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Sliman H, Sliman RKA, Knaapen P, Nap A, Henriques J, Verouden N, Claessen BE. The role of chronic total occlusions in non-infarct-related arteries in acute coronary syndrome patients: a systematic review. Future Cardiol 2024; 20:581-590. [PMID: 39382445 DOI: 10.1080/14796678.2024.2406651] [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: 06/07/2024] [Accepted: 09/17/2024] [Indexed: 10/10/2024] Open
Abstract
Aim: This systematic review evaluated the impact of a chronic total occlusion (CTO) in a non-infarct-related artery (non-IRA) on clinical outcomes in acute coronary syndrome (ACS) patients and assessed the benefits of staged revascularization.Methods: We performed a comprehensive systematic review to provide further insight into the impact of a CTO in a non-IRA on clinical outcomes after ACS. Moreover, we review the currently available evidence on the clinical significance of staged revascularization for a CTO in a non-IRA patients with ACS and propose whether prophylactic CTO percutaneous coronary intervention (PCI) could improve outcomes in patients who subsequently develop an ACS.Results: Our search identified 999 studies, from which 30 were selected and ten were included in the analysis. The results showed a trend of higher all-cause mortality and major adverse cardiac event rates in the culprit-only-PCI group compared with the multivessel (MV)-PC I group in ST elevation myocardial infarction patients, with varying statistical significance across different outcomes.Conclusion: This review highlights the significant impact of non-IRA CTOs in ACS. Successful CTO revascularization may provide benefits, particularly in ST elevation myocardial infarction, but the optimal management approach remains uncertain. The presence of a non-IRA CTO, especially in cardiogenic shock, predicts worse outcomes. Further research is warranted to determine the effective strategies to improve survival.
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Affiliation(s)
- Hussein Sliman
- Department of Cardiology, Carmel Medical Center, Heart Center, Haifa, Israel
| | - Rim Kasem Ali Sliman
- Department of Pediatrics, Clalit Health Care Organization, Carmel Medical Center, Haifa, Israel
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, 1105 AZ, The Netherlands
| | - Alex Nap
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, 1105 AZ, The Netherlands
| | - Jose Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, 1105 AZ, The Netherlands
| | - Niels Verouden
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, 1105 AZ, The Netherlands
| | - Bimmer Epm Claessen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, 1105 AZ, The Netherlands
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Hu MJ, Li XS, Yang YJ. Impact of percutaneous coronary intervention on chronic total occlusion in the non-infarct-related artery in patients with STEMI: a systematic review and meta-analysis. SCAND CARDIOVASC J 2022; 56:157-165. [PMID: 35674511 DOI: 10.1080/14017431.2022.2085319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We sought to compare the clinical outcomes between culprit-only percutaneous coronary intervention (PCI) versus multivessel PCI (MV-PCI) in patients with ST-segment elevation myocardial infarction (STEMI) accompanied by chronic total occlusion (CTO) in the non-infarct-related artery(non-IRA). DESIGN Studies that compared culprit-only PCI versus MV-PCI in patients with STEMI accompanied by CTO in the non-IRA were included. Random odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS Eight studies with 2,259 patients were included. The results suggested that in patients with STEMI accompanied by CTO in the non-IRA, culprit-only PCI was associated with higher risks of all-cause mortality (OR: 2.89; 95% CI: 2.09-4.00; I2 = 0.0%), cardiac death (OR: 3.12; 95% CI: 2.05-4.75; I2 = 16.8%), stroke (OR: 2.80; 95% CI: 1.04-7.53; I2 = 0.0%), major adverse cardiovascular event (MACE; OR: 2.06; 95% CI: 1.39-3.06; I2 = 54.0%), and heart failure (OR: 1.99; 95% CI: 1.22-3.24; I2 = 0.0%) compared with staged MV-PCI, which were mainly derived from retrospective studies. No differences were observed in myocardial infarction or revascularization. Pooled multivariable adjusted results consistently indicated that staged MV-PCI was superior to culprit-only PCI. CONCLUSIONS For patients with STEMI accompanied by CTO in the non-IRA, staged MV-PCI may be better compared with culprit-only PCI due to potential reduced risks of all-cause mortality, cardiac death, stroke, MACE, and heart failure. Meanwhile, further randomized trials are warranted to confirm or refute our findings.
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Affiliation(s)
- Meng-Jin Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiao-Song Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue-Jin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Rha SW, Li H, Choi CU, Choi BG. Impact of complete revascularization on long-term clinical outcomes for patients with diabetes mellitus and coronary chronic total occlusion lesion. Heart Vessels 2022; 37:1679-1688. [PMID: 35525845 DOI: 10.1007/s00380-022-02079-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
Abstract
Diabetes mellitus (DM) is a substantial risk factor in developing coronary artery disease (CAD), coronary chronic total occlusion (CTO) lesions are discovering 10-35% in patients who underwent coronary angiography. This study compares the long-term clinical outcomes of two treatment strategies, percutaneous coronary intervention (PCI) with complete recanalization versus medication therapy (MT) with CTO lesion in DM patients with CTO. This study is a single-center, prospective, all-comer registry designed to reflect "real world" practice since 2004. Of a total of 4909 consecutive patients were diagnosed with significant CAD by coronary angiography (CAG). A total of 372 patients has DM and CTO lesions. Patients were divided into the PCI group (n = 184) and the MT group (n = 179). The primary endpoint, defined as the composite of death or myocardial infarction (MI), was compared between the two groups up to 5 years. In addition, inverse probability weighting (IPTW) analysis, derived from the logistic regression model, was performed to adjust for potential confounders. Compared to the MT group, the PCI group was associated with a significantly reduced incidence of the primary endpoint before [hazard ratio; HR 0.267, 95% confidence interval (CI) 0.116-0.614] and after (HR 0.142, 95% CI 0.032-0.629) adjusting confounding factors by IPTW. Complete revascularization by CTO-PCI with MT in DM patients should be the preferred treatment strategy compared with the MT alone strategy since it reduces the composite of death or MI up to 5 years.
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Affiliation(s)
- Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Hu Li
- Cardiovascular Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Republic of Korea.
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Melotti E, Belmonte M, Gigante C, Mallia V, Mushtaq S, Conte E, Neglia D, Pontone G, Collet C, Sonck J, Grancini L, Bartorelli AL, Andreini D. The Role of Multimodality Imaging for Percutaneous Coronary Intervention in Patients With Chronic Total Occlusions. Front Cardiovasc Med 2022; 9:823091. [PMID: 35586657 PMCID: PMC9108201 DOI: 10.3389/fcvm.2022.823091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPercutaneous coronary intervention (PCI) of Chronic total occlusions (CTOs) has been traditionally considered a challenging procedure, with a lower success rate and a higher incidence of complications compared to non-CTO-PCI. An accurate and comprehensive evaluation of potential candidates for CTO-PCI is of great importance. Indeed, assessment of myocardial viability, left ventricular function, individual risk profile and coronary lesion complexity as well as detection of inducible ischemia are key information that should be integrated for a shared treatment decision and interventional strategy planning. In this regard, multimodality imaging can provide combined data that can be very useful for the decision-making algorithm and for planning percutaneous CTO recanalization.AimsThe purpose of this article is to appraise the value and limitations of several non-invasive imaging tools to provide relevant information about the anatomical characteristics and functional impact of CTOs that may be useful for the pre-procedural assessment and follow-up of candidates for CTO-PCI. They include echocardiography, coronary computed tomography angiography (CCTA), nuclear imaging, and cardiac magnetic resonance (CMR). As an example, CCTA can accurately delineate CTO location and length, distal coronary bed, vessel tortuosity and calcifications that can predict PCI success, whereas stress CMR, nuclear imaging and stress-CT can provide functional evaluation in terms of myocardial ischemia and viability and perfusion defect extension.
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Affiliation(s)
- Eleonora Melotti
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Marta Belmonte
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Carlo Gigante
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Vincenzo Mallia
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio, Pisa, Italy
- Istituto di Scienze della Vita Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Luca Grancini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Antonio L. Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
- *Correspondence: Daniele Andreini
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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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Hu MJ, Li XS, Jin C, Yang YJ. Does multivessel revascularization fit all patients with STEMI and multivessel coronary artery disease? A systematic review and meta-analysis. IJC HEART & VASCULATURE 2021; 35:100813. [PMID: 34169144 PMCID: PMC8209177 DOI: 10.1016/j.ijcha.2021.100813] [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] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 11/04/2022]
Abstract
Objective We sought to assess the relative merits of different revascularization strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease complicated by cardiogenic shock or chronic total occlusion (CTO). Background Recent randomized trials and meta-analysis have suggested that multivessel percutaneous coronary intervention (PCI) is associated with better outcomes in patients with STEMI and multivessel coronary artery disease, however, patients complicated by cardiogenic shock or CTO were excluded. Methods Studies that compared multivessel PCI (immediate or staged) with culprit-only PCI in patients with STEMI and multivessel coronary artery disease complicated by cardiogenic shock or CTO were included. Random odd ratio (OR) and 95% confidence interval (CI) were conducted. Results Sixteen studies with 8695 patients complicated by cardiogenic shock and eight studies with 2259 patients complicated by CTO were included. In patients complicated by cardiogenic shock, a strategy of CO-PCI was associated with lower risk for short-term renal failure (OR: 0.75; 95% CI: 0.61–0.93; I2 = 0.0%), with no significant difference in MACE, all-cause mortality, re-infarction, revascularization, cardiac death, heart failure, major bleeding, or stroke compared with an immediate MV-PCI strategy. In patients complicated by CTO, a strategy of CO-PCI was associated with higher risk for long-term MACE (OR: 2.06; 95% CI: 1.39–3.06; I2 = 54.0%), all-cause mortality (OR: 2.89; 95% CI: 2.09–4.00; I2 = 0.0%), cardiac death (OR: 3.12; 95% CI: 2.05–4.75; I2 = 16.8%), heart failure (OR: 1.99; 95% CI: 1.22–3.24; I2 = 0.0%), and stroke (OR: 2.80; 95% CI: 1.04–7.53; I2 = 0.0%) compared with a staged MV-PCI strategy, without any difference in re-infarction, revascularization, or major bleeding. Conclusions For patients with STEMI and multivessel coronary artery disease complicated by cardiogenic shock, an immediate multivessel PCI was not advocated due to a higher risk for short-term renal failure, whereas for patients complicated by CTO, a staged multivessel PCI was advocated due to reduced risks for long-term MACE, all-cause mortality, cardiac death, heart failure, and stroke.
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Affiliation(s)
- Meng-Jin Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Xiao-Song Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Chen Jin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yue-Jin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
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The 11-Year Prognostic Impact of Chronic Total Occlusion in the Noninfarct-Related Coronary Artery on Patients with Acute Myocardial Infarction. J Interv Cardiol 2021; 2021:6646804. [PMID: 33824627 PMCID: PMC7994075 DOI: 10.1155/2021/6646804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/13/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background The prognostic significance of CTO in the non-IRA in patients with AMI has been under dispute. Relevant long-term follow-up studies are lacking. Hypothesis. CTO in the non-IRA is an independent predictor of poor long-term prognosis in patients with AMI. Methods We prospectively enrolled 2336 patients with AMI who received emergent percutaneous coronary intervention successfully from January 2006 to May 2011. Our primary endpoints included death from cardiovascular causes, recurrent myocardial infarction, stroke, and target-vessel revascularization. We adopted Cox regression analysis adjusted for confounders to analyze the impact of CTO in the non-IRA on long-term mortalities. Results We identified 628 (27.6%) subjects with CTO in the non-IRA among 2282 AMI patients. After a mean follow-up duration of 134.3 months, we found the CTO group had significantly higher MACCE rate than the group without CTO (30.4% versus 24.3%, P=0.004). CTO in the non-IRA independently predicted 11-year MACCE in the male AMI subgroup (hazard ratio 1.28, 95% confidence interval 1.06 to 1.54, P=0.01) and in the male NSTEMI subgroup (hazard ratio 1.53, 95% confidence interval 1.09 to 2.15, P=0.02). In the CTO group, three-vessel disease independently predicted 11 year MACCE (hazard ratio 2.05, 95% confidence interval 1.29 to 3.28, P=0.002). Conclusions Our long-term observational study supported the association between CTO in the non-IRA and poorer prognosis in AMI patients undergoing primary PCI. We identified the group with the three-vessel disease as a high-risk subgroup in patients with CTO in the non-IRA.
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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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Vescovo GM, Zivelonghi C, Scott B, Agostoni P. Percutaneous Coronary Intervention for Chronic Total Occlusion. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2020.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Treatment of coronary chronic total occlusions represents one of the major challenges in the field of interventional cardiology. This is due to the complexity of these procedures and to the relatively higher risk of complications. In recent years, the development of innovative techniques and the evolution of materials have produced significant progress in this field. Better procedural outcomes have been achieved, with fewer complications. This article highlights the most recent scientific evidence and techniques, with the intention to guide interventional cardiologists in optimal patient selection and procedure choice.
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Affiliation(s)
- Giovanni Maria Vescovo
- Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Pierfrancesco Agostoni
- Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
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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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Multicenter experience with percutaneous coronary intervention for chronic total occlusion in Korean population: analysis of the Korean nationwide multicenter chronic total occlusion registry. Coron Artery Dis 2020; 31:319-326. [PMID: 31913165 DOI: 10.1097/mca.0000000000000838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains challenging because of limited success and higher target vessel failure rates. Detailed safety and efficacy data for CTO-PCI from a multicenter real-world Korean registry are limited. METHODS Since May 2007, the Korean multicenter retrospective CTO registry has enrolled 3271 patients who underwent CTO-PCI at 26 major medical centers. Baseline clinical, angiographic, and procedural characteristics and 12-month major adverse cardiac event (MACE) rates after PCI were retrospectively collected. RESULTS Baseline cardiovascular risk factors included: male sex, 73.8%; prior myocardial infarction (MI), 14.8%; prior PCI, 26.6%; hypertension, 62.3%; diabetes mellitus, 34.8%; dyslipidemia, 33.3%; and current smoker, 30.9%. Pre-PCI myocardial viability testing was performed in 23.6% of patients and pre-PCI cardiac computed tomography (CT) in 17.6%. CTO arterial lesions were distributed as follows: right coronary, 41.0%; left anterior descending, 40.0%; left circumflex, 22.5%; and left main, 0.4%. Unfavorable lesion morphology was detected by angiography in 38.1%. Intravascular ultrasound guidance and the retrograde approach were utilized in 23.6 and 3.1% of CTO-PCI procedures, respectively. More than 75% of patients received drug-eluting stents (sirolimus-eluting, 26.5%; paclitaxel-eluting, 23.8%; zotarolimus-eluting, 23.4%; everolimus-eluting, 11.0%; and others, 4.0%). The overall success rate was 81.6% (2672/3271 patients). Twelve-month event rates were: total mortality, 2.4%; any MI, 0.7%; target lesion revascularization, 4.4%; target vessel revascularization, 6.7%; and total MACE, 9.4%. CONCLUSIONS Twelve-month success rates, safety profiles, and cumulative clinical outcomes of Korean CTO patients were favorable post-PCI. Long-term follow-up of larger study populations is necessary to validate our findings.
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Su YM, Pan M, Geng HH, Zhang R, Qu YY, Ma GS. Outcomes after percutaneous coronary intervention and comparison among scoring systems in predicting procedural success in elderly patients (≥ 75 years) with chronic total occlusion. Coron Artery Dis 2019; 30:481-487. [PMID: 31136309 PMCID: PMC6791511 DOI: 10.1097/mca.0000000000000765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/20/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence-based data on percutaneous coronary intervention in elderly patients with chronic total occlusion (CTO) and comparison among different scoring systems have not been well established. PATIENTS AND METHODS A total of 246 consecutive patients were stratified into two groups according to the age: elderly group (age≥ 75 years, n = 68) and nonelderly group (age < 75 years, n = 178). Clinical and angiographic characteristics including the Synergy Between PCI With TAXUS and Cardiac Surgery score, in-hospital major adverse cardiac events, procedural success rates, and predictive capacity of four scoring systems [J-CTO, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO), clinical and lesion-related (CL), and ostial location, Rentrop grade < 2, age ≥ 75 years (ORA) scores] were examined. RESULTS Triple-vessel disease and the Synergy Between PCI With TAXUS and Cardiac Surgery score in the elderly group were significantly higher than those in the nonelderly group (73.53 vs. 53.93%, P = 0.005; 31.39 ± 7.68 vs. 27.85 ± 7.16, P = 0.001, respectively). The in-hospital major adverse cardiac event rates, vascular access complication rates, and major bleeding rates were similar between the elderly and the nonelderly group (2.94 vs. 2.25%, P = 0.669; 1.47 vs. 0.56%, P = 0.477; 2.94 vs. 1.12%, P = 0.306, respectively). By contrast, the procedural success rate was statistically lower in the elderly group than that in the nonelderly group (73.53 vs. 84.83%, P = 0.040). All the four scoring systems showed a moderate predictive capacity [area under the curve (AUC) for J-CTO score: 0.806, P < 0.0001; AUC for PROGRESS CTO score: 0.727, P < 0.0001; AUC for CL score: 0.800, P < 0.0001; AUC for ORA score: 0.672, P < 0.0001, respectively]. Compared with the ORA score, the J-CTO score, and the CL score showed a significant advantage in predicting procedural success among overall patients (ΔAUC = 0.134, P = 0.0122; ΔAUC = 0.128, P = 0.0233, respectively). CONCLUSION Despite the lower procedural success rate, percutaneous coronary intervention in elderly patients with CTO is feasible and safe. J-CTO, PROGRESS, ORA, and CL scoring systems have moderate discriminatory capacity.
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Affiliation(s)
- Ya-Min Su
- Department of Cardiology, School of Medicine, Southeast University, Nanjing
| | - Min Pan
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Hai-Hua Geng
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Rui Zhang
- Department of Cardiology, School of Medicine, Southeast University, Nanjing
| | - Yang-Yang Qu
- Department of Cardiology, School of Medicine, Southeast University, Nanjing
| | - Gen-Shan Ma
- Department of Cardiology, School of Medicine, Southeast University, Nanjing
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