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Sharma V, Choudhury A, Basavarajaiah S, Rashid M, Yuan M, Jefferey D, Vanezis AP, Sall H, Smith WHT, Parasa R, Kelly P, Kinnaird T, Mamas MA. Chronic total occlusion in non-ST elevation myocardial infarction - A multi-centre observational study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 64:62-67. [PMID: 38395628 DOI: 10.1016/j.carrev.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES To evaluate the characteristics and outcomes of patients with a chronic total occlusion (CTO) in a Non-ST Elevation Myocardial Infarction (NSTEMI) cohort. BACKGROUND There is limited data on the clinical characteristics, revascularisation strategies and outcomes of patients presenting with a NSTEMI and a CTO. METHODS Retrospective analysis of a six-centre percutaneous coronary intervention (PCI) registry in the UK between January 2015 and December 2020 was performed. Patients with a NSTEMI with and without a CTO were compared for baseline characteristics and outcomes. RESULTS There were 17,355 NSTEMI patients in total of whom 1813 patients had a CTO (10.4 %). Patients with a CTO were more likely to be older (CTO: 67.8 (±11.5) years vs. no CTO: 67.2 (±12) years, p = 0.04), male (CTO: 81.1 % vs.71.9 %, p < 0.0001) with a greater prevalence of cardiovascular risk factors. All-cause mortality at 30 days: HR 2.63, 95 % CI 1.42-4.84, p = 0.002 and at 1 year: HR: 1.87, 95 % CI 1.25-2.81, p = 0.003 was higher in the CTO cohort. CTO patients who underwent revascularisation were younger (Revascularisation 66.4 [±11.7] years vs. no revascularisation 68.4 [±11.4] years, p = 0.001). Patients with failed CTO revascularisation had lower survival (HR 0.21, 95 % CI 0.10-0.42, p < 0.0001). The mean time to revascularisation was 13.4 days. There was variation in attempt at CTO revascularisation between the 6 centres for (16 % to 100 %) with success rates ranging from 65 to 100 %. CONCLUSIONS In conclusion, the presence of a CTO in NSTEMI patients undergoing PCI was associated with worse in-hospital and long-term outcomes.
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Affiliation(s)
- Vinoda Sharma
- Birmingham City Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland; University of Birmingham, United Kingdom of Great Britain and Northern Ireland.
| | - Anirban Choudhury
- Morriston Cardiac Centre, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Sandeep Basavarajaiah
- Heartlands Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Muhammad Rashid
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland; Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
| | - Mengshi Yuan
- Birmingham City Hospital, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Daniel Jefferey
- Morriston Cardiac Centre, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Andrew P Vanezis
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Hanish Sall
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - William H T Smith
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Ramya Parasa
- The Essex Cardiothoracic Centre, Basildon, United Kingdom of Great Britain and Northern Ireland
| | - Paul Kelly
- The Essex Cardiothoracic Centre, Basildon, United Kingdom of Great Britain and Northern Ireland
| | - Tim Kinnaird
- University Hospital Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Mamas A Mamas
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland; Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
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van Veelen A, Coerkamp CF, Somsen YBO, Råmunddal T, Ioanes D, Laanmets P, van der Schaaf RJ, Eriksen E, Bax M, Suttorp MJ, Strauss BH, Barbato E, Marques KM, Meuwissen M, Bertrand O, van der Ent M, Knaapen P, Tijssen JGP, Claessen BEPM, Hoebers LPC, Elias J, Henriques JPS. Ten-Year Outcome of Recanalization or Medical Therapy for Concomitant Chronic Total Occlusion After Myocardial Infarction. J Am Heart Assoc 2024; 13:e033556. [PMID: 38726918 PMCID: PMC11179819 DOI: 10.1161/jaha.123.033556] [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: 11/15/2023] [Accepted: 03/21/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The EXPLORE (Evaluating Xience and Left Ventricular Function in PCI on Occlusions After STEMI) trial was the first and only randomized trial investigating chronic total occlusion (CTO) percutaneous coronary intervention (PCI) early after primary PCI for ST-segment-elevation myocardial infarction, compared with medical therapy for the CTO. We performed a 10-year follow-up of EXPLORE to investigate long-term safety and clinical impact of CTO PCI after ST-segment-elevation myocardial infarction, compared with no-CTO PCI. METHODS AND RESULTS In EXPLORE, 302 patients post-ST-segment-elevation myocardial infarction with concurrent CTO were randomized to CTO PCI within ≈1 week or no-CTO PCI. We performed an extended clinical follow-up for the primary end point of major adverse cardiac events, consisting of cardiovascular death, coronary artery bypass grafting, or myocardial infarction. Secondary end points included all-cause death, angina, and dyspnea. Median follow-up was 10 years (interquartile range, 8-11 years). The primary end point occurred in 25% of patients with CTO PCI and in 24% of patients with no-CTO PCI (hazard ratio [HR], 1.11 [95% CI, 0.70-1.76]). Cardiovascular mortality was higher in the CTO PCI group (HR, 2.09 [95% CI, 1.10-2.50]), but all-cause death was similar (HR, 1.53 [95% CI, 0.93-2.50]). Dyspnea relief was more frequent after CTO PCI (83% versus 65%, P=0.005), with no significant difference in angina. CONCLUSIONS This 10-year follow-up of patients post-ST-segment-elevation myocardial infarction randomized to CTO PCI or no-CTO PCI demonstrated no clinical benefit of CTO PCI in major adverse cardiac events or overall mortality. However, CTO PCI was associated with a higher cardiovascular mortality compared with no-CTO PCI. Our long-term data support a careful weighing of effective symptom relief against an elevated cardiovascular mortality risk in CTO PCI decisions. REGISTRATION URL: https://www.trialregister.nl; Unique identifier: NTR1108.
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Affiliation(s)
- Anna van Veelen
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Casper F Coerkamp
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Yvemarie B O Somsen
- Department of Cardiology, Heart Center, Amsterdam UMC, Location VUMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Truls Råmunddal
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Dan Ioanes
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Peep Laanmets
- Department of Cardiology North-Estonia Medical Center Tallinn Estonia
| | | | - Erlend Eriksen
- Department of Cardiology Haukeland University Hospital Bergen Norway
| | - Matthijs Bax
- Department of Cardiology Haga Teaching Hospital The Hague the Netherlands
| | | | - Bradley H Strauss
- Department of Cardiology Sunnybrook Health Sciences Centre Toronto Canada
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine Sapienza University of Rome Rome Italy
| | - Koen M Marques
- Department of Cardiology, Heart Center, Amsterdam UMC, Location VUMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | | | - Olivier Bertrand
- Department of Cardiology Quebec Heart-Lung Institute Quebec Canada
| | | | - Paul Knaapen
- Department of Cardiology, Heart Center, Amsterdam UMC, Location VUMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Jan G P Tijssen
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Bimmer E P M Claessen
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - Loes P C Hoebers
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
- Department of Cardiology Maastricht UMC+ Maastricht the Netherlands
| | - Joëlle Elias
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
| | - José P S Henriques
- Department of Cardiology, Heart Center, Amsterdam UMC, Location AMC Amsterdam Cardiovascular Sciences Amsterdam the Netherlands
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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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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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Goyal A, Shahbaz H, Jain H, Fatima L, Abbasi HQ, Ullah I, Sheikh AB, Sohail AH. The impact of chronic total occlusion in non-infarct related arteries on patient outcomes following percutaneous coronary intervention for STEMI superimposed with cardiogenic shock: A pilot systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102237. [PMID: 38042227 DOI: 10.1016/j.cpcardiol.2023.102237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Chronic total occlusion (CTO) is defined as a near-total blockage of a coronary artery and often occurs in arteries that are not directly responsible for the event, known as non-infarct-related arteries (NIRA). Cardiogenic shock (CS) is a complication of ST-elevated myocardial infarction (STEMI) that carries significant mortality. We performed a meta-analysis to find an association between mortality in patients undergoing PCI for STEMI that have superimposed CS, with the presence of CTO in the NIRA. MATERIALS AND METHODOLOGY A comprehensive literature search was conducted using PubMed, EMBASE, Google Scholar and clinicaltrials.gov from inception till October 2023 to retrieve studies that compare the presence of CTO with the absence of CTO in NIRA in STEMI with CS patients undergoing PCI. The primary endpoint was 30-day mortality and the secondary endpoints were risk of all-cause mortality (ACM) and repeat myocardial infarction (MI). Forest plots were generated using the random effects model by pooling odds ratios (ORs) with a 95 % confidence interval. Statistical significance was set at p < 0.05. RESULTS 5 observational studies with a total of 5186 patients (1031 with CTO in NIRA and 4155 with no CTO in NIRA) were included. The presence of CTO in NIRA was associated with higher odds of 30-day mortality [OR: 3.10; 95 % CI: 1.52, 6.32; p < 0.002], and ACM [OR: 2.37; 95 % CI: 1.83, 3.08; p < 0.00001]. The odds of repeat MI were comparable between the two groups [OR: 1.61, 95 % CI: 0.03, 74.36, p = 0.81]. CONCLUSIONS The presence of CTO in the NIRA serves as an independent indicator of unfavorable clinical outcomes including increased risk of 30-day mortality and all-cause mortality. The risk of repeat MI was comparable between the two groups. Large-scale, multicenter trials are warranted to identify the most effective management approach for these patients.
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Affiliation(s)
- Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Haania Shahbaz
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS)-Jodhpur, Jodhpur, Rajasthan, India
| | - Laveeza Fatima
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Irfan Ullah
- Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM, USA
| | - Amir Humza Sohail
- Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM, USA.
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Ahmed TAN, Othman AAA, Demitry SR, Elmaghraby KM. Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease. BMC Cardiovasc Disord 2024; 24:68. [PMID: 38262995 PMCID: PMC10804526 DOI: 10.1186/s12872-023-03657-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 12/05/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The residual burden of coronary artery disease (CAD) after percutaneous coronary intervention (PCI) drew a growing interest. The residual SYNTAX Score (rSS) was a strong prognostic factor of adverse events and all-cause mortality in patients who underwent PCI. In addition, the SYNTAX Revascularization Index (SRI), a derivative of rSS, was used to figure out the treated proportion of CAD and could be used as a prognostic utility in PCI for patients with multi-vessel disease (MVD). PURPOSE We aimed at the assessment of the use of rSS and the SRI as predictors of in-hospital outcomes and up to two-year cumulative follow-up outcomes in patients with MVD who had PCI for the treatment of ST-Elevation Myocardial Infarction (STEMI) or Non-STEMI (NSTEMI). METHODS We recruited 149 patients who had either STEMI or NSTEMI while having MVD and received treatment with PCI. We divided them into tertiles based on their rSS and SRI values. We calculated baseline SYNTAX Score (bSS) and rSS using the latest version of the calculator on the internet, and we used both scores to calculate SRI. The study end-points were In-hospital composite Major Adverse Cardiovascular Events (MACE) and its components, in-hospital death, and follow-up cumulative MACE up to 2 years. RESULTS Neither rSS nor SRI were significant predictors of in-hospital adverse events, while female sex, hypertension, and left ventricular ejection fraction were independent predictors of in-hospital MACE. At the two-year follow-up, Kaplan-Meyer analysis showed a significantly increased incidence of MACE within the third rSS tertile (rSS > 12) compared to other tertiles (log rank p = 0.03). At the same time, there was no significant difference between the three SRI tertiles. Unlike SRI, rSS was a significant predictor of cumulative MACE on univariate Cox regression (HR = 1.037, p < 0.001). On multivariate Cox regression, rSS was a significant independent predictor of two-year cumulative MACE (HR = 1.038, p = 0.0025) along with female sex, hypertension, and left ventricular ejection fraction. We also noted that all patients with complete revascularization survived well throughout the entire follow-up period. CONCLUSIONS Neither rSS nor SRI could be good predictors of in-hospital MACE, while the rSS was a good predictor of MACE at two-year follow-up. Patients with rSS values > 12 had a significantly higher incidence of cumulative MACE after 2 years. The best prognosis was achieved with complete revascularization.
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Affiliation(s)
- Tarek A N Ahmed
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, 71526, Egypt
| | - Amr A A Othman
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, 71526, Egypt.
| | - Salwa R Demitry
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, 71526, Egypt
| | - Khaled M Elmaghraby
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, 71526, Egypt
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Gok M, Kurtul A, Taylan G, Ozturk C, Cakır B, Yılmaz E, Altay S, Yalta K. Impact of chronic total occlusion in a non-infarct-related coronary artery on contrast-associated nephropathy in acute ST-elevation myocardial infarction. Acta Cardiol 2023; 78:118-123. [PMID: 35678246 DOI: 10.1080/00015385.2022.2085357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Co-existing chronic total occlusion (CTO) in a non-infarct-related artery (IRA) might serve as an important trigger of adverse outcomes in ST-segment elevation myocardial infarction (STEMI). Therefore, we planned to analyse the potential impact of non-IRA CTO on the evolution of contrast-associated nephropathy (CAN) in STEMI patients managed with primary percutaneous coronary intervention (P-PCI). METHODS A total of 537 subjects with STEMI undergoing P-PCI during the first 12 h after the onset of their symptoms were enrolled in this retrospective study. The subjects were categorised based on the angiographic presence of non-IRA CTO. Moreover, the subjects were also divided into 2 groups based on their CAN status following P-PCI (CAN (+) and CAN (-)). RESULTS Co-existing non-IRA CTO was demonstrated in 86 subjects (16%). During the hospitalisation period, we identified 81 (15.1%) subjects with CAN. Subjects with non-IRA CTO had a significantly higher incidence of CAN compared with those without (56 [12.4%] vs 25 [29.1%], respectively, p < 0.001). In a logistic regression analysis, an existing non-IRA CTO (odds ratio: 2.840, 95%CI: 1.451-5.558, p = 0.002), as well as age, haemoglobin, diabetes mellitus, creatinine, and white blood cell count, were independent of predictors of CAN. CONCLUSION In STEMI patients managed with P-PCI, a co-existing non-IRA CTO had an independent association with the evolution of CAN.
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Affiliation(s)
- Murat Gok
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Alparslan Kurtul
- Faculty of Medicine, Department of Cardiology, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Gokay Taylan
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Cihan Ozturk
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Burcu Cakır
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Efe Yılmaz
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Servet Altay
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
| | - Kenan Yalta
- Faculty of Medicine, Department of Cardiology, Trakya University, Edirne, Turkey
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Relevance of Chronic Total Occlusion for Outcome of Ventricular Tachycardia Ablation in Ischemic Cardiomyopathy. J Interv Cardiol 2022; 2022:6829725. [PMID: 35935125 PMCID: PMC9314168 DOI: 10.1155/2022/6829725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/02/2022] [Indexed: 12/01/2022] Open
Abstract
Background Catheter ablation of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) is an effective tool to prevent VT recurrences. Chronic total occlusion (CTO) represents a clinically relevant entity in ICM patients and is an independent predictor of ventricular arrhythmia and mortality. The effects of CTO on the outcome of VT ablation are not well-studied. Objective This analysis aimed to identify the impact of CTO, revascularized, or not revascularized, on the outcome of VT ablation. Methods and Results Of 385 consecutive subjects with ICM-VT who underwent catheter VT ablation for monomorphic VT at Heart Center Leipzig between 2008 and 2017, 108 patients without CTO and 191 patients with CTO were included in the analysis. Within a median follow-up time of 557 days (IQR 149, 1095), VT recurred in 77 (40%) patients in the CTO and 40 (37.0%) in the non-CTO cohort (p = 0.62). In a multivariable model, a 10% stepwise change in LVEF as well as ICD on admission was associated with VT recurrence (HRadj 1.82, 95% CI 1.04–3.18 and HRadj 1.35, 95% CI 1.23–1.61, respectively). Of the CTO cohort before ablation, 45% had received revascularization, which was independently associated with a higher risk for VT recurrence (HR 2.12, 95% CI 1.35–3.34) as compared to nonrevascularized CTO. Conclusion In ICM patients with and without CTO, VT ablation was associated with equal effectiveness with regard to VT recurrence. However, in revascularized CTO patients, the risk of recurrence of VT after ablation was significantly increased.
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Demir M, Özbek M. A novel predictor in patients with coronary chronic total occlusion: systemic immune-inflammation index: a single-center cross-sectional study. Rev Assoc Med Bras (1992) 2022; 68:579-585. [DOI: 10.1590/1806-9282.20211097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
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Extracorporeal Membrane Oxygenation in Infarct-Related Cardiogenic Shock. J Clin Med 2022; 11:jcm11051256. [PMID: 35268347 PMCID: PMC8910965 DOI: 10.3390/jcm11051256] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/18/2022] Open
Abstract
Mortality in infarct-related cardiogenic shock (CS) remains high, reaching 40–50%. In refractory CS, active mechanical circulatory support devices including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are rapidly evolving. However, supporting evidence of VA-ECMO therapy in infarct-related CS is low. The current review aims to give an overview on the basics of VA-ECMO therapy, current evidence, ongoing trials, patient selection and potential complications.
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Nagalli S, Kikkeri NS, Nasir U, Rai Ahuja K, Ali Waheed T, Bhatia N. Trends and In-Hospital Outcomes of Patients Admitted with ST Elevation Myocardial Infarction and Chronic Total Occlusions: Insights from a National Database. Curr Probl Cardiol 2022; 48:101132. [PMID: 35114292 DOI: 10.1016/j.cpcardiol.2022.101132] [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: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Chronic total occlusion (CTO) is seen in a minority of ST-elevation myocardial infarction (STEMI) patients and is implicated in poor outcomes due to "double jeopardy". There is no large national data evaluating the trend and outcomes of STEMI patients who have a CTO (STEMI-CTO). We analyzed the Nationwide In-patients sample database from 2008-2011 and compared the trends, clinical characteristics, and in-hospital outcomes of STEMI patients with and without CTO. An increasing trend of CTO was seen in STEMI patients from 2008 to 2011. STEMI-CTO patients were younger, more likely develop cardiogenic shock, undergo percutaneous coronary intervention and thrombolysis. In this large, contemporary, national database, we also found that STEMI-CTO patients were more likely to have iatrogenic cardiac & vascular complications and undergo percutaneous mechanical circulatory support. We did not find significant difference in in-hospital deaths between STEMI-CTO patients and those without CTO.
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Affiliation(s)
- Shivaraj Nagalli
- Department of Internal Medicine, Brookwood Baptist Health, Alabaster, Alabama, USA.
| | - Nidhi Shankar Kikkeri
- Department of Internal Medicine, Reading Hospital - Tower Health, Reading, Pennsylvania, USA
| | - Usama Nasir
- Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Keerat Rai Ahuja
- Department of Cardiovascular Disease, Reading Hospital - Tower Health, Reading, Pennsylvania, USA
| | - Tayyab Ali Waheed
- Department of Cardiovascular Disease, Reading Hospital - Tower Health, Reading, Pennsylvania, USA
| | - Nirmanmoh Bhatia
- Department of Cardiovascular Disease, Heart South Vascular Institute
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12
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Qin Q, Chen L, Ge L, Qian J, Ma J, Ge J. A comparison of long-term clinical outcomes between percutaneous coronary intervention (PCI) and medical therapy in patients with chronic total occlusion in noninfarct-related artery after PCI of acute myocardial infarction. Clin Cardiol 2022; 45:136-144. [PMID: 34989416 PMCID: PMC8799053 DOI: 10.1002/clc.23771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Chronic total occlusion (CTO) in a noninfarct-related artery (IRA) is one of the risk factors for mortality after acute myocardial infarction (AMI). However, there are limited data comparing the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with patients having medical therapy (MT) in CTO lesion after AMI PCI. METHODS We retrospectively enrolled 330 patients (successful CTO PCI in 166 patients, failed CTO PCI in 32 patients, MT in 132 patients) with non-IRA CTO from a total of 4372 patients who underwent PCI after AMI in our center. Propensity score matching (PSM) was used to adjust for baseline differences. RESULTS The primary analysis is based on the intention-to-treat population. During a median follow-up period of 946 days, patients in the PCI group (n = 198) had significantly higher cardiac death-free survival (96.6% vs. 82.8%, p = .004) compared with patients in MT group (n = 132). However, no significant difference in the occurrence of cardiac death was observed after PSM. The analysis based on the per-protocol population demonstrated significantly higher cardiac death-free survival in the successful CTO PCI group (n = 166) compared with the occluded CTO group (n = 164) both before and after PSM. In subgroup analysis, successful CTO PCI was associated with less cardiac death in patients over 65 years old, with LVEF < 50%, left anterior descending (LAD) IRA, and non-LAD CTO lesion compared with occluded CTO group. CONCLUSIONS Patients undergoing successful revascularization of non-IRA CTO after AMI might have a better long-term prognosis. Moreover, patients with LVEF < 50% may benefit from successful non-IRA CTO PCI after AMI.
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Affiliation(s)
- Qing Qin
- Department of Cardiology, Zhongshan Hospital, Fudan UniversityShanghai Institute of Cardiovascular DiseaseShanghaiChina
| | - Lu Chen
- Department of Cardiology, Zhongshan Hospital, Fudan UniversityShanghai Institute of Cardiovascular DiseaseShanghaiChina
| | - Lei Ge
- Department of Cardiology, Zhongshan Hospital, Fudan UniversityShanghai Institute of Cardiovascular DiseaseShanghaiChina
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan UniversityShanghai Institute of Cardiovascular DiseaseShanghaiChina
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan UniversityShanghai Institute of Cardiovascular DiseaseShanghaiChina
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan UniversityShanghai Institute of Cardiovascular DiseaseShanghaiChina
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13
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Davies RE, Rier JD, McEntegart M, Riley RF, Kearney K, Lombardi W. Subintimal tracking and reentry as a tool in CTO-PCI: Past, present, and future. Catheter Cardiovasc Interv 2021; 98:1144-1151. [PMID: 34399015 DOI: 10.1002/ccd.29924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Rhian E Davies
- Department of Cardiology, WellSpan Health, York, Pennsylvania, USA
| | - Jeremy D Rier
- Department of Cardiology, WellSpan Health, York, Pennsylvania, USA
| | | | - Robert F Riley
- The Christ Hospital Health System, Ohio Heart and Vascular, Cincinnati, Ohio, USA
| | - Kathleen Kearney
- Department of Cardiology, University of Washington, Seattle, Washington, USA
| | - William Lombardi
- Department of Cardiology, University of Washington, Seattle, Washington, USA
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14
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Paradies V, Waldeyer C, Laforgia P, Clemmensen P, Smits PC. Completeness of revascularisation in acute coronary syndrome patients with multivessel disease. EUROINTERVENTION 2021; 17:193-201. [PMID: 34167938 PMCID: PMC9725070 DOI: 10.4244/eij-d-20-00957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A significant proportion of patients presenting with acute coronary syndromes (ACS) have multivessel disease (MVD). Despite the abundance of clinical trials in this area, several questions regarding the procedure of complete coronary revascularisation remain unanswered. This state-of-the-art review summarises the latest evidence on complete revascularisation (CR) in this subset of patients and critically appraises clinical decision making based on non-culprit lesion (NCL) assessment. Future areas of research are put into perspective.
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Affiliation(s)
- Valeria Paradies
- Maasstad Ziekenhuis, Maasstadweg 21, 3079 DZ Rotterdam, the Netherlands
| | - Christoph Waldeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany,German Center for Cardiovascular Research (DZHK eV.), partner site Hamburg/Kiel/Lübeck, Germany
| | - Pietro Laforgia
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Peter Clemmensen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany,German Center for Cardiovascular Research (DZHK eV.), partner site Hamburg/Kiel/Lübeck, Germany,Faculty of Health Sciences, Department of Regional Health Research, University of Southern Denmark, and Nykoebing Falster Hospital, Odense, Denmark
| | - Pieter C. Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
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15
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Milasinovic D, Mladenovic D, Zaharijev S, Mehmedbegovic Z, Marinkovic J, Jelic D, Zobenica V, Radomirovic M, Dedovic V, Pavlovic A, Dobric M, Stojkovic S, Asanin M, Vukcevic V, Stankovic G. Prognostic impact of non-culprit chronic total occlusion over time in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:990-998. [PMID: 34151365 DOI: 10.1093/ehjacc/zuab041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/06/2021] [Accepted: 05/21/2021] [Indexed: 11/13/2022]
Abstract
AIMS Previous studies indicated that a chronic total occlusion (CTO) in a non-infarct-related artery is linked to higher mortality mainly in the acute setting in patients with ST-elevation myocardial infarction (STEMI). Our aim was to assess the temporal distribution of mortality risk associated with non-culprit CTO over years after STEMI. METHODS AND RESULTS The study included 8679 STEMI patients treated with primary percutaneous coronary intervention (PCI). Kaplan-Meier cumulative mortality curves for non-culprit CTO vs. no CTO were compared with log-rank test, with landmarks set at 30 days and 1 year. Adjusted Cox regression models were constructed to assess the impact of non-culprit CTO on mortality over different time intervals. Tests for interaction were pre-specified between non-culprit CTO and acute heart failure and left ventricular ejection fraction. The primary outcome variable was all-cause mortality, and the median follow-up was 5 years. Non-culprit CTO was present in 11.6% of patients (n = 1010). Presence of a CTO was associated with increased early [30-day adjusted hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.54-2.36; P < 0.001] and late mortality (5-year adjusted HR 1.66, 95% CI 1.42-1.95; P < 0.001). Landmark analyses revealed an annual two-fold increase in mortality in patients with vs. without a CTO after the first year of follow-up. The observed pattern of mortality increase over time was independent of acute or chronic LV impairment. CONCLUSIONS Non-culprit CTO is independently associated with mortality over 5 years after primary PCI for STEMI, with a constant annual two-fold increase in the risk of death beyond the first year of follow-up.
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Affiliation(s)
- Dejan Milasinovic
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Djordje Mladenovic
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Stefan Zaharijev
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Zlatko Mehmedbegovic
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Marinkovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Dario Jelic
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Vladimir Zobenica
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Marija Radomirovic
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Vladimir Dedovic
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Andrija Pavlovic
- Department of Cardiology, University Children's Hospital, Belgrade, Serbia
| | - Milan Dobric
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sinisa Stojkovic
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milika Asanin
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Emergency Department, Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Vladan Vukcevic
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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16
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Fu M, Chang S, Ge L, Huang D, Yao K, Zhang F, Qin Q, Ma J, Qian J, Ge J. Reattempt Percutaneous Coronary Intervention of Chronic Total Occlusions after Prior Failures: A Single-Center Analysis of Strategies and Outcomes. J Interv Cardiol 2021; 2021:8835104. [PMID: 33935602 PMCID: PMC8079192 DOI: 10.1155/2021/8835104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 03/24/2021] [Accepted: 04/09/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The initial recanalization rate of coronary chronic total occlusions (CTOs) is >85% when performed by experienced operators, but only 10% of prior failed CTO patients receive reattempted recanalization. This retrospective study analyzed the success rate and strategies used in reattempt percutaneous coronary intervention (PCI) of CTOs after prior failures. METHODS Overall, 206 patients with 212 CTOs were enrolled. All patients with prior recanalization failures received reattempt PCIs from January 2015 to March 2019 at Zhongshan Hospital, Fudan University. Data on clinical factors (age, sex, comorbidities, left ventricular ejection fraction, history of cigarette usage, and revascularization), angiographic characteristics of CTOs (target lesion, Japanese Chronic Total Occlusion (J-CTO) score, the morphology of CTO lesions, and collateral channel scale), strategies (procedural approach and use of devices), and major adverse events were obtained and analyzed. RESULTS The mean age of enrolled patients was 60.96 ± 12.36 years, with a male predominance of 90.3%. Of the patients, 47.1% had a prior myocardial infarction and 70.4% underwent stent implantation previously, while the in-stent occlusion rate was 6.6%. CTOs were primarily localized in the left anterior descending artery (43.9%) and the right coronary artery (43.9%). 80.7% of lesions were classified as very difficult (J-CTO score ≥3), and the overall success rate was 81.1%. In multivariable regression analysis, J-CTO score, collateral channel scale, application of coronary multispiral computed tomography angiography, dual injection, intravascular ultrasound, active greeting technique, parallel wiring, and CTO morphology were predictors of recanalization success. There were no significant differences in rates of procedural complications between the final recanalization success and failure groups. CONCLUSIONS Recanalization of complex CTOs is associated with high success rate and low complication rates when performed by high-volume CTO operators and after multiple reattempts.
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Affiliation(s)
- Mingqiang Fu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Lei Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Dong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Kang Yao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Qing Qin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
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17
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Akashi N, Tsukui T, Yamamoto K, Seguchi M, Taniguchi Y, Sakakura K, Wada H, Momomura SI, Fujita H. Comparison of clinical outcomes and left ventricular remodeling after ST-elevation myocardial infarction between patients with and without diabetes mellitus. Heart Vessels 2021; 36:1445-1456. [PMID: 33715109 PMCID: PMC8379135 DOI: 10.1007/s00380-021-01827-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/05/2021] [Indexed: 11/17/2022]
Abstract
Left ventricular remodeling (LVR) after ST-elevation myocardial infarction (STEMI) is generally thought to be an adaptive but compromising phenomenon particularly in patients with diabetes mellitus (DM). However, whether the extent of LVR is associated with poor prognostic outcome with or without DM after STEMI in the modern era of reperfusion therapy has not been elucidated. This was a single-center retrospective observational study. Altogether, 243 patients who were diagnosed as having STEMI between January 2016 and March 2019, and examined with echocardiography at baseline (at the time of index admission) and mid-term (from 6 to 11 months after index admission) follow-up were included and divided into the DM (n = 98) and non-DM groups (n = 145). The primary outcome was major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, heart failure (HF) hospitalization, and non-fatal myocardial infarction. The median follow-up duration was 621 days (interquartile range: 304–963 days). The DM group was significantly increased the rate of MACEs (P = 0.020) and HF hospitalization (P = 0.037) compared with the non-DM group, despite of less LVR. Multivariate Cox regression analyses revealed that the patients with DM after STEMI were significantly associated with MACEs (Hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.20–6.47, P = 0.017) and HF hospitalization (HR 3.62, 95% CI 1.19–11.02, P = 0.023) after controlling known clinical risk factors. LVR were also significantly associated with MACEs (HR 2.44, 95% CI 1.03–5.78, P = 0.044) and HF hospitalization (HR 3.76, 95% CI 1.15–12.32, P = 0.029). The patients with both DM and LVR had worse clinical outcomes including MACEs and HF hospitalization, suggesting that it is particularly critical to minimize LVR after STEMI in patients with DM.
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Affiliation(s)
- Naoyuki Akashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan.
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18
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Impact of chronic total occlusion and revascularization strategy in patients with infarct-related cardiogenic shock: A subanalysis of the culprit-shock trial. Am Heart J 2021; 232:185-193. [PMID: 33253678 DOI: 10.1016/j.ahj.2020.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/18/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The impact of coronary artery chronic total occlusion (CTO) and its management with percutaneous coronary intervention (PCI) in the setting of myocardial infarction (MI) related cardiogenic shock (CS) remains unclear. METHODS This is a pre-specified analysis from the culprit-lesion-only PCI vs multivessel PCI in CS (CULPRIT-SHOCK) trial which randomized patients presenting with MI and multivessel disease complicated by CS to a culprit-lesion-only or immediate multivessel PCI strategy. CTO was defined by central core-laboratory evaluation. The independent associations between the presence of CTO and adverse outcomes at 30 days and 1 year were assessed using multivariate logistics models. RESULTS A noninfarct related CTO was present in 157 of 667 (23.5%) analyzed patients. Patients presenting with CTO had more frequent diabetes mellitus or prior PCI but less frequently presented with ST segment elevation MI as index event. The presence of CTO was associated with higher rate of death at 30 days (adjusted Odds ratio 1.63; 95% confidence interval [CI] 1.01-2.60). Rate of death at 1 year was also increased but did not reach statistical significance (adjusted Odds ratio 1.62; 95%CI 0.99-2.66). Compare to immediate multivessel PCI, a strategy of culprit-lesion-only PCI was associated with lower rates of death or renal replacement therapy at 30 days in patients with and without CTO (Odds ratio 0.79 95%CI 0.42-1.49 and Odds ratio 0.67 95%CI 0.48-0.96, respectively), without significant interaction (P = .68). CONCLUSIONS In patients with MI-related CS and multivessel disease, the presence of CTO is associated with adverse outcomes while a strategy of culprit-lesion-only PCI seems beneficial regardless of the presence of CTO.
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19
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Liu Y, Wang LF, Yang XC, Lu CL, Li KB, Chen ML, Li N, Wang HS, Zhong JC, Xu L, Ni ZH, Li WM, Xia K, Zhang DP, Sun H, Guo ZS, Chi YH, He JF, Zhang ZY, Jiang F, Wang HJ. The long-term impact of a chronic total occlusion in a non-infarct-related artery on acute ST-segment elevation myocardial infarction after primary coronary intervention. BMC Cardiovasc Disord 2021; 21:59. [PMID: 33516191 PMCID: PMC7847020 DOI: 10.1186/s12872-021-01874-1] [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: 08/21/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To investigate the long-term outcome of patients with acute ST-segment elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) and the risk factors for mortality. Methods The enrolled cohort comprised 323 patients with STEMI and multivessel diseases (MVD) that received a primary percutaneous coronary intervention between January 2008 and November 2013. The patients were divided into two groups: the CTO group (n = 97) and the non-CTO group (n = 236). The long-term major adverse cardiovascular and cerebrovascular events (MACCE) experienced by each group were compared. Results The rates of all-cause mortality and MACCE were significantly higher in the CTO group than they were in the non-CTO group. Cox regression analysis showed that an age ≥ 65 years (OR = 3.94, 95% CI: 1.47–10.56, P = 0.01), a CTO in a non-IRA(OR = 5.09, 95% CI: 1.79 ~ 14.54, P < 0.01), an in-hospital Killip class ≥ 3 (OR = 4.32, 95% CI: 1.71 ~ 10.95, P < 0.01), and the presence of renal insufficiency (OR = 5.32, 95% CI: 1.49 ~ 19.01, P = 0.01), stress ulcer with gastraintestinal bleeding (SUB) (OR = 6.36, 95% CI: (1.45 ~ 28.01, P = 0.01) were significantly related the 10-year mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 (OR = 2.97,95% CI:1.46 ~ 6.03, P < 0.01) and the presence of renal insufficiency (OR = 5.61, 95% CI: 1.19 ~ 26.39, P = 0.03) were significantly related to the 10-year mortality of patients with STEMI and a CTO. Conclusions The presence of a CTO in a non-IRA, an age ≥ 65 years, an in-hospital Killip class ≥ 3, and the presence of renal insufficiency, and SUB were independent risk predictors for the long-term mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 and renal insufficiency were independent risk predictors for the long-term mortality of patients with STEMI and a CTO.
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Affiliation(s)
- Yu Liu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Le-Feng Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China.
| | - Xin-Chun Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Chang-Lin Lu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Kui-Bao Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Mu-Lei Chen
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Na Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Hong-Shi Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Jiu-Chang Zhong
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Li Xu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Zhu-Hua Ni
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Wei-Ming Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Kun Xia
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Da-Peng Zhang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Hao Sun
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Zong-Sheng Guo
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Yong-Hui Chi
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Ji-Fang He
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Zhi-Yong Zhang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Feng Jiang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
| | - Hong-Jiang Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China
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Kim SH, Behnes M, Mashayekhi K, Bufe A, Meyer-Gessner M, El-Battrawy I, Akin I. Prognostic Impact of Percutaneous Coronary Intervention of Chronic Total Occlusion in Acute and Periprocedural Myocardial Infarction. J Clin Med 2021; 10:E258. [PMID: 33445664 PMCID: PMC7828144 DOI: 10.3390/jcm10020258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
Coronary chronic total occlusion (CTO) has gained increasing clinical attention as the most advanced form of coronary artery disease. Prior studies already indicated a clear association of CTO with adverse clinical outcomes, especially in patients with acute myocardial infarction (AMI) and concomitant CTO of the non-infarct-related coronary artery (non-IRA). Nevertheless, the prognostic impact of percutaneous coronary intervention (PCI) of CTO in the acute setting during AMI is still controversial. Due to the complexity of the CTO lesion, CTO-PCI leads to an increased risk of complications compared to non-occlusive coronary lesions. Therefore, this review outlines the prognostic impact of CTO-PCI in patients with AMI. In addition, the prognostic impact of periprocedural myocardial infarction caused by CTO-PCI will be discussed.
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Affiliation(s)
- Seung-Hyun Kim
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany; (M.B.); (I.E.-B.); (I.A.)
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany; (M.B.); (I.E.-B.); (I.A.)
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany;
| | - Alexander Bufe
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, 47805 Krefeld, Germany;
- University Witten/Herdecke, 58455 Witten, Germany
| | - Markus Meyer-Gessner
- Department of Cardiology and Intensive Care, Augusta Hospital, 40472 Düsseldorf, Germany;
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany; (M.B.); (I.E.-B.); (I.A.)
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany; (M.B.); (I.E.-B.); (I.A.)
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van Veelen A, Claessen BEPM, Houterman S, Hoebers LPC, Elias J, Henriques JPS, Knaapen P. Incidence and outcomes of chronic total occlusion percutaneous coronary intervention in the Netherlands: data from a nationwide registry. Neth Heart J 2020; 29:4-13. [PMID: 33263890 PMCID: PMC7782624 DOI: 10.1007/s12471-020-01521-y] [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] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
Background Patients with chronic total coronary occlusions (CTO) are at increased risk for poor clinical outcomes. We aimed to determine the incidence of CTO percutaneous coronary intervention (PCI) and to identify CTO patients at risk for cardiac events in the nationwide Netherlands Heart Registration (NHR). Methods We included all PCI procedures with ≥1 CTO registered in the NHR from January 2015 to December 2018, excluding acute interventions. We used multivariable logistic regression of baseline characteristics to calculate the risk for events as odds ratios (OR) with 95% confidence intervals (CI). Results Of the PCIs performed during the study period, 6.3% (8,343/133,042) were for CTOs, with the percentage increasing significantly over time from 5.9% in 2015 to 6.6% in 2018 (p < 0.001). Coronary artery bypass grafting <24 h was carried out in 0.3%, and the only significant predictor was diabetes mellitus (OR 2.97, 95% CI 1.04–8.49, p = 0.042). Myocardial infarction (MI) <30 days occurred in 0.5%, and renal insufficiency (i.e. estimated glomerular filtration rate <30 ml/min per 1.73 m2) was identified as an independent predictor (OR 4.70, 95% CI 1.07–20.61, p = 0.040). Among patients undergoing CTO-PCI, 1‑year mortality was 3.7%, and independent predictors included renal insufficiency (OR 5.59, 95% CI 3.25–9.59, p < 0.001), left ventricular ejection fraction <30% (OR 3.43, 95% CI 2.00–5.90, p < 0.001), previous MI (OR 1.62, 95% CI 1.14–2.31, p = 0.007) and age (OR 1.06 per year increment, 95% CI 1.04–1.07, p < 0.001). Target-vessel revascularisation <1 year occurred in 11.3%. Conclusion CTO-PCI is still infrequently performed in the Netherlands. The most important predictor of mortality after CTO-PCI was renal insufficiency. Identification of patients at risk may help improve the prognosis of CTO patients in the future. Electronic supplementary material The online version of this article (10.1007/s12471-020-01521-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A van Veelen
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B E P M Claessen
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - S Houterman
- Netherlands Heart Registration, Utrecht, The Netherlands
| | - L P C Hoebers
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Elias
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J P S Henriques
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P Knaapen
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University, Amsterdam, The Netherlands.
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Prognostic Value of the Residual SYNTAX Score on In-Hospital and Follow-Up Clinical Outcomes in ST Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Interventions. Cardiol Res Pract 2020; 2020:9245431. [PMID: 33178454 PMCID: PMC7644317 DOI: 10.1155/2020/9245431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
Aims We investigated the prognostic significance of residual SYNTAX score (RSS) in patients undergoing PCI due to STEMI and relationship between RSS and in-hospital and long-term ischemic cardiac events. Methods Between June 2015 and December 2018, 538 patients who underwent primary PCI were evaluated for in-hospital events and 478 patients were evaluated for clinical events during follow-up. Primary and secondary endpoints for both in-hospital and follow-up periods were cardiac death and major adverse cardiac events (MACE). Results 538 patients were included the study. RSS values of 131 patients were 0, and RSS values of 407 patients were >0. The median value of the RSS > 0 group was 7. According to this value, the RSS > 0 group was divided into 2 groups as R-ICR (RSS < 7, N = 188) and ICR (RSS ≥ 7, n = 219). In the RSS ≥ 7 group, during in-hospital and follow-up period, both mortality and MACE rates were higher than the other two groups. Area under the curve (AUC) for RSS for in-hospital death was found to be higher than SS (p=0.035) but similar to Grace Score (GS) (p=0.651). For MACE, RSS was higher than SS (p=0.025) and higher than the GS (p=0.041). For follow-up cardiac mortality, the AUC of the RSS was found to be higher than SS (0.870/0.763, p=0.02) and GS (0.870/0.733, p=0.001). For MACE, the AUC of RSS was higher than SS (p=0.03) and GS (p=0.004). Conclusions High RSS values in STEMI patients are associated with increased risk of ischemic cardiac events. RSS may help determine revascularization and level of additional PCI to improve prognosis by reducing the risk of ischemic cardiac events after P-PCI.
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Tsukui T, Sakakura K, Taniguchi Y, Yamamoto K, Seguchi M, Jinnouchi H, Wada H, Fujita H. Factors associated with poor clinical outcomes of ST-elevation myocardial infarction in patients with door-to-balloon time <90 minutes. PLoS One 2020; 15:e0241251. [PMID: 33091051 PMCID: PMC7580980 DOI: 10.1371/journal.pone.0241251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background Recent guidelines for ST-elevation myocardial infarction (STEMI) recommended the door-to-balloon time (DTBT) <90 minutes. However, some patients could have poor clinical outcomes in spite of DTBT <90 minutes, which suggest the importance of therapeutic targets except DTBT. The purpose of this study was to find factors associated with poor clinical outcomes in STEMI patients with DTBT <90 minutes. Methods This retrospective study included 383 STEMI patients with DTBT <90 minutes. The primary endpoint was the major adverse cardiac events (MACE) defined as the composite of all-cause death, acute myocardial infarction, and acute heart failure requiring hospitalization. Result The median follow-up duration was 281 days, and the cumulative incidence of MACE was 16.2%. In the multivariate Cox hazard model, low body mass index (< 20 kg/m2) (vs. >20 kg/m2: HR 2.80, 95% CI 1.39–5.64, p = 0.004), history of previous myocardial infarction (HR 2.39, 95% CI 1.06–5.37, p = 0.04), and Killip class 3 or 4 (vs. Killip class 1 or 2: HR 2.39, 95% CI 1.30–4.40, p = 0.005) were significantly associated with MACE. In another multivariate Cox hazard model, flow worsening during percutaneous coronary intervention (PCI) (HR 3.24, 95% CI 1.79–5.86, p<0.001) and use of mechanical support (HR 3.15, 95% CI 1.71–5.79, p<0.001) were significantly associated with MACE, whereas radial approach (HR 0.54, 95% CI 0.32–0.92, p = 0.02) was inversely associated with MACE. Conclusion Low body mass index, Killip class 3/4, history of previous myocardial infarction, use of mechanical support, and flow worsening were significantly associated with MACE, whereas radial-access was inversely associated with MACE. It is important to avoid flow worsening during primary PCI even when appropriate DTBT was achieved.
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Affiliation(s)
- Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- * E-mail:
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Khan AA, Khalid MF, Ayub MT, Murtaza G, Sardar R, White CJ, Mukherjee D, Nanjundappa A, Paul TK. Outcomes of Percutaneous Coronary Intervention Versus Optimal Medical Treatment for Chronic Total Occlusion: A Comprehensive Meta-analysis. Curr Probl Cardiol 2020; 46:100695. [PMID: 33010951 DOI: 10.1016/j.cpcardiol.2020.100695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/15/2020] [Indexed: 01/11/2023]
Abstract
The presence of concurrent chronic total occlusion (CTO) is a strong predictor for both short-term and long-term mortality. Successful percutaneous coronary intervention (PCI) of CTO has been associated with clinical benefit. We sought to perform a meta-analysis comparing CTO-PCI versus optimal medical therapy. PubMed, ClinicalTrials.gov, Google scholar and the Cochrane Central Register of Controlled Trials were searched for studies published from 2006 to 2019. A total of 16 studies, with 11,314 patients were included. We analyzed data on mortality, cardiac deaths, myocardial re-infarction, major adverse cardiac events, stroke, and repeat CTO-PCI using random-effects models. The odds ratios (OR) with 95% confidence interval (CI) were computed and P < 0.05 was considered as a level of significance. Compared with medical therapy alone, CTO-PCI was associated with lower mortality (OR: 0.45, CI: 0.32-0.63, P < 0.00001) and cardiac deaths (OR: 0.58, CI: 0.38-0.89, P = 0.01). These results were primarily driven by observational studies with no difference observed in randomized controlled trials. There was no significant difference in the incidence of major adverse cardiac events (OR: 0.71, CI: 0.48-1.05, P = 0.54), myocardial re-infarction (OR: 0.71, CI: 0.48-1.05, P = 0.54), stroke (OR: 0.61, CI: 0.32-1.17, P = 0.14, and repeat PCI (OR: 1.28, CI: 0.91-1.78, P = 0.16). This meta-analysis shows lower long-term mortality and cardiac deaths in CTO-PCI group as compared to OMT driven by observational studies with no difference observed in randomized controlled trials. Further randomized trials are needed to confirm these findings and evaluate long term results.
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25
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Joshi FR, Pedersen F, Räder S, Raunsø J, Kjaergaard J, Lindholm M, Hassager C, Engstrøm T, Holmvang L, Helqvist S, Jørgensen E. Jeopardized Myocardium and Survival in Patients Presenting to the Catheterization Laboratory With ST-Elevation Myocardial Infarction and Shock. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:843-848. [DOI: 10.1016/j.carrev.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/22/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022]
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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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27
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One-year clinical outcomes of coronary chronic total occlusion intervention in patients with acute coronary syndrome versus stable angina: from the Korean chronic total occlusion registry. Coron Artery Dis 2020; 31:430-437. [PMID: 32168045 DOI: 10.1097/mca.0000000000000880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic total occlusion intervention remains challenging and detailed real-world data on the safety and efficacy of which are limited. This study sought to determine whether there are differences in the 1-year clinical outcomes between chronic total occlusion patients with acute coronary syndrome and stable angina following chronic total occlusion intervention. PATIENTS AND METHODS Data from the Korean chronic total occlusion registry were collected from May 2003 to September 2012, and a total of 3268 patients who underwent chronic total occlusion intervention were enrolled. Cardiovascular outcomes up to 12 months in the acute coronary syndrome group were compared with stable angina group. RESULTS The acute coronary syndrome group consisted of 1657 patients, and stable angina group consisted of 1264 patients. In the acute coronary syndrome group, patients with successful chronic total occlusion intervention had a lower incidence of total death and cardiac death compared to patients with failed intervention. However, there were no significant differences in cardiovascular events in the stable angina group. The successful chronic total occlusion intervention was a significant prognostic factor for lower total death (P = 0.006, hazard ratio = 0.46) and cardiac death (P = 0.003, hazard ratio = 0.36) within acute coronary syndrome group. On the other hand, successful chronic total occlusion intervention was not a prognostic factor for cardiovascular events within stable angina group. CONCLUSIONS Successful chronic total occlusion intervention in acute coronary syndrome patients was associated with a lower incidence of cardiovascular outcome compared to patients with failed chronic total occlusion intervention.
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Sabell T, Banaszewski M, Lassus J, Nieminen MS, Tolppanen H, Jäntti T, Kataja A, Hongisto M, Køber L, Sionis A, Parissis J, Tarvasmäki T, Harjola VP, Jurkko R. Prognostic impact of angiographic findings, procedural success, and timing of percutaneous coronary intervention in cardiogenic shock. ESC Heart Fail 2020; 7:768-773. [PMID: 32163675 PMCID: PMC7160464 DOI: 10.1002/ehf2.12637] [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] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 01/20/2023] Open
Abstract
Aims Urgent revascularization is the mainstay of treatment in acute coronary syndrome (ACS) related cardiogenic shock (CS). The aim was to investigate the association of angiographic results with 90‐day mortality. Procedural complications of percutaneous coronary intervention (PCI) were also examined. Methods and results This CardShock (NCT01374867) substudy included 158 patients with ACS aetiology and data on coronary angiography and complications during PCI procedure. Survival analysis was conducted with Kaplan–Meier curves and Cox regression analysis. Median age was 67 ± 11 years, and 77% were men. During 90‐day follow‐up, 66 (42%) patients died. Patients with one‐vessel disease (n = 49) had lower mortality than patients with two‐vessel (n = 59) or three‐vessel (n = 50) disease (25% vs. 48% vs. 52%, P = 0.011). Successful revascularization [Thrombolysis in Myocardial Infarction (TIMI) Flow 3 post‐PCI) was achieved more often in survivors than non‐survivors (81% vs. 60%, P = 0.019). The median symptom‐to‐balloon time was 340 (196–660) minutes, with no difference between survivors and non‐survivors. In multivariable mortality analysis, multivessel disease (HR 2.59, CI95% 1.29–5.18) and TIMI flow <3 post‐PCI (HR 2.41, CI95% 1.4–4.15) were associated with 90‐day mortality. Procedural PCI complications were recorded in 51 (35%) patients, arrhythmic complications being the most common (n = 32, 63%). The incidence of complications was similar between survivors and non‐survivors (31% vs. 42%, P = 0.21). Conclusions Multivessel disease is associated with worse survival in ACS‐related CS. In patients undergoing PCI, arrhythmic complications were common, but not associated with excess mortality. Successful revascularization of the IRA had positive effect on outcome despite delay from symptom onset.
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Affiliation(s)
- Tuija Sabell
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Marek Banaszewski
- Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland
| | - Johan Lassus
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Markku S Nieminen
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Heli Tolppanen
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Toni Jäntti
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Anu Kataja
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Mari Hongisto
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - John Parissis
- ER and Heart Failure Clinic, Attikon University Hospital, Athens, Greece
| | - Tuukka Tarvasmäki
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Veli-Pekka Harjola
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Raija Jurkko
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
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Tsukui T, Sakakura K, Taniguchi Y, Yamamoto K, Seguchi M, Wada H, Momomura SI, Fujita H. Association between the Door-to-balloon Time and Mid-term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction. Intern Med 2020; 59:1597-1603. [PMID: 32612063 PMCID: PMC7402959 DOI: 10.2169/internalmedicine.4287-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective In primary percutaneous coronary intervention (PCI), the door-to-balloon time (DTBT) is known to be associated with in-hospital death in patients with ST-segment elevation myocardial infarction (STEMI). However, little is known regarding the association between the DTBT and the mid-term clinical outcomes in patients with STEMI. The purpose of this study was to investigate the association between the DTBT and mid-term all-cause death. Methods The study population included 309 STEMI patients, who were divided into the short DTBT (DTBT<60 minutes, n=103), intermediate DTBT (DTBT 60-120 minutes, n=174) and long DTBT (DTBT >120 minutes, n=32) groups. The median follow-up period was 287 days (interquartile range: 182-624 days). Results The incidence of all-cause death in the long DTBT group was significantly higher in comparison to the other groups (p<0.001). In the multivariate Cox regression analysis, although a short DTBT [vs. intermediate DTBT: hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.39-2.55, p=0.99] was not associated with all-cause death, a long DTBT (vs. intermediate DTBT: HR 2.80, 95% CI 1.26-6.17, p=0.011) was significantly associated with all-cause death, after controlling for confounding factors such as Killip class 4, an impaired renal function, and the number of diseased vessels. Conclusion The DTBT was significantly associated with the incidence of mid-term all-cause death. Our results support the strong adherence to the DTBT in patients with STEMI.
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Affiliation(s)
- Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
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30
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Vallabhajosyula S, Prasad A, Gulati R, Barsness GW. Contemporary prevalence, trends, and outcomes of coronary chronic total occlusions in acute myocardial infarction with cardiogenic shock. IJC HEART & VASCULATURE 2019; 24:100414. [PMID: 31517033 PMCID: PMC6727101 DOI: 10.1016/j.ijcha.2019.100414] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/27/2019] [Accepted: 08/17/2019] [Indexed: 01/05/2023]
Abstract
Background There are limited data on the prevalence and outcomes of chronic total occlusions (CTO) of the coronary artery in acute myocardial infarction with cardiogenic shock (AMI-CS) patients. Methods Using the National Inpatient Sample, all admissions with AMI-CS that underwent diagnostic angiography between January 1, 2008, and December 31, 2014, were included. CTO, percutaneous coronary intervention (PCI), comorbidities and concomitant cardiac arrest was identified for all admissions. Outcomes of interest included temporal trends, in-hospital mortality, and resource utilization in cohorts with and without CTO. Results In this 7-year period, 163,628 admissions with AMI-CS admissions met the inclusion criteria, with 68% being ST-elevation AMI-CS. CTO was noted in 27,343 (16.7%) admissions, with an increase in prevalence during the study period. The cohort with CTOs was more likely to be male and bearing private insurance. The CTO cohort had higher cardiovascular comorbidity, higher rates of cardiac arrest and higher use of PCI and mechanical circulatory support. The presence of a CTO was independently associated with higher in-hospital mortality (adjusted odds ratio 1.20 [95% confidence interval 1.16–1.23]; p < 0.001). The cohort with CTO had lower resource utilization (hospital stay and hospitalization costs) but was discharged more frequently to other hospitals. The presence of a CTO was associated with higher in-hospital mortality in the sub-groups of ST-elevation AMI-CS (31.5% vs. 28.7%; p < 0.001) and non-ST-elevation AMI-CS (24.8% vs. 23.2%; p < 0.001). Conclusions In this cohort of AMI-CS admissions that underwent diagnostic angiography, the presence of a CTO identified a higher risk cohort that had higher in-hospital mortality. CTOs are seen in 17% of all AMI-CS admissions with higher rates in STEMI. The CTO cohort had higher cardiac arrest, PCI & mechanical circulatory support use. Presence of a CTO was a marker of higher adjusted in-hospital mortality.
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Affiliation(s)
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
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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: 5] [Impact Index Per Article: 1.0] [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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32
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Rathod KS, Koganti S, Jain AK, Rakhit R, Dalby MC, Lockie T, Kalra S, Malik IS, Knight CJ, Whitbread M, Mathur A, Firoozi S, Bogle R, Redwood S, MacCarthy PA, Sirker A, O'Mahony C, Wragg A, Jones DA. Complete Versus Culprit only Revascularisation in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction: Incidence and Outcomes from the London Heart Attack Group. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:350-358. [PMID: 31327710 DOI: 10.1016/j.carrev.2019.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/24/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite advances in technology, patients with Cardiogenic Shock (CS) presenting with ST-segment myocardial infarction (STEMI) still have a poor prognosis with high mortality rates. A large proportion of these patients have multi-vessel coronary artery disease, the treatment of which is still unclear. We aimed to assess the trends in management of CS patients with multi-vessel disease (MVD), particularly looking at the incidence and outcomes of complete revascularisation compared to culprit vessel only. METHODS AND RESULTS We undertook an observational cohort study of 21,210 STEMI patients treated between 2005 and 2015 at the 8 Heart Attack Centres in London, UK. Patients' details were recorded prospectively into local databases using the British Cardiac Intervention Society (BCIS) PCI dataset. 1058 patients presented with CS and MVD. Primary outcome was all-cause mortality. Patients were followed-up for a median of 4.1 years (IQR range: 2.2-5.8 years). 497 (47.0%) patients underwent complete revascularisation during primary PCI for CS with stable rates seen over time. These patients were more likely to be male, hypertensive and more likely to have poor LV function compared to the culprit vessel intervention group. Although crude, in hospital major adverse cardiac events (MACE) rates were similar (40.8% vs. 36.0%, p = 0.558) between the two groups. Kaplan-Meier analysis demonstrated no significant differences in mortality rates between the two groups (53.8% complete revascularisation vs. 46.8% culprit vessel intervention, p = 0.252) during the follow-up period. After multivariate cox analysis (HR 0.69 95% CI (0.44-0.98)) and the use of propensity matching (HR: 0.81 95% CI: 0.62-0.97) complete revascularisation was associated with reduced mortality. A number of co-variates were included in the model, including age, gender, diabetes, hypertension, hypercholesterolaemia, previous PCI, previous MI, chronic renal failure, Anterior infarct, number of treated vessels, pre-procedure TIMI flow, procedural success and GP IIb/IIIA use. CONCLUSION In a contemporary observational series of CS patients with MVD, complete revascularisation appears to be associated with better outcomes compared to culprit vessel only intervention. This supports on-going clinical trials in this area and provides further evidence of the association of complete revascularisation in STEMI with good outcomes.
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Affiliation(s)
- Krishnaraj S Rathod
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Sudheer Koganti
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Ajay K Jain
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Roby Rakhit
- Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom of Great Britain and Northern Ireland
| | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Middlesex, London, United Kingdom of Great Britain and Northern Ireland
| | - Tim Lockie
- Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom of Great Britain and Northern Ireland
| | - Sundeep Kalra
- Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom of Great Britain and Northern Ireland
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, Du Cane Road, London, United Kingdom of Great Britain and Northern Ireland
| | - Charles J Knight
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Mark Whitbread
- London Ambulance Service NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Anthony Mathur
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Sam Firoozi
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Richard Bogle
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Simon Redwood
- St Thomas' NHS Foundation Trust, Guys & St. Thomas Hospital, Westminster Bridge Rd, London, United Kingdom of Great Britain and Northern Ireland
| | - Philip A MacCarthy
- King's College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom of Great Britain and Northern Ireland
| | - Alexander Sirker
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Constantinos O'Mahony
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Wragg
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Daniel A Jones
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland.
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33
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Allahwala UK, De Silva K, Bhindi R. Utilizing coronary physiology to guide acute coronary syndrome management: are we there yet? Future Cardiol 2019; 15:323-327. [PMID: 31290332 DOI: 10.2217/fca-2019-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Kalpa De Silva
- Bristol Heart Institute, University Hospitals Bristol & University of Bristol, BS2 8ED Bristol, UK
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
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Cardi T, Kayali A, Trimaille A, Marchandot B, Ristorto J, Hoang VA, Hess S, Kibler M, Jesel L, Ohlmann P, Morel O. Prognostic Value of Incomplete Revascularization after Percutaneous Coronary Intervention Following Acute Coronary Syndrome: Focus on CKD Patients. J Clin Med 2019; 8:jcm8060810. [PMID: 31174280 PMCID: PMC6617537 DOI: 10.3390/jcm8060810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/23/2019] [Accepted: 06/03/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Residual coronary artery disease (CAD) has been associated with worsened prognosis in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). The residual SYNTAX Score (rSS) aims to assess residual CAD after PCI. The association between kidney function and rSS has not been investigated in ACS patients. In this study, we sought to determine whether chronic kidney disease (CKD) patients exhibit more incomplete revascularization following stage revascularization procedures by PCI. We evaluated the impact of incomplete revascularization on the occurrence of major cardiovascular events (MACE) at one-year follow-up. Methods: A total of 831 ACS patients undergoing PCI were divided into 3 subgroups according to their estimated Glomerular Filtration Rate (eGFR): 695 with eGFR ≥ 60 mL/min/1.73 m², 108 with eGFR 60–30 mL/min/1.73 m², 28 with eGFR < 30 mL/min/1.73 m². Initial SYNTAX score (SS) and rSS were calculated for all patients. Incomplete revascularization was defined by rSS > 8. The primary endpoint was the occurrence of MACE (all-cause mortality, myocardial infarction (MI), repeated revascularization except from planned revascularization, stroke and definite or probable recurrent stent thrombosis) one year after the index procedure. Results: Severe CKD patients had significantly higher MACE (12.0% vs. 25.9% vs. 35.7%; p < 0.001), all-cause mortality, cardiovascular mortality and heart failure events. Patients with rSS > 8 had higher MACE, all-cause and cardiovascular mortality. CKD was an independent predictive factor of rSS > 8 (HR: 1.65, 95% CI: 1.01 to 2.71; p = 0.048). Multivariate analysis identified rSS > 8, but not CKD, as an independent predictor of cardiac death and MACE. Conclusion: In ACS, CKD is predictive of incomplete revascularization, which stands out as a strong predictor of adverse cardiovascular outcomes including cardiac death and MACE.
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Affiliation(s)
- Thomas Cardi
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
| | - Anas Kayali
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
| | - Antonin Trimaille
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
| | - Benjamin Marchandot
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
| | - Jessica Ristorto
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
| | - Viet Anh Hoang
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
- Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong, Dong Da, 10000 Hanoi, Vietnam.
| | - Sébastien Hess
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
| | - Marion Kibler
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
| | - Laurence Jesel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
- Regenerative Nanomedicine, UMR 1260, INSERM (French National Institute of Health and Medical Research), FMTS (Fédération de Médecine Translationnelle de l'Université de Strasbourg),
Université de Strasbourg, Faculté de Médecine, 11 rue Humann, 67085 Strasbourg, France.
| | - Patrick Ohlmann
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
| | - Olivier Morel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67090 Strasbourg, France.
- Regenerative Nanomedicine, UMR 1260, INSERM (French National Institute of Health and Medical Research), FMTS (Fédération de Médecine Translationnelle de l'Université de Strasbourg),
Université de Strasbourg, Faculté de Médecine, 11 rue Humann, 67085 Strasbourg, France.
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Noguchi M, Sakakura K, Akashi N, Adachi Y, Watanabe Y, Taniguchi Y, Ibe T, Yamamoto K, Wada H, Momomura SI, Fujita H. The Comparison of Clinical Outcomes Between Inferior ST-Elevation Myocardial Infarction with Right Ventricular Infarction Versus Without Right Ventricular Infarction. Int Heart J 2019; 60:560-568. [PMID: 31105155 DOI: 10.1536/ihj.18-515] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Right ventricular infarction (RVI) is a complication following inferior ST-elevation myocardial infarction (STEMI). The aim of the present study was to investigate the clinical outcomes of RVI in the contemporary primary percutaneous coronary intervention (PCI) era. The primary endpoint was in-hospital death, and the secondary endpoint was major adverse cardiac events (MACE), defined as the composite of cardiovascular death, re-hospitalization for heart failure, and non-fatal acute myocardial infarction (AMI). Event-free survival curves for MACE were constructed using the Kaplan-Meier method, and statistical differences between curves were assessed using the log-lank test. A total of 1354 patients with AMI were screened from January 2010 to December 2016. The final study population involved 315 patients with STEMI whose infarct related artery (IRA) was the right coronary artery (RCA). We categorized these 315 patients into the RVI group (n = 85) and the non-RVI group (n = 230). Median follow-up duration was 358 (IQR: 208-987) days. In-hospital deaths were more frequently observed in the RVI group (9.4%) than in the non-RVI group (3.0%) (P = 0.018). However, the incidence of MACE was not different between the groups (P = 0.537). In conclusion, in-hospital clinical outcomes were poorer in the RVI group than in the non-RVI group. However, mid-term MACE was not different between the two groups, suggesting the importance of aggressive acute treatment for STEMI patients with RVI.
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Affiliation(s)
- Masamitsu Noguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Naoyuki Akashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yusuke Adachi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Tatsuro Ibe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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36
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Allahwala UK, Jolly SS, Džavík V, Cairns JA, Kedev S, Balasubramanian K, Stankovic G, Moreno R, Valettas N, Bertrand O, Lavi S, Velianou JL, Sheth T, Meeks B, Brilakis ES, Bhindi R. The Presence of a CTO in a Non-Infarct-Related Artery During a STEMI Treated With Contemporary Primary PCI Is Associated With Increased Rates of Early and Late Cardiovascular Morbidity and Mortality: The CTO-TOTAL Substudy. JACC Cardiovasc Interv 2019; 11:709-711. [PMID: 29622151 DOI: 10.1016/j.jcin.2017.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 12/22/2022]
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37
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Xenogiannis I, Tajti P, Burke MN, Chavez I, Gössl M, Mooney M, Poulose A, Sorajja P, Traverse J, Wang Y, Brilakis ES. Coronary revascularization and use of hemodynamic support in acute coronary syndromes. Hellenic J Cardiol 2019; 60:165-170. [DOI: 10.1016/j.hjc.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 01/24/2023] Open
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38
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Flores‐Umanzor EJ, Vázquez S, Cepas‐Guillen P, Ivey‐Miranda J, Caldentey G, Jimenez‐Britez G, Regueiro A, Freixa X, Andrea R, Ferreira‐González I, Sabaté M, Martin‐Yuste V. Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients. Catheter Cardiovasc Interv 2019; 94:527-535. [DOI: 10.1002/ccd.28163] [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] [Received: 09/05/2018] [Accepted: 02/09/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - Sara Vázquez
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Pedro Cepas‐Guillen
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Juan Ivey‐Miranda
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Guillem Caldentey
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Gustavo Jimenez‐Britez
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Ander Regueiro
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Xavier Freixa
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Rut Andrea
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Ignacio Ferreira‐González
- Cardiology DepartmentVall d'hebron Hospital, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Manel Sabaté
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Victoria Martin‐Yuste
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
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Omori T, Kurita T, Dohi K, Takasaki A, Nakata T, Nakamori S, Fujimoto N, Kitagawa K, Hoshino K, Tanigawa T, Sakuma H, Ito M. Prognostic impact of unrecognized myocardial scar in the non-culprit territories by cardiac magnetic resonance imaging in patients with acute myocardial infarction. Eur Heart J Cardiovasc Imaging 2018; 19:108-116. [PMID: 28950314 DOI: 10.1093/ehjci/jex194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/10/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Unrecognized myocardial scar by late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) is strongly associated with cardiac event in patients with stable coronary artery disease. The purpose of this study was to evaluate the prognostic impact of unrecognized non-infarct-related LGE (non-IR-LGE) in patients with acute myocardial infarction (AMI). Methods and results We studied 269 patients with a first clinical episode of AMI underwent cardiac MRI within 6 weeks after onset (209 men; age, 66 ± 12 years). LGE, cine MRI and T2-weighted imaging were obtained to evaluate the presence and extent of LGE and to evaluate cardiac function. Major adverse cardiac events (MACE) were defined as cardiovascular death, non-fatal AMI, unstable angina requiring revascularization, fatal arrhythmia, and heart failure. Unrecognized non-IR LGE was observed in 13.0% of patients. During follow-up periods (median, 22 months; range, 3-95 months), 8.9% of patients experienced MACE in this study. In addition, 22.9% of patients with unrecognized non-IR LGE and 6.8% of patients without unrecognized non-IR-LGE experienced MACE (P < 0.01). The presence of unrecognized non-IR LGE predicted MACE with a hazard ratio of 3.45 (95% confidential interval, 1.03-11.47; P < 0.01). In addition, unrecognized non-IR LGE was the strongest independent predictors of MACE with a hazard ratio of 3.30 by the Cox proportional hazards model (P < 0.01). In contrast, angiography-proven multi-vessel disease and transmural extent of infarct-related LGE were not independently associated with MACE. Conclusion Among patients with a first clinical episode of AMI, unrecognized non-IR myocardial scar provides incremental prognostic value for predicting MACE beyond that of common clinical, angiographic and functional variables.
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Affiliation(s)
- Taku Omori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Akihiro Takasaki
- Department of Cardiology, Matsusaka Central Hospital, 102 Kawai, Matsusaka 515-8566, Japan
| | - Tomoyuki Nakata
- Department of Cardiology, Nagai Hospital, 29-29 Nishimarunouchi, Tsu 514-8508, Japan
| | - Shiro Nakamori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Naoki Fujimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Graduate School of Medicine, 2-174 Edobashi Tsu 514-8507, Japan
| | - Kozo Hoshino
- Department of Cardiology, Nagai Hospital, 29-29 Nishimarunouchi, Tsu 514-8508, Japan
| | - Takashi Tanigawa
- Department of Cardiology, Matsusaka Central Hospital, 102 Kawai, Matsusaka 515-8566, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, 2-174 Edobashi Tsu 514-8507, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
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40
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Abstract
Myocardial infarction (MI) complicated by cardiogenic shock (MI-CS) is a major cause of cardiovascular morbidity and mortality. Predictors of outcomes in MI-CS include clinical, laboratory, radiologic variables, and management strategies. This article reviews the existing literature on short- and long-term predictors and risk stratification in MI complicated by CS.
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Affiliation(s)
- Deepak Acharya
- From the Section of Advanced Heart Failure, Mechanical Circulatory Support, and Pulmonary Vascular Disease, University of Alabama at Birmingham, Birmingham, AL
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41
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Dhoble A, Anderson HV. Culprit-Only or Multivessel PCI in AMI With Cardiogenic Shock: No Simple Answers. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:645-646. [DOI: 10.1016/j.carrev.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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42
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Saad M, Stiermaier T, Fuernau G, Pöss J, Desch S, Thiele H, Eitel I. Impact of chronic total occlusion in a non-infarct-related coronary artery on myocardial injury assessed by cardiac magnetic resonance imaging and prognosis in ST-elevation myocardial infarction. Int J Cardiol 2018; 265:251-255. [DOI: 10.1016/j.ijcard.2018.03.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 02/06/2023]
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Megaly M, Saad M, Tajti P, Burke MN, Chavez I, Gössl M, Lips D, Mooney M, Poulose A, Sorajja P, Traverse J, Wang Y, Kohl LP, Bradley SM, Brilakis ES. Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling. J Interv Cardiol 2018; 31:562-571. [DOI: 10.1111/joic.12538] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/14/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
- Division of Cardiology; Department of Medicine, Hennepin County Medical Center; Minneapolis Minnesota
| | - Marwan Saad
- Department of Cardiovascular Medicine; University of Arkansas; Little Rock Arkansas
| | - Peter Tajti
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - M. Nicholas Burke
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Ivan Chavez
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Mario Gössl
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Daniel Lips
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Michael Mooney
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Anil Poulose
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Jay Traverse
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Yale Wang
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Louis P. Kohl
- Division of Cardiology; Department of Medicine, Hennepin County Medical Center; Minneapolis Minnesota
| | - Steven M. Bradley
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
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Mangiacapra F, Bressi E, Sticchi A, Morisco C, Barbato E. Fractional flow reserve (FFR) as a guide to treat coronary artery disease. Expert Rev Cardiovasc Ther 2018; 16:465-477. [PMID: 29923434 DOI: 10.1080/14779072.2018.1489236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The presence and extent of myocardial ischemia are the major determinants of prognosis in patients with coronary artery disease (CAD). Unlike coronary angiography alone, fractional flow reserve (FFR) has enabled interventional cardiologists to accurately determine whether coronary atherosclerotic plaques are responsible for myocardial ischemia, and therefore deserve to be revascularized. Areas covered: An overview on the role of FFR in the diagnosis and treatment of coronary artery disease, as well as the potential related controversies is provided. Authors describe the coronary physiology underneath this technique and all the procedural aspects in the catheterization laboratory. The landmark trials and the current applications in different coronary lesions and syndromes are also described and potential future research involving FFR and comparisons with other methodologies for the evaluation of coronary physiology are introduced. Expert commentary: FFR is still unsurpassed in diagnostic performance when compared to non-hyperemic indices and noninvasive techniques, and remains the gold standard for the detection of ischemia-inducing coronary stenoses. FFR-guided PCI has been demonstrated superior to an angiography-guided PCI and over medical therapy alone, and ongoing investigation will clarify whether it could perform better, or at least equalize the results of cardiac surgery in patients with severe multivessel disease.
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Affiliation(s)
- Fabio Mangiacapra
- a Unit of Cardiovascular Science , Campus Bio-Medico University , Rome , Italy
| | - Edoardo Bressi
- a Unit of Cardiovascular Science , Campus Bio-Medico University , Rome , Italy
| | - Alessandro Sticchi
- a Unit of Cardiovascular Science , Campus Bio-Medico University , Rome , Italy
| | - Carmine Morisco
- b Department of Advanced Biomedical Sciences , University of Naples Federico II , Napoli , Italy
| | - Emanuele Barbato
- b Department of Advanced Biomedical Sciences , University of Naples Federico II , Napoli , Italy.,c Cardiovascular Research Center Aalst , OLV Hospital , Aalst , Belgium
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Saad M, Fuernau G, Desch S, Eitel I, de Waha S, Pöss J, Ouarrak T, Schneider S, Zeymer U, Thiele H. Prognostic impact of non-culprit chronic total occlusions in infarct-related cardiogenic shock: results of the randomised IABP-SHOCK II trial. EUROINTERVENTION 2018; 14:e306-e313. [PMID: 29205158 DOI: 10.4244/eij-d-17-00451] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the current study was to investigate the impact of a chronic total occlusion (CTO) in a non-infarct-related coronary artery (non-IRA) on one-year mortality and occurrence of cardiac arrhythmia in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). METHODS AND RESULTS In a retrospective sub-analysis of the Intraaortic Balloon Pump in Cardiogenic Shock II trial (IABP-SHOCK II) and its accompanying registry, 201 (26%) of 761 patients had a CTO in a non-IR major coronary artery. Mortality was significantly higher in the CTO group at day of admission (19% vs. 11%; p=0.005), 30 days (53% vs. 41%, p=0.002), and 12 months (63% vs. 51%, p=0.002). In the adjusted multivariate Cox regression analysis, a CTO in a non-IRA was an independent predictor of mortality at 12 months (hazard ratio 1.30, 95% confidence interval [CI]: 1.02-1.67, p=0.03). At 30-day follow-up, ventricular arrhythmias requiring defibrillation occurred more frequently in patients with non-IRA CTO in the univariate analysis (33% vs. 21%, odds ratio 1.83, 95% CI: 1.28-2.62, p=0.002). CONCLUSIONS In patients with CS complicating AMI, the presence of CTO in a non-IRA is associated with a higher incidence of ventricular arrhythmias and is an independent predictor of mortality at 12-month follow-up.
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Affiliation(s)
- Mohammed Saad
- Medical Clinic II, University Heart Center Lübeck, Lübeck
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Claessen BE, Henriques JP. Acute myocardial infarction, chronic total occlusion, and cardiogenic shock: the ultimate triple threat. EUROINTERVENTION 2018; 14:e252-e254. [DOI: 10.4244/eijv14i3a42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Marechal P, Davin L, Gach O, Martinez C, Lempereur M, Lhoest N, Lancellotti P. Coronary chronic total occlusion intervention: utility or futility. Expert Rev Cardiovasc Ther 2018; 16:361-367. [PMID: 29589974 DOI: 10.1080/14779072.2018.1459187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Despite an incidence of about 18-52% of the patients undergoing coronary angiography, chronic total occlusions (CTO) are rarely revascularised by percutaneous angioplasty (PCI). Nevertheless, current evidence suggests that successful CTO angioplasty improves symptoms, quality of life and long-term survival. During the last decade, the improvement of specific tools and techniques for these complex procedures, and the increasing experience of operators, have led to the achievement of success and complication rates almost equivalent to non-CTO angioplasty. Areas covered: This review focuses on the clinical benefits of CTO revascularization and on appropriate patient selection. Expert commentary: Current evidence suggests that successful CTO-PCI improves symptoms, quality of life and long-term survival. During the last years, the improvement of specific techniques for these complex procedures and the increasing experience of operators, have led to the achievement of success and complication rates almost equivalent to non-CTO lesion angioplasty.
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Affiliation(s)
- Patrick Marechal
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium
| | - Laurent Davin
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium
| | - Olivier Gach
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium
| | - Christophe Martinez
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium
| | - Mathieu Lempereur
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium
| | | | - Patrizio Lancellotti
- a GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman , University of Liège Hospital , Liège , Belgium.,c Gruppo Villa Maria Care and Research , Anthea Hospital , Bari , Italy
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Teng HI, Sung SH, Huang SS, Pan JP, Lin SJ, Chan WL, Lee WL, Lu TM, Wu CH. The impact of successful revascularization of coronary chronic total occlusions on long-term clinical outcomes in patients with non-ST-segment elevation myocardial infarction. J Interv Cardiol 2018; 31:302-309. [PMID: 29495125 DOI: 10.1111/joic.12501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess the long-term clinical impact of revascularization of coronary concomitant coronary chronic total occlusion (CTO) in patients with Non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND CTO is associated with poorer prognosis in patients with NSTEMI. The evidence of revascularization of CTO in patients with NSTEMI is still conflicting. METHODS Consecutive patients with NSTEMI and CTO who underwent percutaneous coronary intervention (PCI) within 72 h of admission from 2006 to 2015 were retrospectively recruited and analyzed. A total of 967 patients underwent PCI for NSTEMI. Among them, 106 (11%) patients had concomitant CTO and were recruited for analysis. CTO lesions were revascularized successfully in 67 (63.2%) patients (successful CTO PCI group), while the CTO in the remaining 39 patients were either not attempted or failed (No/failed CTO PCI group). RESULTS The 30-day cardiac death and major adverse cardiac events (MACE) were significantly lower in the successful CTO PCI group (both cardiac death and MACE were 3% vs 30%, P < 0.001, respectively). A landmark analysis set at 30th day for 30-day survivals was performed. After a mean of 2.5-year follow-up, the long-term cardiac death was still significantly lower (16.9% vs 42.3%, P < 0.001), whereas the MACE showed a trend toward lower incidence (26.2% vs 40.7%, P = 0.051) in the successful CTO PCI group. In multivariate Cox regression analysis, successful revascularization of CTO is an independent protective predictor for long-term cardiac death (HR 0.310, 95% CI, 0.109-0.881, P = 0.028) in all population and in propensity-score matched cohort (P = 0.007). CONCLUSIONS Successful revascularization of CTO was associated with reduced risk of long-term cardiac death in patients with NSTEMI and concomitant CTO.
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Affiliation(s)
- Hsin-I Teng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shao-Sung Huang
- Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ju-Pin Pan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Leong Chan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Lieng Lee
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tse-Min Lu
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Elias J, van Dongen IM, Råmunddal T, Laanmets P, Eriksen E, Meuwissen M, Michels HR, Bax M, Ioanes D, Suttorp MJ, Strauss BH, Barbato E, Marques KM, Claessen BEPM, Hirsch A, van der Schaaf RJ, Tijssen JGP, Henriques JPS, Hoebers LP. Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction. Heart 2018; 104:1432-1438. [DOI: 10.1136/heartjnl-2017-312698] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/04/2018] [Accepted: 01/13/2018] [Indexed: 01/16/2023] Open
Abstract
BackgroundDuring primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO.MethodsThe Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO. Patients were randomised to either CTO-PCI or CTO-No PCI. The primary end point of the current study was occurrence of major adverse cardiac events (MACE): cardiac death, coronary artery bypass grafting and MI. Other end points were 1-year left ventricular function (LVF); LV-ejection fraction and LV end-diastolic volume and angina status.ResultsThe median long-term follow-up was 3.9 (2.1–5.0) years. MACE was not significantly different between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93). Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02) with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI 0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms. However, there were more patients with freedom of angina in the CTO-PCI arm at 1 year (94% vs 87%, P=0.03).ConclusionsIn this randomised trial involving patients with STEMI with a concurrent CTO, CTO-PCI was not associated with a reduction in long-term MACE compared to CTO-No PCI. One-year LVF was comparable between both treatment arms. The finding that there were more patients with freedom of angina after CTO-PCI at 1-year follow-up needs further investigation.Clinical trial registrationEXPLORE trial number NTR1108 www.trialregister.nl.
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Revascularization Strategies in Cardiogenic Shock Patients With MVD. J Am Coll Cardiol 2018; 71:857-859. [DOI: 10.1016/j.jacc.2017.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 11/17/2022]
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