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1
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Mutlu D, Rempakos A, Alexandrou M, Al-Ogaili A, Gorgulu S, Choi JW, Elbarouni B, Khatri JJ, Jaffer F, Riley R, Smith AJC, Davies R, Frizzel J, Patel M, Koutouzis M, Tsiafoutis I, Rangan BV, Mastrodemos OC, Sandoval Y, Burke MN, Brilakis ES. Emergency coronary artery bypass surgery after chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry. Int J Cardiol 2024; 405:131931. [PMID: 38432608 DOI: 10.1016/j.ijcard.2024.131931] [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: 01/12/2024] [Revised: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Emergency coronary artery bypass surgery (eCABG) is a serious complication of chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI). METHODS We examined the incidence and outcomes eCABG among 14,512 CTO PCIs performed between 2012 and 2023 in a large multicenter registry. RESULTS The incidence of eCABG was 0.12% (n = 17). Mean age was 68 ± 6 years and 69% of the patients were men. The most common reason for eCABG was coronary perforation (70.6%). eCABG patients had larger target vessel diameter (3.36 ± 0.50 vs. 2.90 ± 0.52; p = 0.003), were more likely to have moderate/severe calcification (85.7% vs. 45.8%; p = 0.006), side branch at the proximal cap (91.7% vs. 55.4%; p = 0.025), and balloon undilatable lesions (50% vs. 7.4%; p = 0.001) and to have undergone retrograde crossing (64.7% vs. 30.8%, p = 0.006). eCABG cases had lower technical (35.3% vs. 86.7%; p < 0.001) and procedural (35.3% vs. 86.7%; p < 0.001) success and higher in-hospital mortality (35.3% vs. 0.4%; p < 0.001), coronary perforation (70.6% vs. 4.6%; p < 0.001), pericardiocentesis (47.1% vs. 0.8%; p < 0.001), and major bleeding (11.8% vs. 0.5%; p < 0.001). CONCLUSIONS The incidence of eCABG after CTO PCI was 0.12% and associated with high in-hospital mortality (35%). Coronary perforation was the most common reason for eCABG.
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Affiliation(s)
- Deniz Mutlu
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ahmed Al-Ogaili
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - James W Choi
- Texas Health Presbyterian Dallas Hospital, Dallas, TX, USA
| | | | | | | | | | - A J Conrad Smith
- University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA, USA
| | | | | | - Mitul Patel
- University of California San Diego, San Diego, CA, USA
| | | | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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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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Cilia L, Megaly M, Davies R, Tehrani BN, Batchelor WB, Truesdell AG. A non-interventional cardiologist's guide to coronary chronic total occlusions. Front Cardiovasc Med 2024; 11:1350549. [PMID: 38380179 PMCID: PMC10876789 DOI: 10.3389/fcvm.2024.1350549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Coronary chronic total occlusions (CTO) are present in up to one-third of patients with coronary artery disease (CAD). It is thus essential for all clinical cardiologists to possess a basic awareness and understanding of CTOs, including optimal evaluation and management. While percutaneous coronary intervention (PCI) for CTO lesions has many similarities to non-CTO PCI, there are important considerations pertaining to pre-procedural evaluation, interventional techniques, procedural complications, and post-procedure management and follow-up unique to patients undergoing this highly specialized intervention. Distinct from other existing topical reviews, the current manuscript focuses on key knowledge relevant to non-interventional cardiologists.
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Affiliation(s)
- Lindsey Cilia
- Virginia Heart, Falls Church, VA, United States
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Michael Megaly
- Willis Knighton Medical Center, Shreveport, LA, United States
| | | | - Behnam N. Tehrani
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Wayne B. Batchelor
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Alexander G. Truesdell
- Virginia Heart, Falls Church, VA, United States
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
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Chiabrando JG, Vescovo GM, Lombardi M, Seropian IM, Del Buono MG, Vergallo R, Burzotta F, Escaned J, Berrocal DH. Iatrogenic coronary dissection: state of the art management. Panminerva Med 2023; 65:511-520. [PMID: 36321941 DOI: 10.23736/s0031-0808.22.04781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Iatrogenic coronary artery dissections (ICAD) are rare but potentially devastating complications during coronary angiography and percutaneous coronary interventions (PCI). Intima media complex separation may be produced either by the catheter tip or during PCI. Patient characteristics and procedure related risk factors are intimately linked to catheter induced ICAD over diagnostic angiography. Moreover, the increasing complexity of patients undergoing PCI, which frequently involves treatment of heavily calcified or occluded vessels, has increased the likelihood of dissections during PCI. A prompt recognition, along with a prompt management (either percutaneous, surgical or even careful watching), are key in preventing catastrophic consequences of ICAD, such as left ventricular dysfunction, cardiogenic shock, periprocedural myocardial infarction (MI) or cardiac death. This review aims to summarize the main updates concerning the pathophysiology, highlight key risk factors and suggest recommendations in management and treatment of ICAD.
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Affiliation(s)
- Juan G Chiabrando
- Department of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina -
| | | | - Marco Lombardi
- Department of Cardiovascular and Thoracic Sciences, Sacred Heart Catholic University, Rome, Italy
| | - Ignacio M Seropian
- Department of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Marco G Del Buono
- Department of Cardiovascular and Thoracic Sciences, Sacred Heart Catholic University, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Sacred Heart Catholic University, Rome, Italy
| | - Javier Escaned
- Department of Cardiology, San Carlos Clinical Hospital, Complutense University of Madrid, Madrid, Spain
| | - Daniel H Berrocal
- Department of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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5
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Karacsonyi J, Stanberry L, Simsek B, Kostantinis S, Allana SS, Rempakos A, Okeson B, Alaswad K, Basir MB, Jaffer F, Poommipanit P, Khatri J, Patel M, Mahmud E, Sheikh A, Wollmuth JR, Yeh RW, Chandwaney RH, ElGuindy AM, Abi Rafeh N, Schimmel DR, Benzuly K, Burke MN, Rangan BV, Mastrodemos OC, Sandoval Y, Ungi I, Brilakis ES. Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2023; 202:111-118. [PMID: 37429059 DOI: 10.1016/j.amjcard.2023.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/12/2023]
Abstract
Estimating the likelihood of urgent mechanical circulatory support (MCS) can facilitate procedural planning and clinical decision-making in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,784 CTO PCIs performed between 2012 and 2021 at 12 centers. The variable importance was estimated by a bootstrap applying a random forest algorithm to a propensity-matched sample (a ratio of 1:5 matching cases with controls on center). The identified variables were used to predict the risk of urgent MCS. The performance of the risk model was assessed in-sample and on 2,411 out-of-sample procedures that did not require urgent MCS. Urgent MCS was used in 62 (2.2%) of cases. Patients who required urgent MCS were older (70 [63 to 77] vs 66 [58 to 73] years, p = 0.003) compared with those who did not require urgent MCS. Technical (68% vs 87%, p <0.001) and procedural success (40% vs 85%, p <0.001) was lower in the urgent MCS group compared with cases that did not require urgent MCS. The risk model for urgent MCS use included retrograde crossing strategy, left ventricular ejection fraction, and lesion length. The resulting model demonstrated good calibration and discriminatory capacity with the area under the curve (95% confidence interval) of 0.79 (0.73 to 0.86) and specificity and sensitivity of 86% and 52%, respectively. In the out-of-sample set, the specificity of the model was 87%. The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention CTO MCS score can help estimate the risk of urgent MCS use during CTO PCI.
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Affiliation(s)
- Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Larissa Stanberry
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Salman S Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Brynn Okeson
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Mir B Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Farouc Jaffer
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul Poommipanit
- Department of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mitul Patel
- Cardiovascular Institute, VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - Ehtisham Mahmud
- Cardiovascular Institute, VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - Abdul Sheikh
- Interventional Cardiology Department, WellStar Health System, Marietta, Georgia
| | - Jason R Wollmuth
- Interventional Cardiology, Providence Heart Institute, Portland, Oregon
| | - Robert W Yeh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Raj H Chandwaney
- Interventional Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Louisiana
| | - Daniel R Schimmel
- Cardiovascular Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Keith Benzuly
- Cardiovascular Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Imre Ungi
- Division of Invasive Cardiology, Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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Moroni F, Santiago R, DI Pietro R, Calcagno S, Azzalini L. Complications during chronic total occlusion percutaneous coronary intervention: a sign- and symptom-based approach to early diagnosis and treatment. Minerva Cardiol Angiol 2021; 69:773-786. [PMID: 34338491 DOI: 10.23736/s2724-5683.21.05831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronary chronic total occlusions (CTO) are frequently found in patients undergoing coronary angiography. Despite their high prevalence and indication for revascularization in a relevant proportion of cases, CTO recanalization is attempted only in a minority of cases. This is due to higher risk of procedural complications compared to non-CTO interventions and because the CTO-PCIs are the most complex procedures in interventional cardiology. In particular, the perceived higher risk of complications during CTO intervention might discourage new operators from engaging in this challenging field. The aim of this work is to review the potential complications of CTO percutaneous coronary intervention, and to provide an algorithmic, sign- and symptom-based approach to facilitate early recognition and effective management.
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Affiliation(s)
- Francesco Moroni
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.,Università Vita-Salute San Raffaele, Milan, Italy
| | - Ricardo Santiago
- PCI Cardiology Group and Bayamon Heart & Lung Institute, Bayamon, Puerto Rico
| | | | - Simone Calcagno
- Interventional Cardiology Unit, SM Goretti Hospital, Latina, Italy
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA -
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