularization. CONCLUSION NT pro-BNP levels can help identify individuals who may benefit from CTO revascularization.
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Affiliation(s)
- Daniel A Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Vardhmaan Jain
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew E Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nishant Vatsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shivang R Desai
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Malika Elhage Hassan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chenyang Yuan
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Chang Liu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kiran Ejaz
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zain Alvi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ayman Alkhoder
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Alireza Rahbar
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Wissam A Jaber
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - William J Nicholson
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia..
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Gold DA, Sandesara PB, Kindya B, Gold ME, Jain V, Vatsa N, Desai SR, Yadalam A, Razavi A, Elhage Hassan M, Ko YA, Liu C, Alkhoder A, Rahbar A, Hossain MS, Waller EK, Jaber WA, Nicholson WJ, Quyyumi AA. Circulating Progenitor Cells and Coronary Collaterals in Chronic Total Occlusion. Int J Cardiol 2024; 407:132104. [PMID: 38677332 DOI: 10.1016/j.ijcard.2024.132104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The role of circulating progenitor cells (CPC) in collateral formation that occurs in the presence of chronic total occlusions (CTO) of a coronary artery is not well established. In stable patients with a CTO, we investigated whether CPC levels are associated with (a) collateral development and (b) ischemic burden, as measured by circulating high sensitivity troponin-I (hsTn-I) levels. METHODS CPCs were enumerated by flow cytometry as CD45med+ blood mononuclear cells expressing CD34 and both CD34 and CD133 epitopes. The association between CPC counts and both Rentrop collateral grade (0, 1, 2, or 3) and hsTn-I levels were evaluated using multivariate regression analysis, after adjusting for demographic and clinical characteristics. RESULTS In 89 patients (age 65.5, 72% male, 27% Black), a higher CPC count was positively associated with a higher Rentrop collateral grade; [CD34+ adjusted odds ratio (OR) 1.49 95% confidence interval (CI) (0.95, 2.34) P = 0.082] and [CD34+/CD133+ OR 1.57 95% CI (1.05, 2.36) P = 0.028]. Every doubling of CPC counts was also associated with lower hsTn-I levels [CD34+ β -0.35 95% CI (-0.49, -0.15) P = 0.002] and [CD34+/CD133+ β -0.27 95% CI (-0.43, -0.08) P = 0.009] after adjustment. CONCLUSION Individuals with higher CPC counts have greater collateral development and lower ischemic burden in the presence of a CTO.
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Affiliation(s)
- Daniel A Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Bryan Kindya
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew E Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Vardhmaan Jain
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nishant Vatsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shivang R Desai
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Adithya Yadalam
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Alexander Razavi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Malika Elhage Hassan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Chang Liu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ayman Alkhoder
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Alireza Rahbar
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mohammad S Hossain
- Division of Hematology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Edmund K Waller
- Division of Hematology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wissam A Jaber
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - William J Nicholson
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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Ricottini E, Coletti F, Nusca A, Cocco N, Corlianò A, Appetecchia A, Melfi R, Mangiacapra F, Gallo P, Rinaldi R, Grigioni F, Ussia GP. Coronary Chronic Total Occlusion Revascularization: When, Who and How? J Clin Med 2024; 13:1943. [PMID: 38610708 PMCID: PMC11012595 DOI: 10.3390/jcm13071943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Coronary chronic total occlusions (CTO) are an increasingly frequent entity in clinical practice and represent a challenging percutaneous coronary intervention (PCI) scenario. Despite data from randomized trials that have not yet demonstrated a clear benefit of CTO recanalization, the widespread of CTO-PCI has substantially increased. The improvement in operators' techniques, equipment, and training programs has led to an improvement in the success rate and safety of these procedures, which will represent an important field of future development of PCI. The present review will summarize clinical outcomes and technical and safety issues of CTO revascularization with the aim to guide clinical daily cath-lab practice.
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Affiliation(s)
- Elisabetta Ricottini
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Federica Coletti
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Annunziata Nusca
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Nino Cocco
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Andrea Corlianò
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Alessandro Appetecchia
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Rosetta Melfi
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Fabio Mangiacapra
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Paolo Gallo
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Raffaele Rinaldi
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
| | - Francesco Grigioni
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Gian Paolo Ussia
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (E.R.); (F.C.); (N.C.); (A.C.); (A.A.); (R.M.); (F.M.); (P.G.); (R.R.); (F.G.); (G.P.U.)
- Cardiology Unit, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
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Goyal A, Maheshwari S, Shahbaz H, Shah V, Shamim U, Shrestha AB, Sulaiman SA, Mhatre P, Sohail AH, Sheikh AB, Dani SS. The Presence of Chronic Total Occlusion in Noninfarct-Related Arteries Is Associated With Higher Mortality and Worse Patient Outcomes Following Percutaneous Coronary Intervention for STEMI: A Systematic Review, Meta-Analysis and Meta-Regression. Cardiol Rev 2024:00045415-990000000-00228. [PMID: 38456689 DOI: 10.1097/crd.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Reperfusion therapy with percutaneous coronary intervention improves outcomes in patients with ST-elevation myocardial infarction. We conducted a meta-analysis to assess the impact of chronic total occlusion (CTO) in noninfarct-related artery on the outcomes of these patients. Comprehensive searches were performed using PubMed, Google Scholar, and EMBASE. The primary endpoint was the 30-day mortality rate, with secondary endpoints including all-cause mortality, repeat myocardial infarction, and stroke. Forest plots were created for the pooled analysis of the results, with statistical significance set at P < 0.05. A total of 19 studies were included in this meta-analysis, with 23,989 patients (3589 in CTO group and 20,400 in no-CTO group). The presence of CTO was associated with significantly higher odds of 30-day mortality [18.38% vs 5.74%; relative risk (RR), 3.69; 95% confidence intervals (CI), 2.68-5.07; P < 0.00001], all-cause mortality (31.00% vs 13.40%; RR, 2.79; 95% CI, 2.31-3.37; P < 0.00001), cardiovascular-related deaths (12.61% vs 4.1%; RR, 2.61; 95% CI, 1.99-3.44; P < 0.00001), and major adverse cardiovascular events (13.64% vs 9.88%; RR, 2.08; 95% CI, 1.52-2.86; P < 0.00001) than the non-CTO group. No significant differences in repeated myocardial infarction or stroke were observed between the CTO and non-CTO groups. Our findings underscore the need for further research on the benefits and risks of performing staged or simultaneous percutaneous coronary intervention for CTO in the noninfarct-related artery in patients with ST-elevation myocardial infarction.
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Affiliation(s)
- Aman Goyal
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Surabhi Maheshwari
- Department of Internal Medicine, G.M.E.R.S. Medical College and Hospital, Sola, India
| | - Haania Shahbaz
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Viraj Shah
- Department of Cardiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Urooj Shamim
- Department of Internal Medicine, Aga Khan University, Karachi, Pakistan
| | - Abhigan Babu Shrestha
- Department of Internal Medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | - Samia Aziz Sulaiman
- Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Pauras Mhatre
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Amir Humza Sohail
- Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM; and
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA
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Gold DA, Sandesara PB, Jain V, Gold ME, Vatsa N, Desai SR, Hassan ME, Yuan C, Ko YA, Ejaz K, Alvi Z, Jaber WA, Nicholson WJ, Quyyumi AA. Long-Term Outcomes in Patients With Chronic Total Occlusion. Am J Cardiol 2024; 214:59-65. [PMID: 38195045 PMCID: PMC10947430 DOI: 10.1016/j.amjcard.2023.12.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/24/2023] [Indexed: 01/11/2024]
Abstract
Although a chronic total occlusion (CTO) in the setting of an acute coronary syndrome is associated with greater risk, the prognosis of patients with a CTO and stable coronary artery disease (CAD) remains unknown. This study aimed to investigate adverse event rates in patients with stable CAD with and without a CTO. In 3,597 patients with stable CAD (>50% coronary luminal stenosis) who underwent cardiac catheterization, all-cause mortality, cardiovascular mortality, and the composite major adverse cardiac event (MACE) rates for cardiovascular death, myocardial infarction, and heart failure hospitalization were evaluated. Cox proportional hazards and Fine and Gray subdistribution hazard models were used to compare event-free survival in patient subsets after adjustment for covariates. Event rates were higher in patients with CTOs than in those without CTOs after adjusting for demographic and clinical characteristics (cardiovascular death hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.05 to 1.57, p = 0.012). Patients with CTO revascularization had lower event rates than those of patients without CTO revascularization (cardiovascular death HR 0.43, CI 0.26 to 0.70, p = 0.001). Those with nonrevascularized CTOs were at particularly great risk when compared with those without CTO (cardiovascular death HR 1.52, CI 1.25 to 1.84, p <0.001). Moreover, those with revascularized CTOs had similar event rates to those of patients with CAD without CTOs. Patients with CTO have higher rates of adverse cardiovascular events than those of patients with significant CAD without CTO. This risk is greatest in patients with nonrevascularized CTO.
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Affiliation(s)
- Daniel A Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Vardhmaan Jain
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew E Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nishant Vatsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shivang R Desai
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Malika Elhage Hassan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chenyang Yuan
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kiran Ejaz
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zain Alvi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wissam A Jaber
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - William J Nicholson
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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7
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Gold DA, Sandesara PB, Jain V, Gold ME, Vatsa N, Desai SR, Hassan ME, Yuan C, Ko Y, Alkhoder A, Ejaz K, Alvi Z, Rahbar A, Murtagh G, Jaber WA, Nicholson WJ, Quyyumi AA. High Sensitivity Troponin Level and Benefits of Chronic Total Occlusion Revascularization. J Am Heart Assoc 2023; 12:e031431. [PMID: 37929763 PMCID: PMC10727412 DOI: 10.1161/jaha.123.031431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
Background The survival benefit of revascularization of chronic total occlusion (CTO) of the coronary arteries remains a subject of controversy. We measured high sensitivity troponin-I (hsTn-I) levels as an estimate of myocardial ischemia in patients with stable coronary artery disease, with the hypothesis that (1) patients with CTO have higher levels of hsTn-I than patients without CTO, (2) hsTn-I levels will predict adverse cardiovascular events in patients with CTO, and (3) patients with elevated hsTn-I levels will have a survival benefit from CTO revascularization. Methods and Results In 428 patients with stable coronary artery disease and CTO undergoing coronary angiography, adverse event rates were investigated. Cox proportional hazards models and Fine and Gray subdistribution hazard models were performed to determine the association between hsTn-I level and incident event rates in patients with CTO. HsTn-I levels were higher in patients with compared with those without CTO (median 6.7 versus 5.6 ng/L, P=0.002). An elevated hsTn-I level was associated with higher adverse event rates (adjusted all-cause mortality hazard ratio, 1.19 [95% CI, 1.08-1.32]; P=0.030) for every doubling of hsTn-I level. CTO revascularization was performed in 28.3% of patients. In patients with a high (>median) hsTn-I level, CTO revascularization was associated with substantially lower all-cause mortality (adjusted hazard ratio, 0.26 [95% CI, 0.08-0.88]; P=0.030) compared with those who did not undergo revascularization. In patients with a low (
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Affiliation(s)
- Daniel A. Gold
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Pratik B. Sandesara
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Vardhmaan Jain
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Matthew E. Gold
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Nishant Vatsa
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Shivang R. Desai
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Malika Elhage Hassan
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Chenyang Yuan
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Yi‐An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Ayman Alkhoder
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Kiran Ejaz
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Zain Alvi
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Alireza Rahbar
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | | | - Wissam A. Jaber
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - William J. Nicholson
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Arshed A. Quyyumi
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
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8
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Werner GS, Hildick-Smith D, Martin Yuste V, Boudou N, Sianos G, Gelev V, Rumoroso JR, Erglis A, Christiansen EH, Escaned J, Di Mario C, Teruel L, Bufe A, Lauer B, Galassi AR, Louvard Y. Three-year outcomes of A Randomized Multicentre Trial Comparing Revascularization and Optimal Medical Therapy for Chronic Total Coronary Occlusions (EuroCTO). EUROINTERVENTION 2023; 19:571-579. [PMID: 37482940 PMCID: PMC10493774 DOI: 10.4244/eij-d-23-00312] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO) improves clinical symptoms and quality of life. The longer-term safety of PCI compared to optimal medical therapy (OMT) remains uncertain. AIMS We sought to evaluate the long-term safety of PCI for CTO in a randomised trial as compared to OMT. METHODS A total of 396 patients with a symptomatic CTO were enrolled into a randomised, multicentre clinical trial comparing PCI and OMT. Half of the patients had a single CTO; the others had multivessel disease. Non-CTO lesions were treated prior to randomisation (2:1 ratio). During follow-up, crossover from OMT to PCI occurred in 7.3% (1 year) and 17.5% (3 years) of patients. RESULTS At 3 years, the incidence of cardiovascular death or nonfatal myocardial infarction was not significantly different between the groups (OMT 3.7% vs PCI 6.2%; p=0.29). By per-protocol analysis, the difference remained non-significant (OMT 5.7% vs PCI 4.7%; p=0.67). Overall, major adverse cardiovascular events (MACE) were more frequent with OMT (OMT 21.2% vs PCI 11.2%), largely because of ischaemia-driven revascularisation. The rates of stroke or hospitalisation for bleeding were not different between the groups. CONCLUSIONS At 3 years there was no difference in the rate of cardiovascular death or myocardial infarction between PCI or OMT among patients with a remaining single coronary CTO. The MACE rate was higher in the OMT group due largely to ischaemia-driven revascularisation. CTO PCI appears to be a safe option for patients with a single remaining significant coronary CTO. CinicalTrials.gov: NCT01760083.
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Affiliation(s)
| | | | | | - Nicolas Boudou
- Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France
| | | | | | | | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Javier Escaned
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Carlo Di Mario
- Department of Cardiology, University of Florence, Florence, Italy
| | - Luis Teruel
- Bellvitge University Hospital, Barcelona, Spain
| | | | - Bernward Lauer
- Medizinische Klinik 1, Klinikum der Friedrich-Schiller Universität, Jena, Germany
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9
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Yassin F, Khan J, Mozid A, Connolly D, Sharma V. The Utility of CT Coronary Angiography in Chronic Total Occlusion Percutaneous Coronary Intervention. Eur Cardiol 2023; 18:e48. [PMID: 37655134 PMCID: PMC10466269 DOI: 10.15420/ecr.2022.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/17/2023] [Indexed: 09/02/2023] Open
Abstract
Chronic total occlusion (CTO) of the coronary arteries is a relatively common finding in routine coronary angiography. Of late, there has been considerable improvement in the success rate of percutaneous intervention for coronary CTO, attributed to technological advancement and skills development. CT coronary angiogram (CTCA) is a simple, non-invasive, and cost-effective test that aids in the diagnosis and management of coronary artery disease, including CTOs. The development of multi-slice CT and the use of 3D volume rendering images has revolutionised the diagnostic abilities of CTCA, with improvements in imaging quality and detailed anatomical and morphological characterisation of the plaque disease. In CTO percutaneous intervention, CTCA is used in pre-procedural planning, applying scoring systems to predict the likely success of the intervention as well as the post-procedural evaluation and follow-up. This review examines the different uses of CTCA in CTO intervention, its impact on successful recanalisation and the areas for future consideration.
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Affiliation(s)
- Firas Yassin
- Department of Cardiology, Birmingham City HospitalBirmingham, UK
| | - Jawad Khan
- Department of Cardiology, Birmingham City HospitalBirmingham, UK
- Aston Medical School, University of AstonBirmingham, UK
| | - Abdul Mozid
- Department of Cardiology, Leeds General InfirmaryLeeds, UK
| | - Derek Connolly
- Department of Cardiology, Birmingham City HospitalBirmingham, UK
- Aston Medical School, University of AstonBirmingham, UK
- University of BirminghamBirmingham, UK
| | - Vinoda Sharma
- Department of Cardiology, Birmingham City HospitalBirmingham, UK
- University of BirminghamBirmingham, UK
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10
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Ayoub M, Mashayekhi K, Behnes M, Schupp T, Akin M, Forner J, Akin I, Neumann FJ, Westermann D, Rudolph V, Toma A. Prognostic Value of Different Levels of Uric Acid in Patients with Coronary Chronic Total Occlusion Undergoing Percutaneous Coronary Intervention. J Clin Med 2023; 12:jcm12113794. [PMID: 37297987 DOI: 10.3390/jcm12113794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Recent data suggest that uric acid (UA) might be an independent predictor of clinical outcomes following percutaneous coronary intervention (PCI). The predictive value of uric acid in patients undergoing PCI for chronic total occlusions (CTO) is unknown. We included patients with CTO who underwent PCI at our center in 2005 and 2012, with available uric acid levels before angiography. Subjects were divided into groups according to uric acid tertiles (<5.5 mg/dL, 5.6-6.9 mg/dL, and >7.0 mg/dL), and outcomes were compared among the groups. Out of the 1963 patients (mean age 65.2 ± 11 years), 34.7% (n = 682) had uric acid concentrations in the first tertile, 34.3% (n = 673) in the second tertile, and 31% (n = 608) in the third tertile. Median follow-up was 3.0 years. Uric acid levels in the first tertile were associated with significantly lower all-cause mortality, as compared to the third tertile, with an adjusted hazard ratio (HR) of 0.67 (95% confidence interval (CI): 0.49 to 0.92; p = 0.012). No significant differences regarding all-cause mortality were found between patients in the first and second tertiles (HR: 0.96 [95% CI: 0.71 to 1.3; p = 0.78]). High levels of uric acid emerged as an independent predictor of all-cause mortality in patients with chronic total occlusion treated with PCI. Hence, uric acid levels should be incorporated into the risk assessment of patients with CTO.
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Affiliation(s)
- Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Volker Rudolph
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1080 Vienna, Austria
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11
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Råmunddal T, Holck EN, Karim S, Eftekhari A, Escaned J, Ioanes D, Walsh S, Spratt J, Veien K, Jensen LO, Tilsted HH, Terkelsen CJ, Havndrup O, Olsen NT, Kajander OA, Faurie B, Lanematt P, Jakobsen L, Christiansen EH. International randomized trial on the effect of revascularization or optimal medical therapy of chronic total coronary occlusions with myocardial ischemia - ISCHEMIA-CTO trial - rationale and design. Am Heart J 2023; 257:41-50. [PMID: 36423733 DOI: 10.1016/j.ahj.2022.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Chronic total occlusions (CTO) are frequent among patients with coronary artery disease. Revascularization with percutaneous coronary intervention (PCI) is safe and feasible in experienced hands. However, randomized data are needed to demonstrate symptomatic as well as prognostic effect of CTO-PCI compared to optimal medical therapy alone. METHODS This trial aims to evaluate the effect of CTO PCI in patients with a CTO lesion and target vessel diameter ≥ 2.5 mm, and myocardial ischemia in the relevant territory. First, all patients are subjected to optimal medical therapy (OMT) for at least for 3 months and non-CTO lesions are managed according to guidelines. Subsequently, prior to randomization myocardial ischemia and quality of life (Seattle Questionnaire (SAQ)) is assessed. Patients are divided into two cohorts based on their SAQ score and randomized to either OMT alone or OMT and CTO-PCI. Cohort A is defined as Low- or asymptomatic patients with a quality-of-life score > 60 and/or CCS class < 2, and more than 10 % ischemia in the left ventricle (LV). Cohort B is symptomatic patients with a quality-of-life score < 60 or CCS class angina > 1 and at least ischemia in 5% of the LV. The primary end-point in cohort A is a composite of major adverse cardiac and cerebral events, hospitalization for heart failure and malignant ventricular arrhythmias. The primary endpoint in cohort B is difference in quality of life 6 months after randomization. IMPLICATIONS This trial is designed to investigate if CTO-PCI improves QoL and MACCE. Both positive and negative outcome of the trial will affect future guidelines and recommendations on how to treat patients with CTO.
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Affiliation(s)
| | | | - Salma Karim
- Dept. Cardiology Aarhus University Hospital, Skejby, Denmark
| | - Ashkan Eftekhari
- Dept. of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Javier Escaned
- Hospital Universitario Clíníco San Carlos, Madrid, Spain
| | - Dan Ioanes
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simon Walsh
- Cardiology Department, Belfast Health & Social Care Trust Belfast, Northern Ireland, United Kingdom
| | - James Spratt
- Edinburgh Royal Infirmary, Edinburgh, United Kingdom
| | | | | | | | | | | | - Niels Thue Olsen
- Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Olli A Kajander
- Tays Heart Hospital and Tampere University, Tampere, Finland
| | - Benjamin Faurie
- Cardiovascular Institute, Groupe Hospitalier Mutualiste, Grenoble, France
| | | | - Lars Jakobsen
- Dept. Cardiology Aarhus University Hospital, Skejby, Denmark
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12
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Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS. Recanalisation of coronary chronic total occlusions. EUROINTERVENTION 2022; 18:535-561. [PMID: 36134683 DOI: 10.4244/eij-d-21-01117] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.
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Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Kambis A Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Roberto Garbo
- GVM Care & Research, Maria Pia Hospital, Turin, Italy
| | | | - Niccolò Ciardetti
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt GmbH, Darmstadt, Germany
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13
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Di Mario C, Ciardetti N. The Ultimate Trial of CTO Recanalization. JACC Cardiovasc Interv 2022; 15:1450-1452. [PMID: 35863794 DOI: 10.1016/j.jcin.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy.
| | - Niccolò Ciardetti
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
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14
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Guo L, Lv H, Yin X. Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Graft: Current Evidence and Future Perspectives. Front Cardiovasc Med 2022; 9:753250. [PMID: 35479272 PMCID: PMC9037955 DOI: 10.3389/fcvm.2022.753250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary chronic total occlusion (CTO), which occurs in 18. 4-52% of all patients referred for coronary angiography, represents one of the last barriers in coronary intervention. Approximately half of all patients with prior coronary artery bypass graft (CABG), who undergo coronary angiography, are diagnosed with coronary CTO. In fact, these patients often develop recurrent symptoms and events, necessitating revascularization. Currently, there is neither a consensus nor developed guidelines for the treatment of CTO patients with prior CABG, and the prognosis of these patients remains unknown. In this review, we discuss current evidence and future perspectives on CTO revascularization in patients with prior CABG, with special emphasis on clinical and lesion characteristics, procedural success rates, periprocedural complications, and long-term outcomes.
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Affiliation(s)
| | | | - Xiaomeng Yin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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15
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Hernandez-Suarez DF, Azzalini L, Moroni F, Tinoco de Paula JE, Lamelas P, Campos CM, Ribeiro MH, Filho EM, de los Santos FD, Padilla L, Alcantara-Melendez M, Abud MA, Almodóvar-Rivera IA, Schmidt MM, Echavarria M, Botelho AC, Del Rio V, Quadros A, Santiago R. Outcomes of chronic total occlusion percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the LATAM CTO registry. Catheter Cardiovasc Interv 2022; 99:245-253. [PMID: 34931448 PMCID: PMC8885848 DOI: 10.1002/ccd.30041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/13/2021] [Accepted: 11/27/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with and without prior coronary artery bypass graft (CABG) surgery. BACKGROUND Data on the outcomes of CTO PCI in patients with versus without CABG remains limited and with scarce representation from developing regions like Latin America. METHODS We evaluated patients undergoing CTO PCI in 42 centers participating in the LATAM CTO registry between 2008 and 2020. Statistical analyses were stratified according to CABG status. The outcomes of interest were technical and procedural success and in-hospital major adverse cardiac and cerebrovascular events (MACCE). RESULTS A total of 1662 patients were included (n = 1411 [84.9%] no-CABG and n = 251 [15.1%] prior-CABG). Compared with no-CABG, those with prior-CABG were older (67 ± 11 vs. 64 ± 11 years; p < 0.001), had more comorbidities and lower left ventricular ejection fraction (52.8 ± 12.8% vs. 54.4 ± 11.7%; p = 0.042). Anatomic complexity was higher in the prior-CABG group (J-CTO score 2.46 ± 1.19 vs. 2.10 ± 1.22; p < 0.001; PROGRESS CTO score 1.28 ± 0.89 vs. 0.91 ± 0.85; p < 0.001). Absence of CABG was associated with lower risk of technical and procedural failure (OR: 0.60, 95% CI: 0.43-0.85 and OR: 0.58, 95% CI: 0.40-0.83, respectively). No significant differences in the incidence of in-hospital MACCE (3.8% no-CABG vs. 4.4% prior-CABG; p = 0.766) were observed between groups. CONCLUSION In a contemporary multicenter CTO-PCI registry from Latin America, prior-CABG patients had more comorbidities, higher anatomical complexity, lower success, and similar in-hospital adverse event rates compared with no-CABG patients.
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Affiliation(s)
- Dagmar F. Hernandez-Suarez
- Division of Cardiology, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Francesco Moroni
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Pablo Lamelas
- Interventional Cardiology Division, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina,Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Carlos M. Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil,Instituto Prevent Senior, São Paulo, Brazil
| | | | | | - Felix Damas de los Santos
- National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico,Cardiovascular Center Centro Medico ABC, Mexico City, Mexico
| | - Lucio Padilla
- Interventional Cardiology Division, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Marco Alcantara-Melendez
- Centro Medico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico,Hospital Medica Sur, Mexico City, Mexico
| | - Marcelo A. Abud
- Percutaneous endovascular therapy department, Sanatorio San Gerónimo, Santa Fe, Argentina
| | | | | | | | | | - Valentin Del Rio
- PCI Cardiology Group, Manatí, Puerto Rico,Bayamon Heart and Lung Institute, Bayamón Medical Center, Bayamón, Puerto Rico
| | | | - Ricardo Santiago
- PCI Cardiology Group, Manatí, Puerto Rico,Bayamon Heart and Lung Institute, Bayamón Medical Center, Bayamón, Puerto Rico
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16
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Yang L, Guo L, Lv H, Liu X, Zhong L, Ding H, Zhou X, Zhu H, Huang R. Predictors of Adverse Events Among Chronic Total Occlusion Patients Undergoing Successful Percutaneous Coronary Intervention and Medical Therapy. Clin Interv Aging 2021; 16:1847-1855. [PMID: 34703218 PMCID: PMC8523319 DOI: 10.2147/cia.s337069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Limited data are available on the predictors of major adverse cardiac events (MACE) after a successful coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and medical therapy. This study aimed to identify predictors of MACE in CTO patients undergoing successful recanalization and medical therapy. Methods A total of 2015 patients with CTOs were enrolled. About 718 patients underwent successful CTO recanalization, and 1297 patients received medical therapy. The primary outcome was the frequency of MACE, defined as a composite of cardiac death, myocardial infarction, and target-vessel revascularization. Multivariate models were used to determine predictors of MACE. Results In successful CTO recanalization group, MACE occurred in 123 (17.1%) patients. In multivariate analysis, heart failure (hazard ratio [HR] 1.77, 95% confidence interval [CI]: 1.04–3.04, p = 0.036) was identified as independent predictors for MACE in successful CTO recanalization. Additionally, in medical therapy group, the significant predictors of MACE were male gender (HR 1.53, 95% CI: 1.13–2.05, p = 0.005), diabetes mellitus (HR 1.39, 95% CI: 1.11–1.74, p = 0.003), heart failure (HR 1.44, 95% CI: 1.10–1.87, p = 0.007), J-CTO score (HR 1.17, 95% CI: 1.07–1.28, p = 0.001) and multivessel disease (HR 2.20, 95% CI: 1.42–3.39, p < 0.001). Conclusion Heart failure was predictor for composite cardiovascular events in patients with CTO after successful recanalization. Male gender, diabetes mellitus, heart failure, J-CTO score and multivessel disease were predictors of MACE in CTO patients with medical therapy.
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Affiliation(s)
- Le Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China.,Department of Cardiology, Dalian Third People's Hospital, Dalian City, People's Republic of China
| | - Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Haichen Lv
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Xiaodong Liu
- Department of Radiology, Dalian Friendship Hospital, Dalian City, People's Republic of China
| | - Lei Zhong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Huaiyu Ding
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Xuchen Zhou
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Hao Zhu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Rongchong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China.,Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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17
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Rivera-López R, García-López C, Sánchez-Moreno JM, Rivera-López RA, Almansa-López J, Rivera-Fernández R, Molina-Navarro E, Jiménez-Fernández M, Ortiz-Pérez S, Ramírez-Hernández JA. High Incidence of Cataracts in the Follow-Up of Patients Undergoing Percutaneous Coronary Intervention for Chronic Coronary Total Occlusion. J Clin Med 2021; 10:jcm10215002. [PMID: 34768525 PMCID: PMC8584919 DOI: 10.3390/jcm10215002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Development of cataracts is a well-known adverse effect of ionizing radiation, but little information is available on their incidence in patients after other medical procedures, such as cardiac catheterizations. The study objective was to determine the incidence of cataracts in a cohort of patients undergoing percutaneous coronary intervention (PCI) for chronic coronary total occlusion (CTO) and its association with radiation dose. The study analyzed the incidence of cataracts during the follow-up of 126 patients who underwent chronic total coronary PCI, using Cox regression to identify predictive factors of cataract development. The study included 126 patients, 86.9% male, with a mean age of 60.5 years (range, 55.0-68.0 years). Twenty-three (18.2% n = 23) developed cataracts during a mean follow-up of 49.5 months (range 37.3-64.5 months). A higher incidence was observed in patients who received more than 5 Gy (29.0% vs. 14.7%, Hazard ratio (HR = 2.84 [1.19-6.77]). Multivariate analysis revealed a relationship between cataract development during the follow-up and a receipt of radiation dose >5 Gy (HR = 2.60, 95% confidence interval [CI 1.03-6.61]; p = 0.03), presence or history of predisposing eye disease (HR = 4.42, CI:1.57-12.40), diabetes (HR = 3.33 [1.22-9.24]), and older age, as in >57 (HR, 6.40 [1.81-22.61]). An elevated incidence of cataracts was observed in patients after PCI for CTO. The onset of cataracts is related to the radiation dose during catheterization, which is a potentially avoidable effect of which operators should be aware.
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Affiliation(s)
- Ricardo Rivera-López
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
| | - Celia García-López
- Department of Ophtalmology, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- Correspondence: ; Tel.: +34-958020009
| | - José M. Sánchez-Moreno
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | | | - Julio Almansa-López
- Radiophysics Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | | | - Eduardo Molina-Navarro
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | - Miriam Jiménez-Fernández
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | - Santiago Ortiz-Pérez
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
- Department of Ophtalmology, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- University of Granada (UGR), 18016 Granada, Spain;
| | - José A. Ramírez-Hernández
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
- Medicine Department, University of Granada (UGR), 18016 Granada, Spain
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18
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Fogelson B, Tahir H, Livesay J, Baljepally R. Iatrogenic Arteriovenous Fistula Secondary to Coronary Artery Dissection Caused by Contrast Injection Into a Chronically Occluded Right Coronary Artery. J Med Cases 2021; 12:411-414. [PMID: 34691338 PMCID: PMC8510666 DOI: 10.14740/jmc3754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 11/21/2022] Open
Abstract
Coronary arteriovenous fistulas and coronary cameral fistulas are rare anomalies that involve the abnormal communication between a coronary artery and a venous structure, such as a coronary vein or a right-sided cardiac chamber. Iatrogenic coronary arteriovenous fistulas and coronary cameral fistulas can be uncommon complications of coronary artery angiography and intervention. Acquired coronary arteriovenous fistulas that develop during percutaneous coronary intervention of chronic total occlusions have been previously reported in the literature. However, a coronary arteriovenous fistula resulting from contrast injection into a chronically and totally occluded right coronary artery during diagnostic coronary angiography is very rare. We present a unique case of a contrast-induced iatrogenic right coronary dissection leading to a coronary arteriovenous fistula communicating to the right atrium through the middle cardiac vein.
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Affiliation(s)
- Benjamin Fogelson
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Hassan Tahir
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - James Livesay
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Raj Baljepally
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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19
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DeLago AJ, Essa M, Ghajar A, Hammond-Haley M, Parvez A, Nawaz I, Shalhoub J, Marshall DC, Nazarian S, Calkins H, Salciccioli JD, Philips B. Incidence and Mortality Trends of Atrial Fibrillation/Atrial Flutter in the United States 1990 to 2017. Am J Cardiol 2021; 148:78-83. [PMID: 33640365 DOI: 10.1016/j.amjcard.2021.02.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/07/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
Atrial fibrillation (AF) and flutter (AFL) are the most common clinically significant arrhythmias in older adults with an increasing disease burden due to an aging population. However, up-to-date trends in disease burden and regional variation remain unknown. In an observational study utilizing the Global Burden of Disease (GBD) database, age-standardized mortality and incidence rates for AF overall and for each state in the United States (US) from 1990 to 2017 were determined. All analyses were stratified by gender. The relative change in age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) over the observation period were determined. Trends were analyzed using Joinpoint regression analysis. The mean ASIR per 100,000 population for men was 92 (+/-8) and for women was 62 (+/-5) in the US in 2017. The mean ASDR per 100,000 population for men was 5.8 (+/-0.3) and for women was 4.4 (+/-0.4). There were progressive increases in ASIR and ASDR in all but 1 state. The states with the greatest percentage change in incidence were New Hampshire (+13.5%) and Idaho (+16.0%) for men and women, respectively. The greatest change regarding mortality was seen in Mississippi (+26.3%) for men and Oregon (+53.8%) for women. In conclusion these findings provide updated evidence of increasing AF and/or AFL incidence and mortality on a national and regional level in the US, with women experiencing greater increases in incidence and mortality rates. This study demonstrates that the public health burden related to AF in the United States is progressively worsening but disproportionately across states and among women.
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20
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Shoaib A, Mohamed M, Curzen N, Ludman P, Zaman A, Rashid M, Nolan J, Azam ZA, Kinnaird T, Mamas MA. Clinical outcomes of percutaneous coronary intervention for chronic total occlusion in prior coronary artery bypass grafting patients. Catheter Cardiovasc Interv 2021; 99:74-84. [PMID: 33942465 DOI: 10.1002/ccd.29691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/12/2021] [Accepted: 03/23/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the clinical characteristics and outcomes in patients with stable angina who have undergone chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in native arteries with or without prior coronary artery bypass grafting (CABG) surgery in a national cohort. BACKGROUND There are limited data on outcomes of patients presenting with stable angina undergoing CTO PCI with previous CABG. METHODS We identified 20,081 patients with stable angina who underwent CTO PCI between 2007-2014 in the British Cardiovascular Intervention Society database. Clinical, demographical, procedural and outcome data were analyzed in two groups; group 1-CTO PCI in native arteries without prior CABG (n = 16,848), group 2-CTO PCI in native arteries with prior CABG (n = 3,233). RESULTS Patients in group 2 were older, had more comorbidities and higher prevalence of severe left ventricular systolic dysfunction. Following multivariable analysis, no significant difference in mortality was observed during index hospital admission (OR:1.33, CI 0.64-2.78, p = .44), at 30-days (OR: 1.28, CI 0.79-2.06, p = .31) and 1 year (OR:1.02, CI 0.87-1.29, p = .87). Odds of in-hospital major adverse cardiovascular events (MACE) (OR:1.01, CI 0.69-1.49, p = .95) and procedural complications (OR:1.02, CI 0.88-1.18, p = .81) were similar between two groups but procedural success rate was lower in group 2 (OR: 0.34, CI 0.31-0.39, p < .001). The adjusted risk of target vessel revascularization (TVR) remained similar between the two groups at 30-days (OR:0.68, CI 0.40-1.16, P-0.16) and at 1 year (OR:1.01, CI 0.83-1.22, P-0.95). CONCLUSION Patients with prior CABG presenting with stable angina and treated with CTO PCI in native arteries had more co-morbid illnesses but once these differences were adjusted for, prior CABG did not independently confer additional risk of mortality, MACE or TVR.
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Affiliation(s)
- Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Nick Curzen
- Medicine department, University of Southampton, Southampton, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Azfar Zaman
- Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - James Nolan
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Ziyad A Azam
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Tim Kinnaird
- Cardiology department, University Hospital of Wales, Cardiff, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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21
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Scotti A, Godino C, Munafò A, Pivato CA, Chiarito M, Fiore G, Di Maio S, Vergara P, Della Bella P, Carlino M, Margonato A, Colombo A. Cardiac and sudden death after chronic total occlusion percutaneous coronary intervention: Prognostic role of the target vessel. Catheter Cardiovasc Interv 2021; 97:E789-E800. [PMID: 33332744 DOI: 10.1002/ccd.29425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The role of the target vessel in percutaneous revascularization of chronic total occlusion (CTO) is unclear. OBJECTIVE We sought to assess the long-term results of percutaneous coronary intervention (PCI) for CTO lesions in each coronary artery and to investigate the impact of successful revascularization and previous myocardial infarction (MI) in the territory of the target vessel. METHODS AND RESULTS Cohort observational study on 1,124 patients who have undergone CTO PCI attempt: 371 on left anterior descending artery (LAD), 485 right coronary artery, and 268 left circumflex. Patients were further stratified by successfully revascularized and not-revascularized CTO (CTO-NR). Vessels affected by a previous MI were defined as infarct-related artery (IRA). The primary endpoint was cardiac death; the secondary endpoint was the combined rate of sudden cardiac-death and sustained ventricular-arrhythmias (SCD/SVAs). Propensity score-matching was performed to evaluate LAD versus NON-LAD CTO. Up to 12-year follow-up, the clinical benefit associated with successful PCI was consistent across the three groups. CTO-NR had the greatest association with cardiac death and SCD/SVAs in each coronary artery and in IRA-CTO patients. CONCLUSIONS Unsuccessful percutaneous CTO revascularization was associated with lower cardiac survival and freedom from SCD/SVAs, irrespective of the vessel treated. This result was mainly driven by patients with an IRA CTO.
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Affiliation(s)
- Andrea Scotti
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.,Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Munafò
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo A Pivato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Cardio Center, Humanitas Research Hospital, Milan, Italy
| | - Mauro Chiarito
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Cardio Center, Humanitas Research Hospital, Milan, Italy
| | - Giorgio Fiore
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Silvana Di Maio
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Vergara
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Paolo Della Bella
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Mauro Carlino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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22
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Qiao X, Zhang WJ, Guo WF, Li Y, Liang XY, Wang ZL. Comparison of Clinical Outcomes Between Second-and First-Generation Drug-Eluting Stents in Patients With Chronic Total Occlusion Lesion: A Meta-Analysis. Front Cardiovasc Med 2021; 8:598046. [PMID: 33959639 PMCID: PMC8096061 DOI: 10.3389/fcvm.2021.598046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives: The second-generation drug-eluting stents have been used to treat chronic total occlusion lesion. However, there is limited evidence of the clinical outcomes that whether the second-generation drug-eluting stents is superior to first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The study aimed to compare the differences in clinical outcomes between the two generations drug-eluting stents in patients with those by a meta-analysis. Methods: PubMed, Embase, the Cochrane library and Web of science databases were systemically searched before March, 2021. Randomized controlled trials and observational studies were included to compare the second-generation drug-eluting stents with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The clinical outcomes were major adverse cardiac events (MACE), target vessel revascularization, myocardial infarction, all-cause death. Fixed effects models were used to calculate the odds ratio (OR) and 95% confidence interval (CI) of each clinical outcome. Sensitivity analysis was performed to detect potential sources of heterogeneity. Subgroup analyses were used to assess the differential effects. Results: The meta-analysis included eight studies involving 4,583 patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. Pooled analysis showed that the incidence of MACE (OR = 0.68, 95%CI 0.54–0.85, P = 0.0008), target vessel revascularization (OR = 0.70, 95%CI 0.54–0.91, P = 0.007), and myocardial infarction (OR = 0.58, 95%CI 0.37–0.93, P = 0.02) were lower in the second-generation drug-eluting stents compared with the first-generation ones. However, there was not difference in all-cause deaths between two drug-eluting stents (OR = 0.67, 95%CI 0.45–1.01, P = 0.05). Conclusions: The second-generation drug-eluting stents are associated with lower MACE, target vessel revascularization, and myocardial infarction compared with the first-generation ones in patients with chronic total occlusion lesion undergoing percutaneous coronary intervention. The results of this study can provide a reference for the selection of stents in patients with chronic total occlusion lesion. Further randomized controlled trials are needed to verify that the second-generation drug-eluting stents is superior to the first-generation ones in patients with chronic total occlusion (Registered by PROSPERO, CRD42020158406).
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Affiliation(s)
- Xuan Qiao
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Wen-Jiao Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Wen-Fen Guo
- Department of Cardiology, Baiyin Third People's Hospital, Baiyin, China
| | - Yan Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xi-Ying Liang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Zhi-Lu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
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23
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Mahadevan K, Cosgrove C, Strange JW. Factors Influencing Stent Failure in Chronic Total Occlusion Coronary Intervention. Interv Cardiol 2021; 16:e27. [PMID: 34721666 PMCID: PMC8532005 DOI: 10.15420/icr.2021.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
Stent failure remains one of the greatest challenges for interventional cardiologists. Despite the evolution to superior second- and third-generation drug-eluting stent designs, increasing use of intracoronary imaging and the adoption of more potent antiplatelet regimens, registries continue to demonstrate a prevalence of stent failure or target lesion revascularisation of 15-20%. Predisposition to stent failure is consistent across both chronic total occlusion (CTO) and non-CTO populations and includes patient-, lesion- and procedure-related factors. However, histological and pathophysiological properties specific to CTOs, alongside complex strategies to treat these lesions, may potentially render percutaneous coronary interventions in this cohort more vulnerable to failure. Prevention requires recognition and mitigation of the precipitants of stent failure, optimisation of interventional techniques, including image-guided precision percutaneous coronary intervention, and aggressive modification of a patient's cardiovascular risk factors. Management of stent failure in the CTO population is technically challenging and itself begets recurrence. We aim to provide a comprehensive review of factors influencing stent failure in the CTO population and strategies to attenuate these.
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Affiliation(s)
- Kalaivani Mahadevan
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation TrustBristol, UK
| | - Claudia Cosgrove
- Department of Cardiology, St George’s University NHS TrustLondon, UK
| | - Julian W Strange
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation TrustBristol, UK
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24
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Morino Y. A contemporary review of clinical significances of percutaneous coronary intervention for chronic total occlusions, with some Japanese insights. Cardiovasc Interv Ther 2021; 36:145-157. [PMID: 33656694 DOI: 10.1007/s12928-021-00766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
The clinical "significance" of percutaneous coronary intervention for coronary chronic total occlusion (CTO-PCI) has been evaluated. In the beginning, the effects on clinical endpoints were investigated by comparisons between cases of success and failure of CTO-PCI, which mostly demonstrated better long-term outcomes in the successful cases. Similarly, improvement of cardiac function or wall motion was proven by serial observational studies. Accordingly, several prospective randomized trials (RCTs), which should confirm such accumulated potential benefits, were recently conducted by comparison with studies of patients that had received optical medical therapy (OMT) alone. While they mostly demonstrated significant improvement of angina symptoms and quality of life (QOL) in the CTO-PCI group, they failed to prove a reduction of clinical events or improvement of left ventricle wall motion, compared with OMT. Concurrent guidelines or consensus documents emphasize that the principal indication for CTO-PCI is to improve symptoms. To determine strategy, the following must be discussed in each individual case: the probability of procedural success, the expectation of long-term patency, and an assessment of the balance between procedure-related complications and overall benefits. In essence, we believe the following facts to be the current sincere appraisal of CTO-PCI: (1) improvements of symptoms and QOL are established, but the others remain inconclusive, and; (2) their margins for improvement are narrowing and numbers of candidates are shrinking. Precision medicine or individualization may be the right directions to take, to enhance the potential of this treatment. This course of action demands discrimination of those candidates who will truly receive benefits from invasive treatment, and that still requires further clinical studies or actions.
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Affiliation(s)
- Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idai-Odori, Yahaba, Iwate, 028-3695, Japan.
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25
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Bryniarski L, Opolski MP, Wójcik J, Lesiak M, Pawłowski T, Drozd J, Wojakowski W, Surowiec S, Dąbrowski M, Witkowski A, Dudek D, Grygier M, Bartuś S. Chronic total occlusion percutaneous coronary intervention in everyday clinical practice - an expert opinion of the Association of Cardiovascular Interventions of the Polish Cardiac Society. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:6-20. [PMID: 33868413 PMCID: PMC8039914 DOI: 10.5114/aic.2021.104763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 11/17/2022] Open
Abstract
Coronary chronic total occlusions (CTO) are increasingly encountered during invasive and non-invasive coronary angiography and remain the most challenging lesions for percutaneous revascularization. During recent years success rates and safety outcomes of CTO percutaneous coronary intervention (PCI) have substantially improved, particularly due to the introduction of new techniques and dedicated equipment as well as specialized training programs of CTO operators. Significantly, the steady advances in CTO PCI techniques have coincided with the new data from randomized clinical trials supporting the role of percutaneous recanalization of CTO in relieving angina and improving the quality of life. The current expert consensus document outlines the rationale, clinical outcomes as well as technical, safety and reimbursement issues of CTO PCI. In addition, the requirements for achieving and maintaining competency in CTO PCI among interventional cardiologists are discussed. Finally, we present the modified hybrid algorithm (the so-called Polish hybrid algorithm) providing some unique refinements to the contemporary CTO PCI strategies. Continuous efforts (including active engagement with the payer) are urgently needed to increase guideline-recommended referrals to CTO PCI, and thus improve the quality of life of CTO patients in Poland.
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Affiliation(s)
- Leszek Bryniarski
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maksymilian P. Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Jarosław Wójcik
- Hospital of Invasive Cardiology IKARDIA, Lublin/Nałęczów, Poland
| | - Maciej Lesiak
- First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Pawłowski
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jakub Drozd
- Department of Cardiology, SP ZOZ MSWiA, Lublin, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Sławomir Surowiec
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Dariusz Dudek
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Grygier
- First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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26
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Kawashima H, Takahashi K, Ono M, Hara H, Wang R, Gao C, Sharif F, Mack MJ, Holmes DR, Morice MC, Head SJ, Kappetein AP, Thuijs DJFM, Milojevic M, Noack T, Mohr FW, Davierwala PM, Serruys PW, Onuma Y. Mortality 10 Years After Percutaneous or Surgical Revascularization in Patients With Total Coronary Artery Occlusions. J Am Coll Cardiol 2021; 77:529-540. [PMID: 33538250 DOI: 10.1016/j.jacc.2020.11.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The long-term clinical benefit after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with total occlusions (TOs) and complex coronary artery disease has not yet been clarified. OBJECTIVES The objective of this analysis was to assess 10-year all-cause mortality in patients with TOs undergoing PCI or CABG. METHODS This is a subanalysis of patients with at least 1 TO in the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which investigated 10-year all-cause mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial, beyond its original 5-year follow-up. Patients with TOs were further stratified according to the status of TO recanalization or revascularization. RESULTS Of 1,800 randomized patients to the PCI or CABG arm, 460 patients had at least 1 lesion of TO. In patients with TOs, the status of TO recanalization or revascularization was not associated with 10-year all-cause mortality, irrespective of the assigned treatment (PCI arm: 29.9% vs. 29.4%; adjusted hazard ratio [HR]: 0.992; 95% confidence interval [CI]: 0.474 to 2.075; p = 0.982; and CABG arm: 28.0% vs. 21.4%; adjusted HR: 0.656; 95% CI: 0.281 to 1.533; p = 0.330). When TOs existed in left main and/or left anterior descending artery, the status of TO recanalization or revascularization did not have an impact on the mortality (34.5% vs. 26.9%; adjusted HR: 0.896; 95% CI: 0.314 to 2.555; p = 0.837). CONCLUSIONS At 10-year follow-up, the status of TO recanalization or revascularization did not affect mortality, irrespective of the assigned treatment and location of TOs. The present study might support contemporary practice among high-volume chronic TO-PCI centers where recanalization is primarily offered to patients for the management of angina refractory to medical therapy when myocardial viability is confirmed. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
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Affiliation(s)
- Hideyuki Kawashima
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland. https://twitter.com/HideyukiKawash2
| | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Masafumi Ono
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Hironori Hara
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor Scott and White Health, Dallas, Texas, USA
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital Privé Jacques Cartier, Générale de Santé Massy, France
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | | | - Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
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Fujii S, Miki K, Aizawa Y, Karakama J, Fujita K, Maehara T, Nemoto S, Sumita K. Mid-/Long-Term Outcome of Neuroendovascular Treatment for Chronic Carotid Artery Total Occlusion. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:288-294. [PMID: 37501906 PMCID: PMC10370975 DOI: 10.5797/jnet.oa.2020-0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/26/2020] [Indexed: 07/29/2023]
Abstract
Objective The natural course of chronic carotid artery total occlusion (CTO) is poor. Previous reports suggested that carotid artery stenting (CAS) improves the clinical outcome of CTO. However, its long-term efficacy has not been established. This study assessed the mid- and long-term clinical outcome of CAS for CTO. Methods We evaluated the clinical outcome of 15 patients who underwent CAS for CTO between September 2010 and October 2019. Results The technical success rate of recanalization was 93.3% (14 of 15 patients). Eight patients were treated using self-expanding stents, and six were treated using self-expanding coronary stents. Symptomatic procedure-related complications developed in two patients (13.3%). During the follow-up period (mean 34.9 months), symptomatic ipsilateral stroke was not noted. One patient (7.1%) developed asymptomatic re-occlusion, but stent patency was preserved in 13 patients (92.9%). Conclusion CAS for CTO may be safe and feasible based on the mid- and long-term outcome.
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Affiliation(s)
- Shoko Fujii
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazunori Miki
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Aizawa
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Karakama
- Department of Functional Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyohei Fujita
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Functional Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeru Nemoto
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Sumita
- Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Silveira JBD. Do we need a new score in order to perform a contemporary percutaneous coronary intervention of a chronic total occlusion? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Silveira JBD. Do we need a new score in order to perform a contemporary percutaneous coronary intervention of a chronic total occlusion? Rev Port Cardiol 2020; 39:583-585. [PMID: 32958410 DOI: 10.1016/j.repc.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- João Brum da Silveira
- Laboratório de Hemodinâmica, Centro Hospitalar e Universitário do Porto, Hospital de Santo António, Porto, Portugal.
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Ebisawa S, Kohsaka S, Muramatsu T, Kashima Y, Okamura A, Yamane M, Sakurada M, Matsuno S, Kijima M, Habara M. Derivation and validation of the J-CTO extension score for pre-procedural prediction of major adverse cardiac and cerebrovascular events in patients with chronic total occlusions. PLoS One 2020; 15:e0238640. [PMID: 32915843 PMCID: PMC7485776 DOI: 10.1371/journal.pone.0238640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022] Open
Abstract
We developed a prediction model of long-term risk after percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) based on pre-procedural clinical information. A total of 4,139 eligible patients, who underwent CTO-PCI at 52 Japanese centers were included. Specifically, 1,909 patients with 1-year data were randomly divided into the derivation (n = 1,273) and validation (n = 636) groups. Major adverse cardiac and cardiovascular event (MACCE) was the primary endpoint, including death, stroke, revascularization, and non-fatal myocardial infarction. We assessed the performance of our model using the area under the receiver operating characteristic curve (AUC) and assigned a simplified point-scoring system. One-hundred-thirty-eight (10.8%) patients experienced MACCE in the derivation cohort with hemodialysis (HD: odds ratio [OR] = 2.55), left ventricular ejection fractions (LVEF) <35% (OR = 2.23), in-stent occlusions (ISO: OR = 2.27), and diabetes mellitus (DM: OR = 1.72). The AUC of the derivation model was 0.650. The model's performance was similar in the validation cohort (AUC, 0.610). When assigned a point for each associated factor (HD = 3, LVEF <35%, ISO = 2, and DM = 1 point), the average predicted versus the observed MACCE probability using the Japan-CTO extension score for the low, moderate, high, and very high risk groups was 8.1% vs. 7.3%, 16.9% vs. 15.9%, 22.0% vs. 26.1%, and 56.2% vs. 44.4%, respectively. This novel risk model may allow for the estimation of long-term risk and be useful in disseminating appropriate revascularization procedures.
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Affiliation(s)
- Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Yoshifumi Kashima
- Division of Cardiology, Sapporo Cardio Vascular Clinic, Hokkaido, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Masahisa Yamane
- Cardiology Department, Saitama Sekishinkai Hospital, Saitama, Japan
| | - Masami Sakurada
- Department of Cardiology, Tokorozawa Heart Center, Saitama, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Mikihiro Kijima
- Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
| | - Maoto Habara
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
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31
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Tsai CT, Huang WC, Teng HI, Tsai YL, Lu TM. Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus. Cardiovasc Diabetol 2020; 19:119. [PMID: 32738906 PMCID: PMC7395357 DOI: 10.1186/s12933-020-01093-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetes mellitus is one of the risk factors for coronary artery disease and frequently associated with multivessels disease and poor clinical outcomes. Long term outcome of successful revascularization of chronic total occlusions (CTO) in diabetes patients remains controversial. METHODS AND RESULTS From January 2005 to December 2015, 739 patients who underwent revascularization for CTO in Taipei Veterans General Hospital were included in this study, of which 313 (42%) patients were diabetes patients. Overall successful rate of revascularization was 619 (84%) patients whereas that in diabetics and non-diabetics were 265 (84%) and 354 (83%) respectively. Median follow up was 1095 days (median: 5 years, interquartile range: 1-10 years). During 3 years follow-up period, 59 (10%) in successful group and 18 (15%) patients in failure group died. Although successful revascularization of CTO was non-significantly associated with better outcome in total cohort (hazard ratio (HR): 0.593, 95% confidence interval (CI) 0.349-0.008, P: 0.054), it might be associated with lower risk of all-cause mortality (HR: 0.307, 95% CI 0.156-0.604, P: 0.001) and CV mortality (HR: 0.266, 95% CI 0.095-0.748, P: 0.012) in diabetics (P: 0.512). In contrast, successful CTO revascularization didn't improve outcomes in non-diabetics (all P > 0.05). In multivariate cox regression analysis, successful CTO revascularization remained an independent predictor for 3-years survival in diabetic subgroup (HR: 0.289, 95% CI 0.125-0.667, P: 0.004). The multivariate analysis result was similar after propensity score matching (all-cause mortality, HR: 0.348, 95% CI 0.142-0.851, P: 0.021). CONCLUSIONS Successful CTO revascularization in diabetes may be related to better long term survival benefit but not in non-diabetic population.
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Affiliation(s)
- Chuan-Tsai Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-I Teng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Lin Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tse-Min Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan. .,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 4038] [Impact Index Per Article: 1009.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Liu MJ, Chen CF, Gao XF, Liu XH, Xu YZ. In-hospital outcomes of chronic total occlusion percutaneous coronary intervention in patients with and without prior coronary artery bypass graft: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e19977. [PMID: 32501965 PMCID: PMC7306325 DOI: 10.1097/md.0000000000019977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/04/2020] [Accepted: 03/21/2020] [Indexed: 12/29/2022] Open
Abstract
The clinical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in prior coronary artery bypass graft (pCABG) patients have been investigated; however, the results are inconsistent.The present meta-analysis compared the clinical outcomes of CTO PCI in patients with and without prior CABG (nCABG). The endpoints included technical success, procedural success, all-cause mortality, myocardial infarction (MI), major bleeding, coronary perforation, pericardial tamponade, emergency CABG, and vascular access complication.A total of 7 studies comprising of 11099 patients were included in this meta-analysis. The results showed that compared to nCABG patents, pCABG patients were associated with lower technical success (82.3% versus 87.8%; OR, 0.60; 95% CI, 0.53-0.68; P < .00001; I = 0%) and procedural success (80.4% versus 86.2%; OR, 0.61; 95% CI, 0.53-0.70; P < .00001; I = 10%); a higher risk of all-cause mortality (OR, 2.95; 95% CI, 1.56-5.57; P = 0.0008; I = 0%), MI (OR, 2.30; 95% CI, 1.40-3.80; P = .001; I = 5%), and coronary perforation (OR, 2.16; 95% CI, 1.51-3.08; P < 0.0001; I = 52%). On the other hand, the risk of pericardial tamponade (OR, 0.42; 95% CI, 0.15-1.18; P = .10; I = 21%), major bleeding (OR, 1.51; 95% CI, 0.90-2.53; P = .11; I = 0%), vascular access complication (OR, 1.50; 95% CI, 0.93-2.41; P = .10; I = 0%), and emergency CABG (OR, 0.99; 95% CI, 0.25-3.91; P = .99; I = 0%) was similar in both groups.Compared to nCABG patients, pCABG patients had lower CTO PCI success rates, higher rates of in-hospital mortality, MI, and coronary perforation, and similar risk of pericardial tamponade and vascular complication rates.
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Othman H, Seth M, Zein R, Rosman H, Lalonde T, Yamasaki H, Alaswad K, Menees D, Mehta RH, Gurm H, Daher E. Percutaneous Coronary Intervention for Chronic Total Occlusion—The Michigan Experience. JACC Cardiovasc Interv 2020; 13:1357-1368. [DOI: 10.1016/j.jcin.2020.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/27/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
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Yoshida R, Ishii H, Morishima I, Tanaka A, Takagi K, Yoshioka N, Morita Y, Unno K, Yoshida Y, Tsuboi H, Murohara T. Rotational Atherectomy for Severely Calcified Lesions in Patients With Left Ventricular Systolic Dysfunction: One-Year Outcomes From aSingle-Center Registry Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1220-1227. [PMID: 32457019 DOI: 10.1016/j.carrev.2020.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/02/2020] [Accepted: 03/31/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND High-risk percutaneous coronary intervention (PCI) in patients with left ventricular (LV) systolic dysfunction has been proven to induce reverse LV remodeling. However, the impact of high-risk PCI focusing on rotational atherectomy (RA) in patients with severe LV systolic dysfunction has not been completely addressed. METHODS Among 4339 consecutive patients who underwent PCI, 178 patients with 192 lesions were treated with RA. The reduced ejection fraction (EF) group (LVEF ≤35%) included 25 patients, the mid-range EF group (LVEF 36-50%) included 44 patients, and the preserved EF group (LVEF >50%) included 109 patients. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and ischemic stroke. RESULTS The cumulative 1-year incidence of the primary outcome was similar among the three groups (reduced EF, 29%; mid-range EF, 25%; preserved EF, 26%; p = 0.95). After adjusting for confounding factors, the incidence of the primary outcome in the reduced EF group (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.43-2.37; p = 0.87) and the mid-range EF group (HR, 0.99; 95% CI, 0.47-1.94; p = 0.97) was similar to that in the preserved EF group. LVEF was significantly improved in the reduced EF and mid-range EF groups compared with the preserved EF group (absolute change in LVEF: 13.6 ± 11.3%, 9.0 ± 10.1%, and -0.7 ± 7.8%, respectively; p < 0.0001). CONCLUSIONS Reduced EF was not associated with increase in the primary outcome in patients undergoing RA. This seemed to result from the improved LV function after PCI. SUMMARY FOR ANNOTATED TABLE OF CONTENTS This single center analysis study investigated 1-year composite outcome of cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and ischemic stroke in patients with severe LV systolic dysfunction undergoing RA compared with that in patients with preserved LV function. The cumulative 1-year incidence of the composite outcome was similar among the three groups (reduced EF, 29%; mid-range EF, 25%; preserved EF, 26%; p = 0.95). LVEF was significantly improved in the reduced EF and mid-range EF groups compared with the preserved EF group (absolute change in LVEF: 13.6 ± 11.3%, 9.0 ± 10.1%, and -0.7 ± 7.8%, respectively; p < 0.0001).
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Affiliation(s)
- Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan; Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan; Department of Cardiology, Japanese RedCross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan.
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Kazumasa Unno
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan; Department of Cardiology, Japanese RedCross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Japanese RedCross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan
| | - Hideyuki Tsuboi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan
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Tian J, Zuo H, Zhang L, Zhang M, Zhang D, Zhang M, Zhou Y, He Y, Mi H, Yang X, Huang R, Song X. The success of opening concurrent chronic total occlusion lesion to improve cardiac function trial in patients with multi-vessel disease (SOS-moral): Study protocol of a prospective multicenter study. Medicine (Baltimore) 2020; 99:e20349. [PMID: 32481325 PMCID: PMC7249893 DOI: 10.1097/md.0000000000020349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS The purpose of the present trial is to determine whether opening co-existing chronic total occlusions (CTOs) using percutaneous coronary interventions (PCIs) improves cardiac function in patients with multi-vessel disease (MVD). Patients with MVD are defined as having at least one additional major vessel exhibiting no less than 75% stenosis combined with the presence of a CTO artery. METHODS AND RESULTS Patients will be prospectively recruited who meet the following criteria:Patients presenting with no necrosis of myocardial tissue in the territory of the CTO will be excluded. Recruited patients will be randomized into 2 groups: those undergoing PCI of only the non-CTO artery (non-CTO PCI group), and those undergoing PCI of the non-CTO artery concurrently with the CTO artery (CTO-PCI group). The primary outcome will be the change in cardiac function evaluated via CMR at a 12-month of follow-up appointment, which will be compared to a baseline measurement. Secondary outcomes include occurrence of major cardiac events, CMR-assessed myocardial viability in the CTO-supplied territory, and quality of life assessed by Seattle angina questionnaire, Patient Health Questionnaire 9 and Generalized Anxiety Disorder Scale-7 after 12-month follow-up. CONCLUSION The SOS-moral trial will provide data necessary to determine whether to open concurrent CTOs among MVD patients with CMR-detected necrotic myocardial tissue.
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Affiliation(s)
| | | | - Lijun Zhang
- Department of Radiology, Beijing Anzhen Hospital
| | | | | | | | | | - Yi He
- Department of Radiology, Beijing Friendship Hospital
| | - Hongzhi Mi
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing
| | | | - Rongchong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian
- The Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Budassi S, Zivelonghi C, Dens J, Bagnall AJ, Knaapen P, Avran A, Spratt JC, Walsh S, Faurie B, Agostoni P. Impact of prior coronary artery bypass grafting in patients undergoing chronic total occlusion-percutaneous coronary intervention: Procedural and clinical outcomes from the REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium, and UnitEd Kingdom (RECHARGE). Catheter Cardiovasc Interv 2020; 97:E51-E60. [PMID: 32369681 DOI: 10.1002/ccd.28954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/11/2020] [Accepted: 04/23/2020] [Indexed: 11/11/2022]
Abstract
AIM Chronic total occlusions (CTO) in patients with history of coronary artery bypass graft (CABG) show more advanced and complex atherosclerotic pathology. Aim of our study is to compare outcomes in patients undergoing CTO percutaneous coronary intervention (PCI) with previous CABG versus those without in the REgistry of Crossboss and Hybrid procedures in FrAnce the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE). METHODS & RESULTS The RECHARGE cohort (1,252 patients) was divided in two groups according to the presence of previous CABG (217) or not. We also focused, in the post-CABG group, on a comparison between CTO in previously grafted vessels versus non-grafted vessels. The CTO complexity scores were higher and the success rate (71.9% vs. 88.7%, p < .001) was lower in the CABG group, this difference was driven by higher failure rates in high-complexity-score CTO. The rate of in-hospital complications was similar. In the post-CABG group, the procedural success of CTO located in previously grafted vessels versus those in vessels not previously grafted, was comparably suboptimal (73.1% vs. 68%, p = .47). CONCLUSION Patients undergoing CTO PCI with prior CABG have a higher prevalence of comorbidities and more complex lesion characteristics. In the post-CABG population the success rate was significantly lower, particularly in high CTO complexity scores, though complication rates were comparable. In the post-CABG population, the CTO success rate was independent of the presence of a previous graft on the CTO vessel.
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Affiliation(s)
- Simone Budassi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.,Cardiology and Interventional Cardiology Department, Policlinico Tor Vergata, Rome, Italy
| | - Carlo Zivelonghi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Joseph Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Alan J Bagnall
- Freeman Hospital, The Newcastle upon Tyne hospitals NHS Trust, Newcastle, UK
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexandre Avran
- Department of Interventional Cardiology, Arnault Tzanck Institute, Saint-Laurent-du-Var, France
| | - James C Spratt
- Department of Cardiology, St George's University Healthcare NHS Trust, London, UK
| | - Simon Walsh
- Department of Cardiology, Belfast Health & Social Care Trust, Belfast, Northern Ireland, UK
| | - Benjamin Faurie
- Cardiovascular Institute, Groupe Hospitalier Mutualiste, Grenoble, France
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Pinto G, Fragasso G, Gemma M, Bertoldi L, Salerno A, Godino Md C, Colombo A, Azzalini L, Margonato A, Carlino M. Long-term clinical effects of recanalization of chronic coronary total occlusions in patients with left ventricular systolic dysfunction. Catheter Cardiovasc Interv 2020; 96:831-838. [PMID: 32187806 DOI: 10.1002/ccd.28850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The aim of the present analysis is to evaluate the clinical impact of chronic total occlusions (CTOs) recanalization in patients with left ventricular (LV) systolic dysfunction. BACKGROUND According to contemporary knowledge, patient selection for percutaneous CTO revascularization is not yet standardized. In particular, data on outcomes in patients with LV systolic dysfunction undergoing percutaneous coronary intervention (PCI) for CTO are scarce. METHODS From a total of 2,421 consecutive patients with at least one CTO, 436 patients with ejection fraction (EF) ≤45%, who were referred for coronary angiography between January 1998 and September 2014, were selected. Patients with successful recanalization of the target CTO were assigned to CTO-revascularized group and those with failed or not attempted recanalization to the CTO-not revascularized (CTO-NR) group. Study endpoints were all-cause death, cardiac death, and occurrence of myocardial infarction on follow-up. RESULTS Out of 436 CTO patients with reduced EF, 228 (52.3%) were successfully recanalized and 208 patients (47.7%) were not, either due to CTO-PCI failure (n = 106, 24.3%) or because CTO-PCI was not attempted (n = 102, 23.4%). At long-term follow-up, CTO-NR patients had significantly higher rate of overall (p = .021) and cardiac mortality (p = .035) compared to those successfully revascularized. CONCLUSION In patients with systolic LV dysfunction (EF ≤ 45%), CTO revascularization was associated with significant lower rate of total and cardiac mortality compared to those with nonrevascularized CTO.
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Affiliation(s)
| | | | - Marco Gemma
- San Raffaele Scientific Institute, Milan, Italy
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Oomens T, de Haan S, Berkhout T, Heestermans AACM, de Swart JBRM, van Ramshorst J, Ruifrok WT, Dirksen MT. The Alkmaar CTO Registry: A Retrospective Cohort Evaluating the Introduction of a Dedicated CTO Program. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1214-1219. [PMID: 32144036 DOI: 10.1016/j.carrev.2020.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) are high risk procedures with low success rates compared to standard PCI. Recently the 'hybrid approach' method has been developed to increase success rate. In 2015 we set up a dedicated program to systematically treat CTOs by this hybrid approach. This retrospective, observational registry aims to report achieved results in a single PCI centre. METHODS AND RESULTS We reviewed all CTO procedures between January 2012 and December 2017. Procedures performed by dedicated operators after December 2014 were assigned to the hybrid cohort, procedures done before this time or performed by a non-CTO operator were assigned to the non-hybrid cohort. Procedural techniques, difficulty of lesions, J-CTO scores, outcomes and complications were analysed. In total 505 procedures were included. Average J-CTO score was 1.9 ± 1.1, which was significantly higher in the hybrid cohort (2.1 ± 1.2 vs. 1.6 ± 1.1; p < 0.001). Overall procedural success rate was 75.4% with significantly higher success rates in the hybrid cohort (81.2% vs. 68.2%; p < 0.001). Combining both cohorts, overall success rate increased over the years (2012-2017 respectively 65.2%, 60.0%, 71.7%, 83.2%, 77.9% and 81.4%). Complication rate was higher in the hybrid cohort compared to the non-hybrid cohort (4.6% vs 0.4%, respectively; p = 0.026). CONCLUSION By introducing a systematic CTO program, including use of the hybrid approach, we observed higher success rates of PCI CTO, despite increased complexity of the lesions (higher J-CTO score). The occurrence of MACE was in accordance with current literature. CONDENSED ABSTRACT Our registry demonstrates that introduction of a dedicated CTO program increases success rates of CTO treatments despites increased lesions difficulty and with acceptable MACEs rates.
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Affiliation(s)
- Thomas Oomens
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands.
| | - Stefan de Haan
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Tim Berkhout
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | | | | | - Jan van Ramshorst
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
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De Gregorio MG, Marcucci R, Migliorini A, Gori AM, Giusti B, Vergara R, Paniccia R, Carrabba N, Marchionni N, Valenti R. Clinical Implications of "Tailored" Antiplatelet Therapy in Patients With Chronic Total Occlusion. J Am Heart Assoc 2020; 9:e014676. [PMID: 32067582 PMCID: PMC7070214 DOI: 10.1161/jaha.119.014676] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Clopidogrel nonresponsiveness is a prognostic marker after percutaneous coronary intervention. Prasugrel and ticagrelor provide a better platelet inhibition and represent the first‐line antiplatelet treatment in acute coronary syndrome. We sought to assess the prognostic impact of high platelet reactivity (HPR) and the potential clinical benefit of a “tailored” escalated or changed antiplatelet therapy in patients with chronic total occlusion. Methods and Results From Florence CTO‐PCI (chronic total occlusion‐percutaneous coronary intervention) registry, platelet function assessed by light transmission aggregometry, was available for 1101 patients. HPR was defined by adenosine diphosphate test ≥70% and optimal platelet reactivity by adenosine diphosphate test <70%. The endpoint of the study was long‐term cardiac survival. Patients were stratified according to light transmission aggregometry results: optimal platelet reactivity (82%) and HPR (18%). Means for the adenosine diphosphate test were 44±16% versus 77±6%, respectively. Three‐year survival was significantly higher in the optimal platelet reactivity group compared with HPR patients (95.3±0.8% versus 86.2±2.8%; P<0.001). With the availability of new P2Y12 inhibitors, a deeper platelet inhibition (46±17%) and similar survival to the optimal platelet reactivity group were achieved in patients with HPR on clopidogrel therapy after escalation. Conversely, HPR on clopidogrel therapy “not switched” was associated with cardiac mortality (hazard ratio 2.37; P=0.003) after multivariable adjustment. Conclusions HPR on treatment could be a modifiable prognostic marker by new antiaggregants providing a deeper platelet inhibition associated with clinical outcome improvement in complex chronic total occlusion patients. A “tailored” antiplatelet therapy, also driven by the entity of platelet inhibition, could be useful in these high risk setting patients.
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Affiliation(s)
- Maria Grazia De Gregorio
- Cardiovascular Department Azienda Ospedaliero-Universitaria Careggi Florence Italy.,Experimental and Clinical Medicine Department University of Florence Italy
| | - Rossella Marcucci
- Cardiovascular Department Azienda Ospedaliero-Universitaria Careggi Florence Italy.,Experimental and Clinical Medicine Department University of Florence Italy
| | - Angela Migliorini
- Cardiovascular Department Azienda Ospedaliero-Universitaria Careggi Florence Italy
| | - Anna Maria Gori
- Experimental and Clinical Medicine Department University of Florence Italy
| | - Betti Giusti
- Experimental and Clinical Medicine Department University of Florence Italy
| | - Ruben Vergara
- Cardiovascular Department Azienda Ospedaliero-Universitaria Careggi Florence Italy
| | - Rita Paniccia
- Experimental and Clinical Medicine Department University of Florence Italy
| | - Nazario Carrabba
- Cardiovascular Department Azienda Ospedaliero-Universitaria Careggi Florence Italy
| | - Niccolò Marchionni
- Cardiovascular Department Azienda Ospedaliero-Universitaria Careggi Florence Italy.,Experimental and Clinical Medicine Department University of Florence Italy
| | - Renato Valenti
- Cardiovascular Department Azienda Ospedaliero-Universitaria Careggi Florence Italy
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Ochiumi Y, Suzuki Y, Murata A, Ito T. The evaluation of technical outcome and wire manipulation time within 30 min in patients with poor distal vessel quality on percutaneous coronary intervention for chronic total occlusion. Cardiovasc Interv Ther 2020; 36:67-73. [PMID: 32052348 DOI: 10.1007/s12928-020-00647-5] [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: 11/13/2019] [Accepted: 02/03/2020] [Indexed: 12/20/2022]
Abstract
The technical outcome of poor distal vessel quality (PDV) on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is yet to be clearly elucidated. PDV has not been evaluated in scoring systems. We examined 193 consecutive CTO-PCIs performed in January 2013-December 2017. The endpoint, including the technical outcomes in these patients between with and without PDV, was analyzed. Moreover, we re-evaluated the predictors for CTO-PCI difficulty according to Japan-CTO score. Out of 193 CTO-PCIs, 181 (93.8%) achieved technical success [including 101 (55.8%) with and 80 (44.2%) without PDV]. In patients with and without PDV, the success rates of guidewire crossing using only the antegrade technique were 46.5% vs. 83.8%, respectively (p < 0.0001) and using the retrograde approach were 53.5% vs. 16.3%, respectively (p < 0.0001). Moreover, there were 56 non-interventional collateral channels in 181 patients. The successful rate of primary antegrade approach was significantly lower and the rate of a rescue retrograde approach was significantly higher with PDV (37.2% vs. 62.8%, 76.9% vs. 23.1%, respectively; p < 0.0119). Significant predictors associated with successful guidewire crossings of ≤ 30 min included blunt stump, calcification, bending, occlusion length ≥ 20 mm, retry lesion following Japan-CTO score, and PDV (p < 0.05, all). Multivariate analyses demonstrated that blunt stump, calcification, bending, retry lesion, and PDV were independent predictors of unsuccessful guidewire crossing of ≤ 30 min (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.71, p = 0.0039; OR 0.34, 95% CI 0.16-0.71, p = 0.0035; OR 0.17, 95% CI 0.05-0.60, p = 0.0034; OR 0.18, 95% CI 0.06-0.54, p = 0.0008; and OR 0.19, 95% CI 0.09-0.41, p < 0.0001, respectively). PDV could affect the technical outcome of CTO-PCI.
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Affiliation(s)
- Yusuke Ochiumi
- Department of Cardiology, Nagoya Heart Center, 1-1-14, Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan.
| | - Yoriyasu Suzuki
- Department of Cardiology, Nagoya Heart Center, 1-1-14, Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Akira Murata
- Department of Cardiology, Nagoya Heart Center, 1-1-14, Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Tatsuya Ito
- Department of Cardiology, Nagoya Heart Center, 1-1-14, Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
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Multicenter experience with percutaneous coronary intervention for chronic total occlusion in Korean population: analysis of the Korean nationwide multicenter chronic total occlusion registry. Coron Artery Dis 2020; 31:319-326. [PMID: 31913165 DOI: 10.1097/mca.0000000000000838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains challenging because of limited success and higher target vessel failure rates. Detailed safety and efficacy data for CTO-PCI from a multicenter real-world Korean registry are limited. METHODS Since May 2007, the Korean multicenter retrospective CTO registry has enrolled 3271 patients who underwent CTO-PCI at 26 major medical centers. Baseline clinical, angiographic, and procedural characteristics and 12-month major adverse cardiac event (MACE) rates after PCI were retrospectively collected. RESULTS Baseline cardiovascular risk factors included: male sex, 73.8%; prior myocardial infarction (MI), 14.8%; prior PCI, 26.6%; hypertension, 62.3%; diabetes mellitus, 34.8%; dyslipidemia, 33.3%; and current smoker, 30.9%. Pre-PCI myocardial viability testing was performed in 23.6% of patients and pre-PCI cardiac computed tomography (CT) in 17.6%. CTO arterial lesions were distributed as follows: right coronary, 41.0%; left anterior descending, 40.0%; left circumflex, 22.5%; and left main, 0.4%. Unfavorable lesion morphology was detected by angiography in 38.1%. Intravascular ultrasound guidance and the retrograde approach were utilized in 23.6 and 3.1% of CTO-PCI procedures, respectively. More than 75% of patients received drug-eluting stents (sirolimus-eluting, 26.5%; paclitaxel-eluting, 23.8%; zotarolimus-eluting, 23.4%; everolimus-eluting, 11.0%; and others, 4.0%). The overall success rate was 81.6% (2672/3271 patients). Twelve-month event rates were: total mortality, 2.4%; any MI, 0.7%; target lesion revascularization, 4.4%; target vessel revascularization, 6.7%; and total MACE, 9.4%. CONCLUSIONS Twelve-month success rates, safety profiles, and cumulative clinical outcomes of Korean CTO patients were favorable post-PCI. Long-term follow-up of larger study populations is necessary to validate our findings.
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Sex Difference and Outcome after Percutaneous Intervention in Patients with Chronic Total Occlusion: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:25-31. [DOI: 10.1016/j.carrev.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/28/2019] [Accepted: 03/07/2019] [Indexed: 01/11/2023]
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Chronic total occlusion intervention of the non-infarct-related artery in acute myocardial infarction patients: the Korean multicenter chronic total occlusion registry. Coron Artery Dis 2019; 29:495-501. [PMID: 29688904 DOI: 10.1097/mca.0000000000000630] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The Korean chronic total occlusion (CTO) registry was collected prospectively from 26 cardiovascular centers since May 2007. The aim of this study is to investigate the impact of a successful staged percutaneous coronary intervention (PCI) of CTO lesions in acute myocardial infarction (AMI) patients on clinical outcomes. PATIENTS AND METHODS Among 2813 patients who underwent a staged PCI because of CTO lesions, 422 (15%) patients underwent primary PCI because of AMI. Among 422 patients, successful staged CTO-PCI was performed in 76%. The clinical outcomes were compared between the successful CTO-PCI group (n=321) and the failed CTO-PCI group (n=101). To adjust for potential confounders, a propensity score matching (PSM) analysis was carried out using the logistic regression model. RESULTS After the PSM analysis, two propensity-matched groups (85 pairs, n=170) were generated and the baseline characteristics were balanced. The incidence of total death (P=0.029) and non-ST-segment elevation myocardial infarction (NSTEMI, P=0.043) at 1 year was higher in the failed CTO-PCI group. Multivariate regression showed that successful CTO-PCI was an independent predictor of preventing mortality (hazard ratio, 0.21, P=0.048). In the subgroup analysis, the Kaplan-Meier curve showed that successful CTO-PCI had a lower incidence of total death (log-rank=0.004) and cardiac death (log-rank=0.005) up to 1 year in NSTEMI patients. Cox-proportional analysis showed that successful CTO-PCI was beneficial in patients with NSTEMI, hypertension, and non-left-anterior descending artery lesion for preventing mortality. CONCLUSION In this study, a staged successful CTO-PCI in AMI patients was associated with improved 1-year survival in the Korean population.
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Gender Differences in Long-Term Outcomes of Medical Therapy and Successful Percutaneous Coronary Intervention for Coronary Chronic Total Occlusions. J Interv Cardiol 2019; 2019:2017958. [PMID: 31772516 PMCID: PMC6766257 DOI: 10.1155/2019/2017958] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/21/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022] Open
Abstract
Background There is a paucity of information about the gender differences in clinical outcomes of successful percutaneous coronary intervention (PCI) compared with medical therapy (MT) in patients with coronary chronic total occlusions (CTOs). Objectives We aimed to investigate the impact of gender on long-term clinical outcomes associated with successful CTO-PCI versus MT in patients with CTOs. Methods Between January 2007 and December 2016, a total of 1702 patients with ≥1 CTO were enrolled. After exclusion, 1294 patients with 1520 CTOs were analyzed and were divided into the female group (n = 304, 23.5%) and the male group (n = 990, 76.5%). The patients in the female or male group were assigned to a MT group or successful CTO-PCI group according to the treatment strategy. In the female group, they were divided into two groups: 177 patients in the MT group and 127 patients in the successful CTO-PCI group. In the male group, they were divided into two groups: 623 patients in the MT group and 367 patients in the successful CTO-PCI group. The primary outcome was cardiac death. The secondary outcome was major adverse cardiac event (MACE). Results The median overall follow-up duration was 3.6 (IQR, 2.1–5.0) years, there were no significant differences between the MT and successful CTO-PCI groups with respect to the prevalence of cardiac death (MT vs. successful PCI: 6.8% vs. 3.9%, p=0.287) and MACE (20.9% vs. 21.3%, p=0.810) in female patients. In the male group, the occurrence of cardiac death (MT vs. successful PCI: 6.6% vs. 3.8%, p=0.066) was similar between the two groups. The MACE rate (30.0% vs. 18.5%, p < 0.001) was significantly higher in the MT group. Heart failure (hazard ratio 3.40, 95% confidence interval 1.23–9.40, p=0.018) was an independent predictor of cardiac death in female patients. Conclusions Successful CTO-PCI was not associated with reduced risk of cardiac death compared with medical therapy alone in both female and male patients. However, men have a significant reduction in MACE rate after successful CTO-PCI. Aggressive CTO-PCI should be considered carefully among female patients.
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Ahn JH, Yang JH, Song YB, Hahn JY, Choi JH, Lee SH, Gwon HC, Choi SH. Impacto de la localización de la oclusión coronaria crónica total en la supervivencia a largo plazo tras intervención coronaria percutánea. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Yoshida R, Ishii H, Morishima I, Tanaka A, Takagi K, Yoshioka N, Kataoka T, Tashiro H, Hitora Y, Niwa K, Furusawa K, Morita Y, Tsuboi H, Murohara T. Prognostic impact of recanalizing chronic total occlusion in non-infarct related arteries on long-term clinical outcomes in acute myocardial infarction patients undergoing primary percutaneous coronary intervention. Cardiovasc Interv Ther 2019; 35:259-268. [PMID: 31456091 DOI: 10.1007/s12928-019-00615-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/19/2019] [Indexed: 12/16/2022]
Abstract
Although chronic total occlusion (CTO) in non-infarct-related arteries (non-IRAs) negatively affects long-term mortality in patients with acute myocardial infarction (AMI) who are undergoing primary percutaneous coronary intervention (PCI), the prognostic impact of successful CTO-PCI has not been completely addressed. Among 1855 consecutive patients with AMI who underwent primary PCI, those who were treated for CTO with either PCI or medical therapy were included. We evaluated the association between recanalization of CTO and long-term cardiac mortality. Of the 172 included patients, 88 underwent CTO-PCI, and the procedures were successful in 65 patients. Thus, the successfully recanalized CTO (SR-CTO) group included 65 patients; and the no recanalized CTO (NR-CTO) group, 107 patients. During the follow-up, 72 patients died, and of whom 56 (77.8%) died because of cardiac causes. The cumulative 10-year, 30-day, and 30-day to 10-year incidences of cardiac mortality were lower in the SR-CTO group than in the NR-CTO group (19.0% vs. 51.9% p = 0.004; 4.6% vs. 14.0%, p = 0.05; 15.0% vs. 44.1%, p = 0.003, respectively). After adjusting for confounding factors, the benefits of SR-CTO for the 10-year cardiac mortality remained significant compared with those of NR-CTO (hazard ratio 0.37; 95% confidence interval 0.17-0.75; p = 0.004). In conclusion, patients with SR-CTO in non-IRAs after AMI was associated with reduced long-term cardiac mortality compared with those with NR-CTO.
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Affiliation(s)
- Ruka Yoshida
- Department of Cardiology, Nagoya University Hospital, 86 Tsurumai-cho, Showa ward, Nagoya, 466-8560, Japan. .,Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Hospital, 86 Tsurumai-cho, Showa ward, Nagoya, 466-8560, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takashi Kataoka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Tashiro
- Department of Cardiology, Nagoya University Hospital, 86 Tsurumai-cho, Showa ward, Nagoya, 466-8560, Japan
| | - Yusuke Hitora
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kiyoshi Niwa
- Department of Cardiology, Nagoya University Hospital, 86 Tsurumai-cho, Showa ward, Nagoya, 466-8560, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Hospital, 86 Tsurumai-cho, Showa ward, Nagoya, 466-8560, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideyuki Tsuboi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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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.
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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
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Kwon O, Lee PH, Lee SW, Lee JY, Kang DY, Ahn JM, Park DW, Kang SJ, Kim YH, Lee CW, Park SW, Park SJ. Retrograde approach for the percutaneous recanalisation of coronary chronic total occlusions: contribution to clinical practice and long-term outcomes. EUROINTERVENTION 2019; 15:e354-e361. [DOI: 10.4244/eij-d-18-00538] [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] [Indexed: 11/23/2022]
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50
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Wu KZ, Huang ZH, Zhong ZA, Liao HT, Zhou Y, Luo BZ, Anantha-Narayanan M, Khouzam RN, Garg A, Vukcevic V, Kounis NG, Zhang B. Successful treatment of complex coronary chronic total occlusions improves midterm outcomes. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:194. [PMID: 31205912 DOI: 10.21037/atm.2019.05.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Data regarding outcomes of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is still limited. Our aim was to evaluate clinical outcomes in patients after successful CTO PCI when compared to patients with failed PCI. METHODS The cohort study enrolled 145 eligible patients with attempted PCI of CTO. Detailed baseline clinical and procedural data, and in-hospital complications were analyzed. The primary end point was occurrence of major adverse cardiac events (MACE). RESULTS Median follow-up was 11.49±2.01 months. Successful revascularization was associated with a significantly lower 1-year MACE compared to failed revascularization [hazard ratio (HR): 0.026; 95% confidence interval (CI): 0.004-0.176; P=0.0002]. A J-CTO score of ≥3 was associated with a significantly higher 1-year MACE compared with a J-CTO score of <3 in patients undergoing PCI (HR: 4.819; 95% CI: 1.463-15.870; P=0.0097). Moreover, in patients with a J-CTO score ≥3, success of CTO PCI was associated with significantly lower risk of 1-year MACE than failure of CTO revascularization (HR: 0.114; 95% CI: 0.023-0.569; P=0.0081). Multivariate analysis identified the J-CTO score (HR: 2.10; 95% CI: 1.09-4.04; P=0.026) as a positive predictor, and the success of CTO PCI (HR: 0.17; 95% CI: 0.05-0.59; P=0.005) as a negative significant independent predictor of MACEs. CONCLUSIONS Among patients with CTOs, high J-CTO score was independently associated with worse clinical outcomes. Furthermore, successful PCI was associated with a lower risk of midterm MACE compared with failed revascularization of CTOs.
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Affiliation(s)
- Kai-Ze Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Ze-Han Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Zhi-An Zhong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Hong-Tao Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Yi Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Bing-Zheng Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Mahesh Anantha-Narayanan
- Division of Cardiovascular Disease, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rami N Khouzam
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aakash Garg
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Vladan Vukcevic
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Bin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
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