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Li QY, Lin XL, Li FQ, Cheng ZC, Tian JY, Zhao DH, Lau WB, Liu JH, Fan Q. A Chinese scoring system for predicting successful retrograde collateral traverse in patients with chronic total coronary occlusion. BMC Cardiovasc Disord 2023; 23:380. [PMID: 37516887 PMCID: PMC10386207 DOI: 10.1186/s12872-023-03405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 07/18/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Retrograde approach technique has been challenging in percutaneous coronary interventional treatment of chronic total occlusion (CTO) coronary disease. The present study endeavors to determine a novel Chinese scoring system for predicting successful collateral channels traverse via retrograde approach. METHODS The demographic characteristics and angiographic characteristics of 309 CTO patient were analyzed by univariable and multivariable analysis for selecting potential predictors. And the nomogram was used to establish the scoring system. Then it was evaluated by the internal and external validation. RESULTS The predictors of Age, Connections between collateral channels and recipient vessels, and Channel Tortuosity (ACT) were identified with univariable and multivariable analysis and employed to the ACT score system. With acceptable calibrations, the area under curve of the scoring system and the external validation were 0.826 and 0.816 respectively. Based on score, the predictors were divided into three risk categories and it showed a consistent prediction power in the validation cohort. CONCLUSIONS The novel Chinese ACT score is a reliable tool for predicting successful retrograde collateral traverse.
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Affiliation(s)
- Qiu Yu Li
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Xiao Long Lin
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Fan Qi Li
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Zi Chao Cheng
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Jia Yu Tian
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Dong Hui Zhao
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Wayne Bond Lau
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Jing Hua Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Qian Fan
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China.
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Vemmou E, Alaswad K, Patel M, Mahmud E, Choi JW, Jaffer FA, Doing AH, Dattilo P, Karmpaliotis D, Krestyaninov O, Khelimskii D, Nikolakopoulos I, Karacsonyi J, Xenogiannis I, Garcia S, Burke MN, Abi Rafeh N, ElGuindy A, Goktekin O, Abdo A, Rangan BV, Abdullah S, Brilakis ES. Chronic total occlusion percutaneous coronary intervention in octogenarians and nonagenarians. J Am Geriatr Soc 2021; 69:1560-1569. [PMID: 33591578 DOI: 10.1111/jgs.17063] [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: 09/16/2020] [Revised: 01/08/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. METHODS We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. <80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. RESULTS There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p = 0.0201; 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p = 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE. CONCLUSION CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity.
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Affiliation(s)
- Evangelia Vemmou
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Mitul Patel
- VA San Diego Health Care System and University of California San Diego, La Jolla, California, USA
| | - Ehtisham Mahmud
- VA San Diego Health Care System and University of California San Diego, La Jolla, California, USA
| | - James W Choi
- Baylor Scott & White Heart and Vascular, Dallas, Texas, USA
| | | | - Anthony H Doing
- UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | - Phil Dattilo
- UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | | | - Oleg Krestyaninov
- Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Dmitrii Khelimskii
- Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | | | - Judit Karacsonyi
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | | | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | | | - Abir Abdo
- American University of Beirut Medical Center, Lebanon
| | - Bavana V Rangan
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Shuaib Abdullah
- VA North Texas Healthcare System and UT Southewestern Medical Center, Dallas, Texas, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Cui C, Sheng Z. Outcomes of percutaneous coronary intervention for chronic total occlusions in the elderly: A systematic review and meta-analysis. Clin Cardiol 2020; 44:27-35. [PMID: 33332739 PMCID: PMC7803357 DOI: 10.1002/clc.23524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/27/2020] [Indexed: 01/16/2023] Open
Abstract
Objective This study aimed to compare outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in the elderly (≥75 years) versus nonelderly and assess the impact of successful CTO‐PCI in the elderly. Methods PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched up to October 1, 2020. Mortality rates and major adverse cardiac events (MACE) were compared between elderly and nonelderly patients and successful versus failed CTO‐PCI in the elderly. Results Eight studies were included. Meta‐analysis indicated no statistically significant difference in the risk of in‐hospital mortality (RR: 1.97 95% CI: 0.78, 4.96 I2 = 0% p = .15) but higher tendency of in‐hospital MACE (RR: 2.30 95% CI: 0.99, 5.35 I2 = 49% p = .05) in the elderly group. Risk of long‐term mortality (RR: 3.79 95% CI: 2.84, 5.04 I2 = 41% p < .00001) and long‐term MACE (RR: 1.53 95% CI: 1.14, 2.04 I2 = 80% p = .004) were significantly increased in the elderly versus nonelderly. Elderly patients had a significantly reduced odds of successful PCI as compared to nonelderly patients (OR: 0.63 95% CI: 0.54, 0.73 I2 = 1% p < .00001). Successful CTO‐PCI was associated with reduction in long‐term mortality (HR: 0.51 95% CI: 0.34, 0.77 I2 = 27% p = .001) and MACE (HR: 0.60 95% CI: 0.37, 0.97 I2 = 53% p = .04) as compared to failed PCI in elderly. Conclusions Elderly patients may have a tendency of higher in‐hospital MACE with significantly increased long‐term mortality and MACE after CTO‐PCI. The success of PCI is significantly lower in the elderly. In elderly patients with successful PCI, the risk of long‐term mortality and MACE is significantly reduced.
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Affiliation(s)
- Chenmin Cui
- Department of Nephrology, Huzhou Hospital of Traditional Chinese Medicine Affiliated Zhejiang University of Traditional Chinese Medicine, Huzhou, China
| | - Zhichao Sheng
- Department of Cardiovascular Medicine, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing, China
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