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Suleman M, Arif N, Khan MI, Jibran MS, Jamil M, Khan SU, Khan SS, Maken GR. The outcomes and complications of percutaneous interventions in chronic total coronary occlusion. Egypt Heart J 2024; 76:62. [PMID: 38782836 PMCID: PMC11116340 DOI: 10.1186/s43044-024-00490-6] [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: 04/27/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The limited availability of complex coronary intervention facilities and qualified operators, due to the high cost associated with chronic total occlusion (CTO) percutaneous intervention (PCI) equipment and a shortage of necessary skills, has led to a scarcity of capable medical centers in Pakistan. This study seeks to examine the outcomes and potential complications associated with CTO PCI procedures conducted at the Cardiac Catheterization Laboratories of a prominent national institute in Pakistan, which handles a large volume of cases. RESULTS Three hundred and six patients were included in the study in the study period of six months. The mean age was 59.49 (± 9.16) years: 256 (83.66%) were male and 50 (16.34%) were female. CTO was successfully re-vascularized in 237 (77.5%) with a complication rate of 13.7%. Two hundred and ninety-eight (97.39%) patients underwent an antegrade approach, while RCA was the most common target vessel (47.71%). Diabetes was the only significant associated risk factor with CTO PCI failure (30.43% vs. 30.43%, P-value = 0.015). CONCLUSION We achieved an excellent procedural success rate with a low complication rate. CTO procedural failure is associated with a higher complication rate, and diabetes is among the risk factors that lead to higher procedural failure.
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Affiliation(s)
- Muhammad Suleman
- Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Punjab, Pakistan
- Department of Cardiology, Peshawar Institute of Cardiology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Nayyar Arif
- Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Punjab, Pakistan
| | - Muhammad Ishaq Khan
- Department of Cardiology, Peshawar Institute of Cardiology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Saad Jibran
- Department of Cardiology, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Jamil
- Department of Cardiology, Services Hospital Peshawar, Peshawar, Pakistan
| | - Shafi Ullah Khan
- Department of Medicine, District Headquarters Teaching Hospital, Kohat, Khyber Pakhtunkhwa, Pakistan.
| | - Shah Sawar Khan
- Department of Cardiology, Peshawar Institute of Cardiology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Ghulam Rasool Maken
- Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Punjab, Pakistan
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Williams T, Mittal A, Karageorgiev D, Iniguez Romo A, Aminian A, Fernandez Portalese J, Kharrat E, Gómez-Hospital JA, Firman D, Trillo Nouche R, Hildick-Smith D. Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e-Ultimaster registry. Catheter Cardiovasc Interv 2021; 99:961-967. [PMID: 34962059 PMCID: PMC9544253 DOI: 10.1002/ccd.30042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/23/2021] [Accepted: 12/06/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of this analysis was to assess the effect of the coronary revascularization strategy during index admission on clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with multivessel coronary artery disease (MVD). BACKGROUND The value of complete revascularization (CR) over incomplete revascularization (IR) in MVD patients is not fully established. METHODS Patients with MVD defined as ≥2 major epicardial vessels with ≥50% stenosis were selected from the observational all-comer e-Ultimaster registry. Patients were treated with a sirolimus-eluting thin-strut coronary stent. Completeness of revascularization was physician assessed at the index procedure or an eventually staged procedure during the index hospitalization. Outcomes measures at 1 year were target lesion failure (TLF) (composite of cardiac death, target vessel-related myocardial infarction [MI], and clinically driven target lesion revascularization [TLR]), and patient-oriented composite endpoint (POCE) (all-cause mortality, MI, or revascularization). The inverse probability of treatment weights (IPTW) methodology was used to perform a matched analysis. RESULTS The registry recruited 37,198 patients of whom 15,441 (41.5%) had MVD. CR on hospital discharge was achieved in 7413 (48.0%) patients and IR in 8028 (52.0%) patients. Mean age was 64.6 ± 11.1 versus 65.7 ± 11.0 years (p < 0.01), male gender 77.9% and 77.3% (p = 0.41) and diabetes 31.3% versus 33.4% (p = 0.01) for CR and IR, respectively. Chronic stable angina patients more commonly underwent CR (47.6% vs. 36.8%, p < 0.01). After propensity weighted analysis, 90.5% of CR patients were angina-free at 1 year compared with 87.5% of IR patients (p < 0.01). TLF (3.3% vs. 4.4%; p < 0.01), POCE (6.8% vs. 10.8%; p < .01), and all-cause mortality (2.3% vs. 3.1%; p < .01) were all lower in CR patients. CONCLUSIONS A physician-directed use of a CR strategy utilizing sirolimus-eluting thin-strut stent results in optimized clinical outcomes and less angina in an all-comer population. Our findings suggest that a CR should be aimed for.
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Affiliation(s)
- Timothy Williams
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK
| | - Aaina Mittal
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK
| | | | - Andres Iniguez Romo
- Department of Cardiology, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium CHU Charleroi, Charleroi, Belgium
| | | | | | | | - Doni Firman
- Department of Cardiology and Vascular Medicine, Harapan Kita National Cardiovascular Center, Faculty of Medicine Universitas, West Jakarta, Indonesia
| | - Ramiro Trillo Nouche
- Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Rathod KS, Spagnolo M, Elliott MK, Beirne AM, Smith EJ, Amersey R, Knight C, Weerackody R, Baumbach A, Mathur A, Jones DA. An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820951792. [PMID: 32913394 PMCID: PMC7444144 DOI: 10.1177/1179546820951792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022]
Abstract
Background: More than half of the patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have multi-vessel coronary artery disease. This is associated with worse outcomes compared with single vessel disease. Whilst evidence now exists to support complete revascularisation for bystander disease the optimal timing is still debated. This study aimed to compare clinical outcomes in patients with STEMI and multi-vessel disease who underwent complete revascularisation as inpatients in comparison to patients who had staged PCI as early outpatients. Methods and results: We conducted an observational cohort study consisting of 1522 patients who underwent primary PCI with multi-vessel disease from 2012 to 2019. Exclusions included patients with cardiogenic shock and previous CABG. Patients were split into 2 groups depending on whether they had complete revascularisation performed as inpatients or as staged PCI at later outpatient dates. The primary outcome of this study was major adverse cardiac events (consisting of myocardial infarction, target vessel revascularisation and all-cause mortality). 834 (54.8%) patients underwent complete inpatient revascularisation and 688 patients (45.2%) had outpatient PCI (median 43 days post discharge). Of the inpatient group, 652 patients (78.2%) underwent complete revascularisation during the index procedure whilst 182 (21.8%) patients underwent inpatient bystander PCI in a second procedure. Overall, there were no significant differences between the groups with regards to their baseline or procedural characteristics. Over the follow-up period there was no significant difference in MACE between the cohorts (P = .62), which persisted after multivariate adjustment (HR 1.21 [95% CI 0.72-1.96]). Furthermore, in propensity-matched analysis there was no significant difference in outcome between the groups (HR: 0.86 95% CI: 0.75-1.25). Conclusions: Our study demonstrated that the timing of bystander PCI after STEMI did not appear to have an effect on cardiovascular outcomes. We suggest that patients with multi-vessel disease can potentially be discharged promptly and undergo early outpatient bystander PCI. This could significantly reduce length of stay in hospital.
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Affiliation(s)
- Krishnaraj Sinhji Rathod
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Marco Spagnolo
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Mark K Elliott
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Anne-Marie Beirne
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Elliot J Smith
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Rajiv Amersey
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Charles Knight
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Roshan Weerackody
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Andreas Baumbach
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Anthony Mathur
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Daniel A Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
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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 2020; 30:481-487. [PMID: 31136309 PMCID: PMC6791511 DOI: 10.1097/mca.0000000000000765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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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Liu MJ, Chen CF, Gao XF, Liu XH, Xu YZ. In-hospital outcomes of chronic total occlusion percutaneous coronary intervention in patients with and without prior coronary artery bypass graft: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e19977. [PMID: 32501965 PMCID: PMC7306325 DOI: 10.1097/md.0000000000019977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/04/2020] [Accepted: 03/21/2020] [Indexed: 12/29/2022] Open
Abstract
The clinical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in prior coronary artery bypass graft (pCABG) patients have been investigated; however, the results are inconsistent.The present meta-analysis compared the clinical outcomes of CTO PCI in patients with and without prior CABG (nCABG). The endpoints included technical success, procedural success, all-cause mortality, myocardial infarction (MI), major bleeding, coronary perforation, pericardial tamponade, emergency CABG, and vascular access complication.A total of 7 studies comprising of 11099 patients were included in this meta-analysis. The results showed that compared to nCABG patents, pCABG patients were associated with lower technical success (82.3% versus 87.8%; OR, 0.60; 95% CI, 0.53-0.68; P < .00001; I = 0%) and procedural success (80.4% versus 86.2%; OR, 0.61; 95% CI, 0.53-0.70; P < .00001; I = 10%); a higher risk of all-cause mortality (OR, 2.95; 95% CI, 1.56-5.57; P = 0.0008; I = 0%), MI (OR, 2.30; 95% CI, 1.40-3.80; P = .001; I = 5%), and coronary perforation (OR, 2.16; 95% CI, 1.51-3.08; P < 0.0001; I = 52%). On the other hand, the risk of pericardial tamponade (OR, 0.42; 95% CI, 0.15-1.18; P = .10; I = 21%), major bleeding (OR, 1.51; 95% CI, 0.90-2.53; P = .11; I = 0%), vascular access complication (OR, 1.50; 95% CI, 0.93-2.41; P = .10; I = 0%), and emergency CABG (OR, 0.99; 95% CI, 0.25-3.91; P = .99; I = 0%) was similar in both groups.Compared to nCABG patients, pCABG patients had lower CTO PCI success rates, higher rates of in-hospital mortality, MI, and coronary perforation, and similar risk of pericardial tamponade and vascular complication rates.
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Geyer M, Wild J, Hirschmann M, Dimitriadis Z, Münzel T, Gori T, Wenzel P. Predictors for Target Vessel Failure after Recanalization of Chronic Total Occlusions in Patients Undergoing Surveillance Coronary Angiography. J Clin Med 2020; 9:jcm9010178. [PMID: 31936478 PMCID: PMC7019748 DOI: 10.3390/jcm9010178] [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: 11/24/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
(1) Background: Knowledge about predictors for the long-time patency of recanalized chronic total coronary occlusions (CTOs) is limited. Evidence from invasive follow-up in the absence of acute coronary syndrome (routine surveillance coronary angiography) is scarce. (2) Methods: In a monocentric-retrospective analysis, we obtained baseline as well as periprocedural data of patients undergoing routine invasive follow-up. We defined target vessel failure (TVF) as a combined primary endpoint, consisting of re-occlusion, restenosis, and target vessel revascularization (TVR). (3) Results: We included 93 consecutive patients (15.1% female) from October 2013 to May 2018. After a follow-up period of 206 ± 129 days (median 185 (IQR 127–237)), re-occlusion had occurred in 7.5%, restenosis in 11.8%, and TVR in 5.4%; the cumulative incidence of TVF was 15.1%. Reduced TIMI-flow immediately after recanalization (OR for TVR: 11.0 (95% CI: 2.7–45.5), p = 0.001) as well as female gender (OR for TVR: 11.0 (95% CI: 2.1–58.5), p = 0.005) were found to be predictive for pathological angiographic findings at follow-up. Furthermore, higher blood values of high-sensitive troponin after successful revascularization were associated with all endpoints. Interestingly, neither the J-CTO score nor the presence of symptoms at the follow-up visit could be correlated to adverse angiographic results. (4) Conclusions: In this medium-sized cohort of patients with surveillance coronary angiography, we were able to identify reduced TIMI flow and female gender as the strongest predictors for future TVF.
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Affiliation(s)
- Martin Geyer
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
- Correspondence: (M.G.); (P.W.); Tel.: +49-6131-17-8785 (M.G.); +49-6131-17-7695 (P.W.)
| | - Johannes Wild
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr 1, 55131 Mainz, Germany
| | - Marc Hirschmann
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
| | - Zisis Dimitriadis
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
| | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Tommaso Gori
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Philip Wenzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Langenbeckstr. 1, 55131 Mainz, Germany
- Correspondence: (M.G.); (P.W.); Tel.: +49-6131-17-8785 (M.G.); +49-6131-17-7695 (P.W.)
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Boudou N, Avran A, Garbo R, Lefèvre T, Hildick-Smith D, Reifart N, Galassi AR, Mattesini A, Dini CS, Brilakis ES, Yamane M, Sianos G, Mashayekhi K, Karmpaliotis D, DeMartini T, Werner GS, Di Mario C. EuroCTO Club 2018 meeting: "Experts Live" in Toulouse. EUROINTERVENTION 2019; 14:e1814-e1817. [PMID: 30956181 DOI: 10.4244/eijv14i18a319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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