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Larik MO, Ahmed A, Shahid AR, Irfan H, Irfan A, Jibran M. Influence of Previous Coronary Artery Bypass Grafting on Clinical Outcomes After Percutaneous Coronary Intervention: A Meta-Analysis of 250 684 Patients. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2024; 18:11795468241274588. [PMID: 39220189 PMCID: PMC11366107 DOI: 10.1177/11795468241274588] [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: 02/27/2024] [Accepted: 07/15/2024] [Indexed: 09/04/2024]
Abstract
Background Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is the preferred strategy for treating obstructive coronary artery disease. Existing literature suggests the worsening of clinical outcomes in patients with previous coronary artery bypass grafting (CABG) history. In light of this, a comprehensive systematic review and meta-analysis was performed. Methods Databases including PubMed, Cochrane Library, and ScienceDirect were utilized for the inclusive systematic search dating from inception to September 01, 2023. The risk of bias assessment was performed using the Newcastle-Ottawa scale for cohort studies, and the Cochrane Risk of Bias Tool for randomized controlled trials. Results Ultimately, there were 16 eligible studies pooled together, involving a total of 250 684 patients, including 231 552 CABG-naïve patients, and 19 132 patients with a prior history of CABG. Overall, patients with CABG history were associated with significantly greater short-term mortality (P = .004), long-term mortality (P = .005), myocardial infarction (P < .00001), major adverse cardiovascular events (P = .0001), and procedural perforation (P < .00001). Contrastingly, CABG-naïve patients were associated with significantly greater risk of cardiac tamponade (P = .02) and repeat CABG (P = .03). No significant differences in stroke, bleeding, revascularization, or repeat PCI were observed. Conclusion Comparatively worsened clinical outcomes were observed, as patients with prior CABG history typically exhibit complex coronary anatomy, and have higher rates of comorbidities in comparison to their CABG-naïve counterparts. The refinement of current procedural and surgical techniques, in conjunction with continued research endeavors, are needed in order to effectively address this trend.
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Affiliation(s)
- Muhammad Omar Larik
- Department of Medicine, Dow International Medical College, Karachi, Pakistan
| | - Ayesha Ahmed
- Department of Medicine, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Abdul Rehman Shahid
- Department of Medicine, Dow International Medical College, Karachi, Pakistan
| | - Hamza Irfan
- Department of Medicine, Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College, Lahore, Pakistan
| | - Areeka Irfan
- Department of Medicine, Dow Medical College, Karachi, Pakistan
| | - Muhammad Jibran
- Department of Internal Medicine, TidalHealth Peninsula Regional, Salisbury, MD, USA
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2
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Back L, Ladwiniec A. Saphenous Vein Graft Failure: Current Challenges and a Review of the Contemporary Percutaneous Options for Management. J Clin Med 2023; 12:7118. [PMID: 38002729 PMCID: PMC10672592 DOI: 10.3390/jcm12227118] [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: 09/26/2023] [Revised: 10/21/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
The use of saphenous vein grafts (SVGs) in the surgical management of obstructive coronary artery disease remains high despite a growing understanding of their limitations in longevity. In contemporary practice, approximately 95% of patients receive one SVG in addition to a left internal mammary artery (LIMA) graft. The precise patency rates for SVGs vary widely in the literature, with estimates of up to 61% failure rate at greater than 10 years of follow-up. SVGs are known to progressively degenerate over time and, even if they remain patent, demonstrate marked accelerated atherosclerosis. Multiple studies have demonstrated a marked acceleration of atherosclerosis in bypassed native coronary arteries compared to non-bypassed arteries, which predisposes to a high number of native chronic total occlusions (CTOs) and subsequent procedural challenges when managing graft failure. Patients with failing SVGs frequently require revascularisation to previously grafted territories, with estimates of 13% of CABG patients requiring an additional revascularisation procedure within 10 years. Redo CABG confers a significantly higher risk of in-hospital mortality and, as such, percutaneous coronary intervention (PCI) has become the favoured strategy for revascularisation in SVG failure. Percutaneous treatment of a degenerative SVG provides unique challenges secondary to a tendency for frequent superimposed thrombi on critical graft stenoses, friable lesions with marked potential for distal embolization and subsequent no-reflow phenomena, and high rates of peri-procedural myocardial infarction (MI). Furthermore, the rates of restenosis within SVG stents are disproportionately higher than native vessel PCI despite the advances in drug-eluting stent (DES) technology. The alternative to SVG PCI in failed grafts is PCI to the native vessel, 'replacing' the grafts and restoring patency within the previously grafted coronary artery, with or without occluding the donor graft. This strategy has additional challenges to de novo coronary artery PCI, however, due to the high burden of complex atherosclerotic lesion morphology, extensive coronary calcification, and the high incidence of CTO. Large patient cohort studies have reported worse short- and long-term outcomes with SVG PCI compared to native vessel PCI. The PROCTOR trial is a large and randomised control trial aimed at assessing the superiority of native vessel PCI versus vein graft PCI in patients with prior CABG awaiting results. This review article will explore the complexities of SVG failure and assess the contemporary evidence in guiding optimum percutaneous interventional strategy.
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Affiliation(s)
- Liam Back
- Glenfield Hospital, Leicester LE39QP, UK;
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3
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Alexandrou M, Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Choi JW, Poommipanit P, Alaswad K, Basir MB, Megaly M, Davies R, Benton S, Jaffer FA, Karmpaliotis D, Azzalini L, Kearney KE, ElGuindy AM, Rafeh NA, Goktekin O, Gorgulu S, Khatri JJ, Aygul N, Jaber W, Nicholson W, Rinfret S, Krestyaninov O, Khelimskii D, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke MN, Brilakis ES. Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Previous Coronary Artery Bypass Graft Surgery. Am J Cardiol 2023; 205:40-49. [PMID: 37586120 DOI: 10.1016/j.amjcard.2023.07.112] [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: 05/24/2023] [Revised: 06/21/2023] [Accepted: 07/21/2023] [Indexed: 08/18/2023]
Abstract
The outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) in patients with previous coronary artery bypass graft (CABG) surgery have received limited study. We examined the baseline characteristics and outcomes of CTO PCIs performed at 47 United States and non-United States centers between 2012 and 2023. Of the 12,164 patients who underwent CTO PCI during the study period, 3,475 (29%) had previous CABG. Previous CABG patients were older, more likely to be men, and had more comorbidities and lower left ventricular ejection fraction and estimated glomerular filtration rate. Their CTOs were more likely to have moderate/severe calcification and proximal tortuosity, proximal cap ambiguity, longer lesion length, and higher Japanese CTO scores. The first and final successful crossing strategy was more likely to be retrograde. Previous CABG patients had lower technical (82.1% vs 88.2%, p <0.001) and procedural (80.8% vs 86.8%, p <0.001) success, higher in-hospital mortality (0.8% vs 0.3%, p <0.001), acute myocardial infarction (0.9% vs 0.5%, p = 0.007) and perforation (7.0% vs 4.2%, p <0.001) but lower incidence of pericardial tamponade and pericardiocentesis (0.1% vs 1.3%, p <0.001). At 2-year follow-up, the incidence of major adverse cardiac events, repeat PCI and acute coronary syndrome was significantly higher in previous CABG patients, whereas all-cause mortality was similar. In conclusion, patients with previous CABG who underwent CTO PCI had more complex clinical and angiographic characteristics and lower success rate, higher perioperative mortality, and myocardial infarction but lower tamponade, and higher incidence of major adverse cardiac events with similar all-cause mortality during follow-up.
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Affiliation(s)
- Michaella Alexandrou
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Paul Poommipanit
- Section of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Mir Bahar Basir
- Division of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Michael Megaly
- Division of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Rhian Davies
- Department of Cardiology, WellSpan York Hospital, York, Pennsylvania
| | - Stewart Benton
- Department of Cardiology, WellSpan York Hospital, York, Pennsylvania
| | - Farouc A Jaffer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | | | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | | | - Nazif Aygul
- Department of Cardiology, Selcuk University, Konya, Turkey
| | - Wissam Jaber
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - William Nicholson
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Stephane Rinfret
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Dmitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Salman S Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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4
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Kozlov BN, Zatolokin VV, Manvelyan DV, Ryabov VV, Mochula AV, Arsenyeva YA. [Repeated Coronary Artery Bypass Surgery 18 Years After the Primary Revascularization of Myocardium in a Patient With Acute Coronary Syndrome Without the Segment ST Elevation]. KARDIOLOGIIA 2023; 63:72-76. [PMID: 37815143 DOI: 10.18087/cardio.2023.9.n1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/26/2021] [Indexed: 10/11/2023]
Abstract
This article describes a clinical case of successful repeated coronary bypass grafting 18 years after the initial surgery in a patient with non-ST-elevation acute coronary syndrome.
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Affiliation(s)
- B N Kozlov
- Research Institute of Cardiology, Tomsk National Research Medical Center
| | - V V Zatolokin
- Research Institute of Cardiology, Tomsk National Research Medical Center
| | - D V Manvelyan
- Research Institute of Cardiology, Tomsk National Research Medical Center
| | - V V Ryabov
- Research Institute of Cardiology, Tomsk National Research Medical Center
| | - A V Mochula
- Research Institute of Cardiology, Tomsk National Research Medical Center
| | - Yu A Arsenyeva
- Research Institute of Cardiology, Tomsk National Research Medical Center
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5
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Dhaduk N, Xia Y, Feit F, Mamas M, Alviar C, Keller N, Rao SV, Bangalore S. In-hospital Outcomes of Patients With and Without Previous Coronary Artery Bypass Graft Surgery Who Present With a Non-ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2023; 194:78-85. [PMID: 36989550 DOI: 10.1016/j.amjcard.2023.02.013] [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] [Received: 11/16/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 03/31/2023]
Abstract
The clinical course of patients with a previous coronary artery bypass graft surgery (CABG) presenting with non-ST-elevation myocardial infarction (NSTEMI) is not well defined. We aimed to compare the management and outcomes of patients with and without previous CABG who present with an NSTEMI. Patients hospitalized with an NSTEMI between 2002 and 2018 were identified from the National Inpatient Sample. The baseline characteristics and outcomes of patients with and without a previous CABG were compared. The outcomes included the rates of invasive procedures (defined as coronary angiography, percutaneous coronary intervention [PCI], or CABG), and its individual components, and in-hospital mortality. A total of 1,445,545 cases of NSTEMI were found, of which 133,691 (9.3%) had a previous CABG. Patients with a previous CABG were older (72.4 vs 68.6 years, p <0.001), more likely men (68.8% vs 56.9%, p <0.001), and of White race (79.7% vs 74.8%, p <0.001). The previous CABG cohort had lower rates of invasive procedures (50.4% vs 65.6%, p <0.001), PCI (23.7% vs 32.0%, p <0.001), or CABG (1.2% vs 10.6%; p <0.001) in the unmatched analysis. The results were consistent in the propensity score-matched analysis with the previous CABG group less likely to receive any invasive procedures (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.47 to 0.49), including coronary angiography (OR 0.54, 95% CI 0.53 to 0.55), PCI (OR 0.66, 95% CI 0.64 to 0.67), or repeat CABG (OR 0.11, 95% CI 0.10 to 0.12). Moreover, the risk of in-hospital mortality was higher in the previous CABG group (OR 1.15, 95% CI 1.10 to 1.21). In the subset of patients who were revascularized in both groups, this excess mortality was no longer observed (OR 0.82, 95% CI 0.66 to 1.03). In conclusion, a previous CABG in patients who present with NSTEMI is associated with lower rates of invasive procedures and revascularization and higher in-hospital mortality than patients without a previous CABG.
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Affiliation(s)
- Nehal Dhaduk
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Yuhe Xia
- Department of Population Health, New York University Langone Medical Center, New York, New York
| | - Frederick Feit
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Mamas Mamas
- Department of Cardiology, Keele University, Keele, United Kingdom
| | - Carlos Alviar
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Norma Keller
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Sunil V Rao
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Sripal Bangalore
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York.
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Parfrey S, Mozid A. Feasibility of facilitated antegrade dissection with Stingray-based re-entry for coronary chronic total occlusions with previously stented graft-to-native-vessel anastomoses. Catheter Cardiovasc Interv 2022; 100:1030-1035. [PMID: 36229936 DOI: 10.1002/ccd.30426] [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: 04/09/2022] [Revised: 09/14/2022] [Accepted: 10/02/2022] [Indexed: 11/10/2022]
Abstract
Facilitated antegrade dissection re-entry (F-ADR) is a technique described for treating post coronary artery bypass surgery chronic total occlusions (CTO) when there is flush occlusion of the distal cap of the CTO at the vein graft anastomosis. In this scenario retrograde access is usually impossible and if antegrade wiring fails, F-ADR is then the best option. Following antegrade dissection past the anastomosis, a balloon is delivered via the vein graft and inflated in the native vessel distal to the anastomosis to facilitate re-entry using a Stingray catheter. However, the applicability and outcome of this technique have not been described in cases where the graft to native vessel anastomosis has previously been stented. We report a case series of successful CTO recanalization using F-ADR across stented graft-native vessel anastomoses.
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Affiliation(s)
- Shane Parfrey
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - Abdul Mozid
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
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7
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Megaly M, Buda K, Mashayekhi K, Werner GS, Grantham JA, Rinfret S, McEntegart M, Brilakis ES, Alaswad K. Comparative Analysis of Patient Characteristics in Chronic Total Occlusion Revascularization Studies: Trials vs Real-World Registries. JACC Cardiovasc Interv 2022; 15:1441-1449. [PMID: 35863793 DOI: 10.1016/j.jcin.2022.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/18/2022] [Accepted: 05/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The few randomized controlled trials (RCTs) on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) are subject to selection bias. OBJECTIVES The purpose of this study was to evaluate the differences between real-world CTO patients and those enrolled in RCTs. METHODS This study performed a meta-analysis of national and dedicated CTO PCI registries and compared patient characteristics and outcomes with those of RCTs that randomized patients to CTO PCI versus medical therapy. Given the large sample size differences between RCTs and registries, the study focused on the absolute numbers and their clinical significance. The study considered a 5% relative difference between groups to be potentially clinically relevant. RESULTS From 2012 to 2022, 6 RCTs compared CTO PCI versus medical therapy (n = 1,047) and were compared with 15 registries (5 national and 10 dedicated CTO PCI registries). Compared with registry patients, RCT patients had fewer comorbidities, including diabetes, hypertension, previous myocardial infarction, and prior coronary artery bypass graft surgery. RCT patients had shorter CTO length (29.6 ± 19.7 mm vs 32.6 ± 23.0 mm, a relative difference of 9.2%) and lower Japan-Chronic Total Occlusion Score scores (2.0 ± 1.1 vs 2.3 ± 1.2, a relative difference of 13%) compared with those enrolled in dedicated CTO registries. Procedural success was similar between RCTs (84.5%) and dedicated CTO registries (81.4%) but was lower in national registries (63.9%). CONCLUSIONS There is a paucity of randomized data on CTO PCI outcomes (6 RCTs, n = 1,047). These patients have lower risk profiles and less complex CTOs than those in real-world registries. Current evidence from RCTs may not be representative of real-world patients and should be interpreted within its limitation.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kevin Buda
- Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Kambis Mashayekhi
- Department of Cardiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany; Department of Cardiology, MediClin Heartcenter Lahr, Lahr, Germany
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt, Darmstadt, Germany
| | - J Aaron Grantham
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Stephane Rinfret
- Department of Cardiology, Emory University, Atlanta, Georgia, USA
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA.
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8
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Guo L, Lv H, Yin X. Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Graft: Current Evidence and Future Perspectives. Front Cardiovasc Med 2022; 9:753250. [PMID: 35479272 PMCID: PMC9037955 DOI: 10.3389/fcvm.2022.753250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary chronic total occlusion (CTO), which occurs in 18. 4-52% of all patients referred for coronary angiography, represents one of the last barriers in coronary intervention. Approximately half of all patients with prior coronary artery bypass graft (CABG), who undergo coronary angiography, are diagnosed with coronary CTO. In fact, these patients often develop recurrent symptoms and events, necessitating revascularization. Currently, there is neither a consensus nor developed guidelines for the treatment of CTO patients with prior CABG, and the prognosis of these patients remains unknown. In this review, we discuss current evidence and future perspectives on CTO revascularization in patients with prior CABG, with special emphasis on clinical and lesion characteristics, procedural success rates, periprocedural complications, and long-term outcomes.
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Affiliation(s)
| | | | - Xiaomeng Yin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Guelker JE, Kinoshita Y, Weber-Albers J, Bufe A, Blockhaus C, Mashayekhi K. Validation of the newly introduced CASTLE Score for predicting successful CTO recanalization. IJC HEART & VASCULATURE 2022; 38:100942. [PMID: 35079620 PMCID: PMC8777279 DOI: 10.1016/j.ijcha.2021.100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022]
Abstract
Background The new EuroCTO CASTLE Score was validated against the widely adopted Japanese Multicenter CTO Registry (J-CTO) score in predicting technical success in percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO). Methods A total of 463 patients treated by CTO PCI were included in a retrospective analysis. Result: The mean CASTLE score was 2.23 ± 1.1 and J-CTO score was 2.84 ± 1.0. The overall technical success rate was 83.2%. At 30 days follow up, a primary composite safety endpoint showed a low proportion of stent thrombosis (0.2%) and re-hospitalization (0.4%). Moreover, an improvement of clinical symptoms was found in 83% of patients. Receiver operating characteristic analysis (ROC) demonstrated a comparable overall discriminatory performance in predicting technical outcome: CASTLE score, area under the ROC curve (AUC) 0.668, 95% CI: 0.606–0.730; J-CTO score AUC 0.692, 95% CI: 0.631–0.752; Comparison of AUCs: p = 0.324. Those findings were even consistent in more complex procedures CASTLE Score ≥ 4 and J-CTO score ≥ 3: CASTLE Score AUC 0.514, 95% CI: 0.409–0.619; J-CTO score, AUC 0.617, 95% CI: 0.493–0.741; Comparison of AUCs: p = 0.211. Furthermore, increasing score values are accompanied by a longer examination and fluoroscopy time, more contrast medium and a higher dose area product. Conclusion Compared to the widely accepted J-CTO score, the new introduced EuroCTO CASTLE score demonstrated a comparable overall discriminatory performance in predicting technical outcomes in CTO PCI.
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Hernandez-Suarez DF, Azzalini L, Moroni F, Tinoco de Paula JE, Lamelas P, Campos CM, Ribeiro MH, Filho EM, de los Santos FD, Padilla L, Alcantara-Melendez M, Abud MA, Almodóvar-Rivera IA, Schmidt MM, Echavarria M, Botelho AC, Del Rio V, Quadros A, Santiago R. Outcomes of chronic total occlusion percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the LATAM CTO registry. Catheter Cardiovasc Interv 2022; 99:245-253. [PMID: 34931448 PMCID: PMC8885848 DOI: 10.1002/ccd.30041] [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: 09/15/2021] [Revised: 11/13/2021] [Accepted: 11/27/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with and without prior coronary artery bypass graft (CABG) surgery. BACKGROUND Data on the outcomes of CTO PCI in patients with versus without CABG remains limited and with scarce representation from developing regions like Latin America. METHODS We evaluated patients undergoing CTO PCI in 42 centers participating in the LATAM CTO registry between 2008 and 2020. Statistical analyses were stratified according to CABG status. The outcomes of interest were technical and procedural success and in-hospital major adverse cardiac and cerebrovascular events (MACCE). RESULTS A total of 1662 patients were included (n = 1411 [84.9%] no-CABG and n = 251 [15.1%] prior-CABG). Compared with no-CABG, those with prior-CABG were older (67 ± 11 vs. 64 ± 11 years; p < 0.001), had more comorbidities and lower left ventricular ejection fraction (52.8 ± 12.8% vs. 54.4 ± 11.7%; p = 0.042). Anatomic complexity was higher in the prior-CABG group (J-CTO score 2.46 ± 1.19 vs. 2.10 ± 1.22; p < 0.001; PROGRESS CTO score 1.28 ± 0.89 vs. 0.91 ± 0.85; p < 0.001). Absence of CABG was associated with lower risk of technical and procedural failure (OR: 0.60, 95% CI: 0.43-0.85 and OR: 0.58, 95% CI: 0.40-0.83, respectively). No significant differences in the incidence of in-hospital MACCE (3.8% no-CABG vs. 4.4% prior-CABG; p = 0.766) were observed between groups. CONCLUSION In a contemporary multicenter CTO-PCI registry from Latin America, prior-CABG patients had more comorbidities, higher anatomical complexity, lower success, and similar in-hospital adverse event rates compared with no-CABG patients.
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Affiliation(s)
- Dagmar F. Hernandez-Suarez
- Division of Cardiology, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Francesco Moroni
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Pablo Lamelas
- Interventional Cardiology Division, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina,Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Carlos M. Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil,Instituto Prevent Senior, São Paulo, Brazil
| | | | | | - Felix Damas de los Santos
- National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico,Cardiovascular Center Centro Medico ABC, Mexico City, Mexico
| | - Lucio Padilla
- Interventional Cardiology Division, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Marco Alcantara-Melendez
- Centro Medico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico,Hospital Medica Sur, Mexico City, Mexico
| | - Marcelo A. Abud
- Percutaneous endovascular therapy department, Sanatorio San Gerónimo, Santa Fe, Argentina
| | | | | | | | | | - Valentin Del Rio
- PCI Cardiology Group, Manatí, Puerto Rico,Bayamon Heart and Lung Institute, Bayamón Medical Center, Bayamón, Puerto Rico
| | | | - Ricardo Santiago
- PCI Cardiology Group, Manatí, Puerto Rico,Bayamon Heart and Lung Institute, Bayamón Medical Center, Bayamón, Puerto Rico
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11
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Shi Y, He S, Luo J, Jian W, Shen X, Liu J. Lesion characteristics and procedural complications of chronic total occlusion percutaneous coronary intervention in patients with prior bypass surgery: A meta-analysis. Clin Cardiol 2022; 45:18-30. [PMID: 34989435 PMCID: PMC8799042 DOI: 10.1002/clc.23766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/07/2022] Open
Abstract
Coronary artery bypass graft (CABG) accelerates the prevalence of native coronary chronic total occlusion (CTO), and this kind of CTO shows extensive challenging and complex atherosclerotic pathology. As a result, the procedural success rate of percutaneous coronary intervention (PCI) is inferior to another kind of lesions. The present meta-analysis aims to compare the lesion characteristics and procedural complications of CTO-PCI in patients with or without prior CABG. A total of 8 studies, comprising of 13439 patients, published from inception to August 2021 were included in this meta-analysis. Results were pooled using random effects model and are presented as odds ratio (OR) with 95% confidence intervals (95% CIs). From the 13439 patients enrolled, 3349 (24.9%) patients had previous CABG and 10090 (75.1%) formed the control group in our analysis. For the clinical characteristic, compared to the non-CABG patients, prior CABG patients were older (OR, 3.98; 95% CI, 3.19-4.78; p < .001; I2 = 72%), had more male (OR, 1.30; 95% CI, 1.14-1.49; p < .001; I2 = 6%), diabetes mellitus (OR, 1.54; 95% CI, 1.36-1.73; p < .001; I2 = 37%), dyslipidemia (OR, 1.89; 95% CI, 1.33-2.69; p < .001; I2 = 81%), hypertension (OR, 1.88; 95% CI, 1.46-2.41; p < .001; I2 = 71%), previous myocardial infarction (OR, 1.94; 95% CI, 1.48-2.56; p < .001; I2 = 85%), and previous PCI (OR, 1.74; 95% CI, 1.52-1.98; p < .001; I2 = 22%). Non-CABG patents had more current smoker (OR, .45; 95% CI, 0.27-0.74; p < .001; I2 = 91%). BMI (OR, -0.01; 95% CI, -0.07-0.06; p = .85; I2 = 36%) were similar in both groups. For lesions location, the right coronary artery (RCA) was predominant target vessel in both groups (50.5% vs 48.7%; p=.49), although, the left circumflex (LCX) was more frequently CTO in the prior CABG group (27.3% vs 18.9%; p<.01), while left anterior descending artery (LAD) in non-CABG ones (16.0% vs 29.1%; p<0.01). For lesions characteristics, prior CABG patients had more blunt stump (OR, 1.71; 95% CI, 1.46-2.00; p < .001; I2 = 40%), proximal cap ambiguity (OR, 1.45; 95% CI, 1.28-1.64; p < .001; I2 = 0.0%), severe calcifications (OR, 2.91; 95% CI, 2.19-3.86; p < .001; I2 = 83%), more bending (OR, 3.07; 95% CI, 2.61-3.62; p < .001; I2 = 0%), lesion length > 20 mm (OR, 1.59; 95% CI, 1.10-2.29; p = .01; I2 = 83%), inadequate distal landing zone (OR, 1.95; 95% CI, 1.75-2.18; p<.001; I2 = 0.0%), distal cap at bifurcation (OR, 1.65; 95% CI, 1.46-1.88; p < .001; I2 = 0.0%), and higher J-CTO score (SMD, 0.52; 95% CI, 0.42-0.63; p < .001; I2 = 65%). But side branch at proximal entry (OR, 0.88; 95% CI, 0.72-1.07; p = .21; I2 = 45%), in-stent CTO (OR, 0.99; 95% CI, 0.86-1.14; p = .88; I2 = 0.0%), lack of interventional collaterals (OR, 0.80; 95% CI, 0.55-1.15; p = .23; I2 = 78%), and previously failed attempt (OR, 0.73; 95% CI, 0.48-1.11; p = .14; I2 = 89%) were similar in both groups. For complication, prior CABG patients had more perforation with need for intervention (OR, 1.91; 95% CI, 1.36-2.69; p < 0.001; I2 = 34%), contrast-induced nephropathy (OR, 3.40; 95% CI, 1.31-8.78; p = .01; I2 = 0.0%). Non-CABG patents had more tamponade (OR, 0.25; 95% CI, 0.09-0.72; p = .01; I2 = 0.0%), and the major bleeding complication (OR, 1.18; 95% CI, 0.57-2.44; p = .65; I2 = 0%) were no significant difference in both groups. In conclusion, Patients with prior CABG undergoing CTO-PCI have more complex lesion characteristics, though procedural complication rates were comparable.
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Affiliation(s)
- Yuchen Shi
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
| | - Songyuan He
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
| | - Jesse Luo
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
| | - Wen Jian
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
| | - Xueqian Shen
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
| | - Jinghua Liu
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, and Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina
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12
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Shoaib A, Mohamed M, Curzen N, Ludman P, Zaman A, Rashid M, Nolan J, Azam ZA, Kinnaird T, Mamas MA. Clinical outcomes of percutaneous coronary intervention for chronic total occlusion in prior coronary artery bypass grafting patients. Catheter Cardiovasc Interv 2021; 99:74-84. [PMID: 33942465 DOI: 10.1002/ccd.29691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/12/2021] [Accepted: 03/23/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the clinical characteristics and outcomes in patients with stable angina who have undergone chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in native arteries with or without prior coronary artery bypass grafting (CABG) surgery in a national cohort. BACKGROUND There are limited data on outcomes of patients presenting with stable angina undergoing CTO PCI with previous CABG. METHODS We identified 20,081 patients with stable angina who underwent CTO PCI between 2007-2014 in the British Cardiovascular Intervention Society database. Clinical, demographical, procedural and outcome data were analyzed in two groups; group 1-CTO PCI in native arteries without prior CABG (n = 16,848), group 2-CTO PCI in native arteries with prior CABG (n = 3,233). RESULTS Patients in group 2 were older, had more comorbidities and higher prevalence of severe left ventricular systolic dysfunction. Following multivariable analysis, no significant difference in mortality was observed during index hospital admission (OR:1.33, CI 0.64-2.78, p = .44), at 30-days (OR: 1.28, CI 0.79-2.06, p = .31) and 1 year (OR:1.02, CI 0.87-1.29, p = .87). Odds of in-hospital major adverse cardiovascular events (MACE) (OR:1.01, CI 0.69-1.49, p = .95) and procedural complications (OR:1.02, CI 0.88-1.18, p = .81) were similar between two groups but procedural success rate was lower in group 2 (OR: 0.34, CI 0.31-0.39, p < .001). The adjusted risk of target vessel revascularization (TVR) remained similar between the two groups at 30-days (OR:0.68, CI 0.40-1.16, P-0.16) and at 1 year (OR:1.01, CI 0.83-1.22, P-0.95). CONCLUSION Patients with prior CABG presenting with stable angina and treated with CTO PCI in native arteries had more co-morbid illnesses but once these differences were adjusted for, prior CABG did not independently confer additional risk of mortality, MACE or TVR.
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Affiliation(s)
- Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Nick Curzen
- Medicine department, University of Southampton, Southampton, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Azfar Zaman
- Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - James Nolan
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Ziyad A Azam
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Tim Kinnaird
- Cardiology department, University Hospital of Wales, Cardiff, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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13
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Gong M, Peng H, Wu Z, Li W, Lv Y, Lv Y, Zheng Z, An T, Zhang J, Lv M, Li X, Gong H, Mao Y, Liu J. Angiographic Scoring System for Predicting Successful Percutaneous Coronary Intervention of In-Stent Chronic Total Occlusion. J Cardiovasc Transl Res 2021; 14:598-609. [PMID: 33409961 DOI: 10.1007/s12265-020-10090-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to develop a scoring model to predict the technical success of recanalizing via antegrade approach in-stent chronic total occlusion (IS-CTO) by percutaneous coronary intervention (PCI). We retrospectively collected data from 474 patients who underwent an uneasy IS-CTO PCI via antegrade approach from January 2015 to December 2018, consecutively. We selected clinical and angiographic factors and utilized a derivation and validation cohort (4:1 sampling ratio) analysis. Factors with strong correlations with technical failure, according to multivariable analysis, were assigned 1 point, and a scoring system with a 4-point maximum was established. The model was then validated with a validation cohort. The overall procedural success rate was 77.4%. On multivariable analysis, the factors that correlated with technical failure were proximal bending (beta coefficient [β] = 2.142), tortuosity (β = 2.622), stent under expansion (β = 3.052), and poor distal landing zone (β = 2.004). The IS-CTO score demonstrated good calibration and excellent predicting capacity in the derivation (receiver-operator characteristic [ROC] area = 0.973 and Hosmer-Lemeshow chi-squared = 5.252; p = 0.072) and validation (ROC area = 0.976 and Hosmer-Lemeshow chi-squared = 0.916; p = 0.632) cohorts. In the validation subset, the IS-CTO score demonstrated superior performance to the Japanese chronic total occlusion score (J-CTO) and PROGRESS CTO scores for predicting technical success (area under the a curve [AUC] 0.976 vs. 0.642 vs. 0.579, respectively; difference in AUC between the IS-CTO score and J-CTO score = 0.334, p < 0.01; difference in AUC between the IS-CTO score and PROGRESS score = 0.397, p < 0.01). Our results suggest that the IS-CTO score system is a helpful tool to predict the technical success of IS-CTO PCI via antegrade approach in china. Graphical Abstract.
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Affiliation(s)
- Minglian Gong
- Department of Cardiology, Dalian The Fifth People's Hospital, No. 890 Huanghe Road, Shahekou District, Dalian, 116021, Liaoning, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Hongyu Peng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Zheng Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Wenzheng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Yun Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Yuan Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Ze Zheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China
| | - Tao An
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science, Peking Union Medical College, National Center for Cardiovascular Disease, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jing Zhang
- Department of Cardiology, Dalian The Fifth People's Hospital, No. 890 Huanghe Road, Shahekou District, Dalian, 116021, Liaoning, China
| | - Mingrui Lv
- Department of Cardiology, Dalian The Fifth People's Hospital, No. 890 Huanghe Road, Shahekou District, Dalian, 116021, Liaoning, China
| | - Xin Li
- Department of Cardiology, Dalian The Fifth People's Hospital, No. 890 Huanghe Road, Shahekou District, Dalian, 116021, Liaoning, China
| | - Hangyu Gong
- Department of Cardiology, Dalian The Sixth People's Hospital, No.269 Luganghuibo Road, Ganjingzi District, Dalian, 116033, Liaoning, China
| | - Yi Mao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science, Peking Union Medical College, National Center for Cardiovascular Disease, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Jinghua Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, No. 2 Chaoyang Road, Chaoyang District, Beijing, 100029, China.
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14
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Kandzari DE, Lembo NJ, Carlson HD, Kalynych A, Spertus JA, Gibson CM, Chi G, Morgan J, Rinehart S, Yehya A, Qian Z, Ajose B, Karmpaliotis D. Procedural, clinical, and health status outcomes in chronic total coronary occlusion revascularization: Results from the PERSPECTIVE study. Catheter Cardiovasc Interv 2020; 96:567-576. [PMID: 31512377 DOI: 10.1002/ccd.28494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Limited research has detailed the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with independent core laboratory and event adjudication. This study examined procedural, clinical, and patient-reported health status outcomes among patients undergoing CTO PCI with specific focus on outcomes for those treated with zotarolimus-eluting stents (ZES). METHODS Among 500 consecutive patients undergoing attempted CTO PCI, procedural and in-hospital clinical outcomes were examined in addition to the 1-year composite endpoint of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events, MACE). In a pre-specified cohort of 250 patients, health status measures were ascertained at baseline and 1 year. A powered secondary endpoint was 1-year MACE among patients treated with ZES compared with a performance goal. RESULTS Demographic, lesion, and procedural characteristics for the overall population included prior bypass surgery, 29.8%; diabetes, 35.2%; occlusion length >20 mm, 71.3%; J-CTO score, 2.5 ± 1.1; and primary retrograde strategy, 30.8%. Overall guidewire crossing was 90.9%; clinical success following guidewire crossing, 94.3%; and 1-year MACE rate, 12.1%. One-year health status significantly improved from baseline with successful CTO-PCI (angina frequency, 72.7 ± 26.5 at baseline to 96.0 ± 10.8, p < .0001). Compared with a performance goal derived from prior CTO DES trials (1-year hierarchal MACE, 25.2%), treatment with ZES was associated with significantly lower MACE (18.2%, one-sided upper CI, 23.6%, p = .017). CONCLUSIONS Favorable procedural success, health status improvements and late-term clinical outcomes inform the relative risks and benefits of CTO PCI when performed in a clinically indicated, complex patient population representative of those treated in clinical practice.
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Affiliation(s)
- David E Kandzari
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Nicholas J Lembo
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Harold D Carlson
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Anna Kalynych
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - John A Spertus
- Cardiovascular Research, Department of Biomedical and Health Informatics, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, Missouri
| | - C Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gerald Chi
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jayne Morgan
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Sarah Rinehart
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Amin Yehya
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Zhen Qian
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Bola Ajose
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
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15
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Qin Q, Ma J, Ge J. Retrograde recanalization of native right coronary artery chronic total occlusion (CTO) through left coronary artery CTO after bypass graft failure: A case report. Medicine (Baltimore) 2020; 99:e20850. [PMID: 32664079 PMCID: PMC7360218 DOI: 10.1097/md.0000000000020850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE With the development and standardization of modern chronic total occlusions (CTOs) recanalization technique, percutaneous coronary intervention has become a promising treatment alternative to surgery after bypass graft failure. Treatment of a native coronary CTO lesion is preferable to treatment of a saphenous vein graft (SVG) CTO supplying the same territory; however, technical expertise is required. PATIENT CONCERNS This is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration. DIAGNOSIS The patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram. INTERVENTIONS We recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery. OUTCOMES Dyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea. LESSONS In case of SVG failure, percutaneous coronary intervention of native vessel should be considered as a treatment option. Retrograde approach through native vessel is safe but has requirements for operators' volume, skill, and experience.
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16
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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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17
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Budassi S, Zivelonghi C, Dens J, Bagnall AJ, Knaapen P, Avran A, Spratt JC, Walsh S, Faurie B, Agostoni P. Impact of prior coronary artery bypass grafting in patients undergoing chronic total occlusion-percutaneous coronary intervention: Procedural and clinical outcomes from the REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium, and UnitEd Kingdom (RECHARGE). Catheter Cardiovasc Interv 2020; 97:E51-E60. [PMID: 32369681 DOI: 10.1002/ccd.28954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/11/2020] [Accepted: 04/23/2020] [Indexed: 11/11/2022]
Abstract
AIM Chronic total occlusions (CTO) in patients with history of coronary artery bypass graft (CABG) show more advanced and complex atherosclerotic pathology. Aim of our study is to compare outcomes in patients undergoing CTO percutaneous coronary intervention (PCI) with previous CABG versus those without in the REgistry of Crossboss and Hybrid procedures in FrAnce the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE). METHODS & RESULTS The RECHARGE cohort (1,252 patients) was divided in two groups according to the presence of previous CABG (217) or not. We also focused, in the post-CABG group, on a comparison between CTO in previously grafted vessels versus non-grafted vessels. The CTO complexity scores were higher and the success rate (71.9% vs. 88.7%, p < .001) was lower in the CABG group, this difference was driven by higher failure rates in high-complexity-score CTO. The rate of in-hospital complications was similar. In the post-CABG group, the procedural success of CTO located in previously grafted vessels versus those in vessels not previously grafted, was comparably suboptimal (73.1% vs. 68%, p = .47). CONCLUSION Patients undergoing CTO PCI with prior CABG have a higher prevalence of comorbidities and more complex lesion characteristics. In the post-CABG population the success rate was significantly lower, particularly in high CTO complexity scores, though complication rates were comparable. In the post-CABG population, the CTO success rate was independent of the presence of a previous graft on the CTO vessel.
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Affiliation(s)
- Simone Budassi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.,Cardiology and Interventional Cardiology Department, Policlinico Tor Vergata, Rome, Italy
| | - Carlo Zivelonghi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Joseph Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Alan J Bagnall
- Freeman Hospital, The Newcastle upon Tyne hospitals NHS Trust, Newcastle, UK
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexandre Avran
- Department of Interventional Cardiology, Arnault Tzanck Institute, Saint-Laurent-du-Var, France
| | - James C Spratt
- Department of Cardiology, St George's University Healthcare NHS Trust, London, UK
| | - Simon Walsh
- Department of Cardiology, Belfast Health & Social Care Trust, Belfast, Northern Ireland, UK
| | - Benjamin Faurie
- Cardiovascular Institute, Groupe Hospitalier Mutualiste, Grenoble, France
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18
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Kalogeropoulos AS, Alsanjari O, Keeble TR, Tang KH, Konstantinou K, Katsikis A, Jagathesan R, Aggarwal RK, Clesham GJ, Kelly PA, Werner GS, Hildick-Smith D, Davies JR, Karamasis G. CASTLE score versus J-CTO score for the prediction of technical success in chronic total occlusion percutaneous revascularisation. EUROINTERVENTION 2020; 15:e1615-e1623. [PMID: 31270036 DOI: 10.4244/eij-d-19-00352] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS We sought to compare the efficiency of the novel EuroCTO (CASTLE) score with the commonly used Multicentre CTO Registry in Japan (J-CTO) score in predicting procedural success of percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTOs). METHODS AND RESULTS We evaluated 660 consecutive CTO PCIs (mean age 66±11 years, 84% male). The mean J-CTO and EuroCTO (CASTLE) scores were 1.86±1.2 and 1.74±1.2, respectively. Antegrade wire escalation, antegrade dissection re-entry and retrograde approach were used in 82%, 14% and 37% of cases, respectively. Receiver operating characteristic analysis demonstrated equal overall discriminatory capacity between the two scores (AUC 0.698, 95% CI: 0.653-0.742, p<0.001 for J-CTO vs AUC 0.676, 95% CI: 0.627-0.725, p<0.001 for EuroCTO; AUC difference: 0.022, p=0.5). However, for more complex procedures (J-CTO ≥3 or EuroCTO [CASTLE] ≥4]), the predictive capacity of the EuroCTO (CASTLE) score appeared superior (AUC 0.588, 95% CI: 0.509-0.668, p=0.03 for EuroCTO [CASTLE] score vs AUC 0.473, 95% CI: 0.393-0.553, p=NS for the J-CTO score, AUC difference: 0.115, p=0.04). CONCLUSIONS In this study, the novel EuroCTO (CASTLE) score was comparable to the J-CTO score in predicting CTO PCI outcome with a superior discriminatory capacity for the more complex cases.
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Megaly M, Abraham B, Pershad A, Rinfret S, Alaswad K, Garcia S, Azzalini L, Gershlick A, Burke MN, Brilakis ES. Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Prior Bypass Surgery. JACC Cardiovasc Interv 2020; 13:900-902. [PMID: 32192982 DOI: 10.1016/j.jcin.2019.11.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 12/29/2022]
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20
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Gallo M, Trivedi JR, Monreal G, Ganzel BL, Slaughter MS. Risk Factors and Outcomes in Redo Coronary Artery Bypass Grafting. Heart Lung Circ 2020; 29:384-389. [DOI: 10.1016/j.hlc.2019.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
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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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Ma X, Chen P, Zhao Y, Zeng C, Xin M, Ye Q, Wang J. Coronary Angiography Characteristics of Symptomatic Patients with Prior Coronary Artery Bypass Graft: A Descriptive Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1832128. [PMID: 31815124 PMCID: PMC6877980 DOI: 10.1155/2019/1832128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The target of this study was to explore the coronary angiography characteristics for symptomatic patients with prior coronary artery bypass graft (CABG). METHODS Between 2009 and 2017, 993 patients who had undergone CABG but subsequently suffered recurrent symptoms in Beijing Anzhen Hospital were selected for this study and divided into either medical therapy (MT) group (n = 351) or percutaneous coronary intervention (PCI) group (n = 642) based on the treatment. Clinical data were analyzed between two groups. RESULTS Patients in the MT group were older and more likely to have chronic lung disease (6.6% vs 3.4%, P=0.026) while patients in the PCI group were more likely to have prior MI (8.8% vs 17.0%, P < 0.001). In the MT group, 54.4% of patients had newly developed lesions both in the graft and native coronary artery while 58.1% in the PCI group (P=0.003), and in the MT group, 80.6% had type C coronary artery disease while 60.1% in the PCI group (P < 0.001). Patients in the MT group presented higher proportion of diffuse lesions (49.3% vs 15.0%, P < 0.001) in native coronary arteries. CONCLUSION Patients receiving MT (35.3%) likely had occluded grafts and type C coronary artery disease featuring as diffuse lesions.
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Affiliation(s)
- Xiaolong Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Pengfei Chen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yicheng Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Caiwu Zeng
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Meng Xin
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qing Ye
- Department of Cardiac Surgery, Beijing Huaxin Hospital, First Hospital of Tsinghua University, Beijing, China
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Predictors for New Native-Vessel Occlusion in Patients with Prior Coronary Bypass Surgery: A Single-Center Retrospective Research. Cardiol Res Pract 2019; 2019:6857232. [PMID: 31662902 PMCID: PMC6778907 DOI: 10.1155/2019/6857232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/30/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives Chronic total occlusion (CTO) is prevalent in patients with prior coronary artery bypass grafting (CABG). However, data available concerning the prevalence of new-onset CTO of native vessels in patients with prior CABG is limited. Therefore, the objective of the study is to determine predictors for new native-vessel occlusion in patients with prior coronary bypass surgery. Methods 354 patients with prior CABG receiving follow-up angiography are selected and analyzed in the present study, with clinical and angiographic variables being analyzed by logistic regression to determine the predictors of new native-vessel occlusion. Results The overall new occlusion rate was 35.59%, with multiple CTOs (42.06%) being the most prevalent (LAD 24.60% and RCA 18.25%, respectively). Additionally, current smoking (OR: 2.67; 95% CI: 2.60 to 2.74; p=0.01), reduced ejection fraction (OR: 1.76; 95% CI: 1.04 to 2.97; p=0.04), severe stenosis (OR: 3.65; 95% CI: 2.55 to 5.24; p=0.01), and diabetes mellitus (OR: 1.86; 95% CI: 1.34 to 2.97; p=0.04) serve as the independent predictors for new native-vessel occlusion. Conclusion As to high incidence of postoperative CTO, appropriate revascularization strategies and postoperative management should be taken into careful consideration.
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Xenogiannis I, Tajti P, Hall AB, Alaswad K, Rinfret S, Nicholson W, Karmpaliotis D, Mashayekhi K, Furkalo S, Cavalcante JL, Burke MN, Brilakis ES. Update on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery. JACC Cardiovasc Interv 2019; 12:1635-1649. [DOI: 10.1016/j.jcin.2019.04.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
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25
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Tajti P, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Mahmud E, Choi JW, Burke MN, Doing AH, Dattilo P, Toma C, Smith AJC, Uretsky B, Holper E, Potluri S, Wyman RM, Kandzari DE, Garcia S, Krestyaninov O, Khelimskii D, Koutouzis M, Tsiafoutis I, Jaber W, Samady H, Moses JW, Lembo NJ, Parikh M, Kirtane AJ, Ali ZA, Doshi D, Xenogiannis I, Stanberry LI, Rangan BV, Ungi I, Banerjee S, Brilakis ES. In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Interv 2019; 12:e007338. [DOI: 10.1161/circinterventions.118.007338] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.T., M.N.B., I.X., L.I.S., B.V.R., E.S.B.)
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary (P.T., I.U.)
| | - Dimitri Karmpaliotis
- Columbia University, New York, NY (D.K., J.W.M., N.J.L., M.P., A.J.K., Z.A.A., D.D.)
| | | | | | - Robert W. Yeh
- Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.)
| | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego, La Jolla (M.P., E.M.)
| | - Ehtisham Mahmud
- VA San Diego Healthcare System and University of California San Diego, La Jolla (M.P., E.M.)
| | - James W. Choi
- Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.)
| | - M. Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.T., M.N.B., I.X., L.I.S., B.V.R., E.S.B.)
| | | | - Phil Dattilo
- Medical Center of the Rockies, Loveland, CO (A.H.D., P.D.)
| | - Catalin Toma
- University of Pittsburgh Medical Center, PA (C.T., A.J.C.S.)
| | | | - Barry Uretsky
- VA Central Arkansas Healthcare System, Little Rock (B.U.)
| | | | | | | | | | - Santiago Garcia
- VA Minneapolis Healthcare System and University of Minnesota (S.G.)
| | - Oleg Krestyaninov
- Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk (O.K., D.K.)
| | - Dmitrii Khelimskii
- Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk (O.K., D.K.)
| | - Michalis Koutouzis
- Korgialeneio-Benakeio Hellenic Red Cross General Hospital of Athens, Greece (M.K., I.T.)
| | - Ioannis Tsiafoutis
- Korgialeneio-Benakeio Hellenic Red Cross General Hospital of Athens, Greece (M.K., I.T.)
| | | | | | - Jeffrey W. Moses
- Columbia University, New York, NY (D.K., J.W.M., N.J.L., M.P., A.J.K., Z.A.A., D.D.)
| | - Nicholas J. Lembo
- Columbia University, New York, NY (D.K., J.W.M., N.J.L., M.P., A.J.K., Z.A.A., D.D.)
| | - Manish Parikh
- Columbia University, New York, NY (D.K., J.W.M., N.J.L., M.P., A.J.K., Z.A.A., D.D.)
| | - Ajay J. Kirtane
- Columbia University, New York, NY (D.K., J.W.M., N.J.L., M.P., A.J.K., Z.A.A., D.D.)
| | - Ziad A. Ali
- Columbia University, New York, NY (D.K., J.W.M., N.J.L., M.P., A.J.K., Z.A.A., D.D.)
| | - Darshan Doshi
- Columbia University, New York, NY (D.K., J.W.M., N.J.L., M.P., A.J.K., Z.A.A., D.D.)
| | - Iosif Xenogiannis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.T., M.N.B., I.X., L.I.S., B.V.R., E.S.B.)
| | - Larissa I. Stanberry
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.T., M.N.B., I.X., L.I.S., B.V.R., E.S.B.)
| | - Bavana V. Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.T., M.N.B., I.X., L.I.S., B.V.R., E.S.B.)
| | - Imre Ungi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary (P.T., I.U.)
| | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas (S.B., E.S.B.)
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.T., M.N.B., I.X., L.I.S., B.V.R., E.S.B.)
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas (S.B., E.S.B.)
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Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients with Diabetes Mellitus: a Treatment-Risk Paradox. Curr Cardiol Rep 2019; 21:9. [PMID: 30790113 DOI: 10.1007/s11886-019-1091-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). This review aims to summarize the available evidence on CTO recanalization in patients with DM. RECENT FINDINGS Coronary artery bypass grafting (CABG) surgery is the recommended revascularization modality for patients with DM and multivessel coronary artery disease (CAD). However, the optimal management strategy in diabetic patients with CTO and single-vessel disease or prior CABG remains a clinical dilemma. Contemporary, large-scale, observational registries support the notion that CTO PCI, if performed at high-volume CTO PCI centers by highly experienced operators, conveys similar high procedural success and low complication rates in patients with and without DM. Although DM patients have more frequently CTOs and may derive greater benefit from complete revascularization, they are less frequently exposed to CTO PCI than non-DM patients (treatment-risk paradox). CTO PCI performed by highly experienced operators constitutes a safe and effective treatment option for selected diabetic CTO patients who are not candidates for CABG. Randomized studies are warranted to compare long-term outcomes of CTO PCI and medical therapy in this high-risk subset.
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Cottens D, Maeremans J, McCutcheon K, Lamers S, Roux L, Duponselle J, Bennett J, Dens J. Prognostic value of the high-sensitivity troponin T assay after percutaneous intervention of chronic total occlusions. J Cardiovasc Med (Hagerstown) 2019; 19:366-372. [PMID: 29877975 DOI: 10.2459/jcm.0000000000000660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The prognostic value of postprocedural high-sensitivity troponin T (hs-TnT) after percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is currently unclear. We aimed to assess the prognostic value of elevated hs-TnT after elective CTO-PCI. METHODS The current study included 409 patients undergoing elective CTO-PCI between September 2011 and August 2016 at two centres who had postprocedural hs-TnT measurements available. Clinical, angiographic and procedural characteristics were correlated with any or at least five times the 99th percentile hs-TnT elevation, as well as a 1-year combined endpoint of major adverse cardiac and cerebrovascular events (MACCE) and mortality. RESULTS Post-CTO-PCI hs-TnT elevation was observed in 85% (n = 349/409) and at least five times hs-TnT elevation occurred in 42% (n = 172/409) of cases. hs-TnT elevation was more frequent in more complex patients (postcoronary artery bypass grafting, peripheral vascular disease, chronic kidney disease, heart failure and multivessel disease) as well as in the more complex CTO procedures (higher Japanese CTO complexity, use of retrograde and antegrade dissection re-entry techniques). After 1 year of follow-up (FU), MACCE was not associated with postprocedural hs-TnT elevation, both any elevation (10.9 vs. 11.7%; P = 0.846) and at least five times hs-TnT elevation (15.7 vs. 11.7%; P = 0.451; hazard ratio = 1.375, confidence interval: 0.599-3.157, P = 0.453), compared with no elevation. A nonsignificant trend towards higher mortality in the at least five times hs-TnT vs. no elevation group (4.7 vs. 0%; P = 0.091) was observed. CONCLUSION In patients undergoing CTO-PCI, postprocedural hs-TnT elevation is frequent, but is not correlated with higher MACCE and mortality rates after 1-year FU in our small study population, suggestive of the limited long-term impact of troponin elevation.
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Affiliation(s)
- Daan Cottens
- Department of Cardiology, Hospital Oost-Limburg, Genk
| | - Joren Maeremans
- Department of Cardiology, Hospital Oost-Limburg, Genk.,Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt
| | - Keir McCutcheon
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven
| | - Scott Lamers
- Faculty of Medicine and Health Sciences, Universiteit Antwerpen, Antwerp, Belgium
| | - Lien Roux
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt
| | - Jolien Duponselle
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven
| | - Jo Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk.,Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt
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Safety and efficacy of dedicated guidewire and microcatheter technology for chronic total coronary occlusion revascularization: principal results of the Asahi Intecc Chronic Total Occlusion Study. Coron Artery Dis 2018; 29:618-623. [PMID: 30308588 DOI: 10.1097/mca.0000000000000668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited study has detailed the procedural outcomes and utilization of contemporary coronary guidewires and microcatheters designed for chronic total occlusion (CTO) percutaneous revascularization and with application of modern techniques. PATIENTS AND METHODS A prospective, multicenter, single-arm trial was conducted to evaluate procedural and in-hospital outcomes among 163 patients undergoing attempted CTO revascularization with specialized guidewires and microcatheters. The primary endpoint was defined as successful guidewire recanalization and absence of in-hospital cardiac death, myocardial infarction, or repeat target vessel revascularization (major adverse cardiac events). RESULTS The prevalence of diabetes was 42.9%; prior myocardial infarction, 41.1%; and previous bypass surgery, 36.8%. Average (mean±SD) CTO length was 41±29 mm, and mean Japanese CTO score was 2.6±1.3. A guidewire support catheter was used in 91.7% of cases, and the mean number of CTO-specific guidewires per procedure was 3.1±2.9. Overall, procedural success was observed in 73.0% of patients. The rate of successful guidewire recanalization was 89.0%, and absence of in-hospital major adverse cardiac event was 81.0%. Methods included antegrade (45.4%), retrograde (5.5%) and combined antegrade/retrograde techniques (49.1%). Total mean procedure time was 119±68 min; mean radiation dose, 2613±1881 mGy; and contrast utilization, 287±142 ml. Clinically significant perforation resulting in hemodynamic instability and/or requiring intervention occurred in 13 (8.0%) patients. CONCLUSION In this multicenter, prospective registration trial representing contemporary technique, favorable procedural success and early clinical outcomes inform technique and strategy using dedicated CTO guidewires and microcatheters in a high lesion complexity patient population.
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Azzalini L, Ojeda S, Karatasakis A, Maeremans J, Tanabe M, La Manna A, Dautov R, Ybarra LF, Benincasa S, Bellini B, Candilio L, Demir OM, Hidalgo F, Karacsonyi J, Gravina G, Miccichè E, D'Agosta G, Venuti G, Tamburino C, Pan M, Carlino M, Dens J, Brilakis ES, Colombo A, Rinfret S. Long-Term Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients Who Have Undergone Coronary Artery Bypass Grafting vs Those Who Have Not. Can J Cardiol 2018; 34:310-318. [DOI: 10.1016/j.cjca.2017.12.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022] Open
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Dautov R, Ybarra LF, Nguyen CM, Gibrat C, Joyal D, Rinfret S. Incidence, predictors and longer-term impact of troponin elevation following hybrid chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv 2018; 92:E308-E316. [PMID: 29481724 DOI: 10.1002/ccd.27545] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 01/17/2018] [Accepted: 01/28/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We examined the incidence of periprocedural cardiac enzyme rise (PCER) [troponin T (TnT) or high-sensivity (hs)TnT >5× the upper limit of normal (ULN)] and periprocedural myocardial infarction (PMI), predictors of PCER and impact of PCER on the longer-term major adverse cardiac events (MACE) following hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND PCER and PMI after CTO PCI, risk factors for PCER and its impact on longer-term MACE are not fully understood. METHODS Among 469 CTO PCI cases performed between 01/2010 and 12/2015, next-day TnT or hsTnT was measured in 455 (97%). We examined the incidence of PCER and PMI (with clinical context or TnT ≥70× ULN). In 269 successful cases who had TnT measured, longer-term MACE (death, MI or target-vessel revascularisation/re-occlusion) were assessed. RESULTS Overall, 420 CTOs (92.3%) were treated successfully. PCER was documented in 34%, while PMI in 2.9%. By multivariable analyses, higher J-CTO score (OR = 1.3 per point; P = 0.002), lower creatinine clearance (OR = 1.01 per each cc/min decrease; P < 0.0001) and recent MI (OR = 2.4; P = 0.007) were independent pre-PCI risk factors for PCER. Among procedural variables, retrograde approach (OR = 1.9; P = 0.014) and procedure duration (OR = 1.2 per 30 min; P = 0.007) were associated with PCER. At a median follow-up of 396 days following successful CTO PCI, PCER was not associated with higher MACE (9.3% vs. 8.1%; P = 0.60), and was not a predictor of MACE in multivariable analysis. CONCLUSIONS PCER following hybrid CTO PCI is detected in 1/3 of patients. However, true PMI occurs in 2.9%. PCER does not predict adverse long-term outcomes.
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Affiliation(s)
- Rustem Dautov
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.,McGill University Health Centre, McGill University, Montreal, Quebec, Canada.,Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Luiz Fernando Ybarra
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada.,Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Can Manh Nguyen
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Claire Gibrat
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Dominique Joyal
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Stéphane Rinfret
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Karmpaliotis D, Karatasakis A, Alaswad K, Jaffer FA, Yeh RW, Wyman RM, Lombardi WL, Grantham JA, Kandzari DE, Lembo NJ, Doing A, Patel M, Bahadorani JN, Moses JW, Kirtane AJ, Parikh M, Ali ZA, Kalra S, Nguyen-Trong PKJ, Danek BA, Karacsonyi J, Rangan BV, Roesle MK, Thompson CA, Banerjee S, Brilakis ES. Outcomes With the Use of the Retrograde Approach for Coronary Chronic Total Occlusion Interventions in a Contemporary Multicenter US Registry. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003434. [PMID: 27307562 DOI: 10.1161/circinterventions.115.003434] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to examine the efficacy and safety of chronic total occlusion percutaneous coronary intervention using the retrograde approach. METHODS AND RESULTS We compared the outcomes of the retrograde versus antegrade-only approach to chronic total occlusion percutaneous coronary intervention among 1301 procedures performed at 11 experienced US centers between 2012 and 2015. The mean age was 65.5±10 years, and 84% of the patients were men with a high prevalence of diabetes mellitus (45%) and previous coronary artery bypass graft surgery (34%). Overall technical and procedural success rates were 90% and 89%, respectively, and in-hospital major adverse cardiovascular events occurred in 31 patients (2.4%). The retrograde approach was used in 539 cases (41%), either as the initial strategy (46%) or after a failed antegrade attempt (54%). When compared with antegrade-only cases, retrograde cases were significantly more complex, both clinically (previous coronary artery bypass graft surgery prevalence, 48% versus 24%; P<0.001) and angiographically (mean Japan-chronic total occlusion score, 3.1±1.0 versus 2.1±1.2; P<0.001) and had lower technical success (85% versus 94%; P<0.001) and higher major adverse cardiovascular events (4.3% versus 1.1%; P<0.001) rates. On multivariable analysis, the presence of suitable collaterals, no smoking, no previous coronary artery bypass graft surgery, and left anterior descending artery target vessel were independently associated with technical success using the retrograde approach. CONCLUSIONS The retrograde approach is commonly used in contemporary chronic total occlusion percutaneous coronary intervention, especially among more challenging lesions and patients. Although associated with lower success and higher major adverse cardiovascular event rates in comparison to antegrade-only crossing, retrograde percutaneous coronary intervention remains critical for achieving overall high success rates.
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Affiliation(s)
- Dimitri Karmpaliotis
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Aris Karatasakis
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Khaldoon Alaswad
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Farouc A Jaffer
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Robert W Yeh
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - R Michael Wyman
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - William L Lombardi
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - J Aaron Grantham
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - David E Kandzari
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Nicholas J Lembo
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Anthony Doing
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Mitul Patel
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - John N Bahadorani
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Jeffrey W Moses
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Ajay J Kirtane
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Manish Parikh
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Ziad A Ali
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Sanjog Kalra
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Phuong-Khanh J Nguyen-Trong
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Barbara A Danek
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Judit Karacsonyi
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Bavana V Rangan
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Michele K Roesle
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Craig A Thompson
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Subhash Banerjee
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.)
| | - Emmanouil S Brilakis
- From the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, New York (D.K., J.W.M., A.J.K., M.P., Z.A.A., S.K.); Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (A.K., P.-K.J.N.-T., B.A.D., J.K., B.V.R., M.K.R., S.B., E.S.B.); Department of Cardiology, Henry Ford Hospital, Detroit, MI (K.A.); Department of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (F.A.J.); CardioVascular Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (R.W.Y.); Lundquist Cardiovascular Institute, Torrance Memorial Medical Center, CA (R.M.W.); Cardiovascular Center, PeaceHealth St. Joseph Medical Center, Bellingham, WA (W.L.L.); Department of Interventional Cardiology, Mid America Heart Institute, Kansas City, MO (J.A.G.); Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K., N.J.L.); Department of Cardiology, Medical Center of the Rockies, Loveland, CO (A.D.); Division of Cardiovascular Medicine, VA San Diego Healthcare System and University of California (M.P., J.N.B.); and Boston Scientific, Natick, MA (C.A.T.).
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Barbero U, Iannaccone M, Barbero C, D'Ascenzo F. A thoughtful use of CT angiography among patients with prior coronary artery bypass grafts: more lights than shadows? Cardiovasc Diagn Ther 2017; 7:S125-S127. [PMID: 28748164 DOI: 10.21037/cdt.2017.05.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Umberto Barbero
- Division of Cardiology, Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mario Iannaccone
- Division of Cardiology, Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Cristina Barbero
- Division of Cardiac Surgery, Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
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Behnes M, Mashayekhi K. Chronic Total Occlusion (CTO): Scientific Benefit and Principal Interventional Approach. Interv Cardiol 2017. [DOI: 10.5772/intechopen.68303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Maeremans J, Spratt JC, Knaapen P, Walsh S, Agostoni P, Wilson W, Avran A, Faurie B, Bressollette E, Kayaert P, Bagnall AJ, Smith D, McEntegart MB, Smith WH, Kelly P, Irving J, Smith EJ, Strange JW, Dens J. Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score. Catheter Cardiovasc Interv 2017; 91:192-202. [DOI: 10.1002/ccd.27092] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/20/2017] [Accepted: 03/25/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Joren Maeremans
- Faculty of Medicine and Life Sciences; Universiteit Hasselt; Hasselt Belgium
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
| | - James C. Spratt
- Department of Cardiology; Forth Valley Royal Hospital; Edinburgh United Kingdom
| | - Paul Knaapen
- Department of Cardiology; VU university medical center; Amsterdam the Netherlands
| | - Simon Walsh
- Department of Cardiology; Belfast City Hospital; Belfast United Kingdom
| | - Pierfrancesco Agostoni
- Department of Cardiology; Universitair Medisch Centrum Utrecht; Utrecht the Netherlands
- Department of Cardiology; St. Antonius Hospital; Nieuwegein the Netherlands
| | - William Wilson
- Department of Cardiology; Royal Melbourne Hospital; Melbourne Australia
| | - Alexandre Avran
- Department of Cardiology; Clinique de Marignane; Marignane Marseille France
| | - Benjamin Faurie
- Department of Cardiology; Groupe Hospitalier Mutualiste; Grenoble France
| | | | - Peter Kayaert
- Department of Cardiology; Universitair Ziekenhuis Brussel; Brussels Belgium
| | - Alan J. Bagnall
- Department of Cardiology; Freeman Hospital; Newcastle upon Tyne United Kingdom
- Institute of Cellular Medicine, Newcastle University; United Kingdom
| | - Dave Smith
- Department of Cardiology; Morriston Hospital; Swansea United Kingdom
| | | | - William H.T. Smith
- Department of Cardiology; Nottingham University Hospital; Nottingham United Kingdom
| | - Paul Kelly
- Department of Cardiology; Essex Cardio-thoracic Centre, Basildon Hospital; Essex United Kingdom
| | - John Irving
- Department of Cardiology; Ninewells Hospital; Dundee United Kingdom
| | - Elliot J. Smith
- Department of Cardiology; Barts Heart Centre, Barts Health NHS Trust; London United Kingdom
| | - Julian W. Strange
- Department of Cardiology; Bristol Heart Institute; Bristol United Kingdom
| | - Jo Dens
- Faculty of Medicine and Life Sciences; Universiteit Hasselt; Hasselt Belgium
- Department of Cardiology; Ziekenhuis Oost-Limburg; Genk Belgium
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Joshi NV, Spratt JC, Wilson S, Walsh SJ, Hanratty CG. A Novel Utility of Facilitated Antegrade Dissection Re-Entry Technique to Recanalize Chronic Total Occlusions. JACC Cardiovasc Interv 2017; 10:e51-e54. [DOI: 10.1016/j.jcin.2016.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/16/2016] [Indexed: 11/24/2022]
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Chang M, Lee CW, Ahn JM, Cavalcante R, Sotomi Y, Onuma Y, Park DW, Kang SJ, Lee SW, Kim YH, Park SW, Serruys PW, Park SJ. Impact of Multivessel Coronary Artery Disease With Versus Without Left Main Coronary Artery Disease on Long-Term Mortality After Coronary Bypass Grafting Versus Drug-Eluting Stent Implantation. Am J Cardiol 2017; 119:225-230. [PMID: 28029362 DOI: 10.1016/j.amjcard.2016.09.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/28/2022]
Abstract
Limited data are available on the impact of concomitant left main coronary artery disease (CAD) on mortality after revascularization of multivessel coronary artery disease (MVD) alone or multivessel plus left main coronary artery disease (MVLMD). This study compared long-term mortality between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents in 2,887 patients with MVD or MVLMD. Data were pooled from the BEST, PRECOMBAT, and SYNTAX trials. The primary outcome was death due to any cause. Of the 2,887 patients, 1,975 (68.4%) were classified as having MVD and 912 (31.6%) as having MVLMD. The median follow-up duration was 60.2 months. In the patients with MVD, primary outcome rate after CABG was significantly lower than after PCI (hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.49 to 0.89; p = 0.007). In the patients with MVLMD, however, CABG and PCI showed similar primary outcome rates (HR 0.98; 95% CI 0.67 to 1.43; p = 0.896). Among those who underwent CABG, primary outcome rate was lower in the patients with MVD than in those with MVLMD (HR 0.66; 95% CI 0.46 to 0.95; p = 0.024). Kaplan-Meier analysis showed a clear separation between the patients with MVD and those with MVLMD 2.5 years after the index surgery. The risk of death due to any cause was significantly lower after CABG than after PCI with drug-eluting stents in patients with MVD but not in those with MVLMD. The advantage of CABG over PCI for multivessel CAD was significantly attenuated if concomitant left main CAD was present.
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Affiliation(s)
- Mineok Chang
- Department of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cheol Whan Lee
- Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Jung-Min Ahn
- Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Rafael Cavalcante
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yohei Sotomi
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Duk-Woo Park
- Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Patrick W Serruys
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands; International Center for Circulatory Health, Imperial College of London, London, United Kingdom
| | - Seung-Jung Park
- Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Toma A, Stähli BE, Gick M, Colmsee H, Gebhard C, Mashayekhi K, Ferenc M, Neumann FJ, Buettner HJ. Long-Term Follow-Up of Patients With Previous Coronary Artery Bypass Grafting Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion. Am J Cardiol 2016; 118:1641-1646. [PMID: 27692593 DOI: 10.1016/j.amjcard.2016.08.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 11/27/2022]
Abstract
Successful revascularization of chronic total occlusions (CTOs) has been associated with clinical benefit. Data on outcomes in patients with previous coronary artery bypass grafting (CABG) undergoing percutaneous coronary intervention (PCI) for CTO, however, are scarce. A total of 2,002 consecutive patients undergoing PCI for CTO from January 2005 to December 2013 were divided into patients with and without previous CABG, and outcomes were retrospectively assessed. The primary outcome measure was all-cause mortality. Median follow-up was 2.6 years (interquartile range 1.1 to 3.1). A total of 292 patients (15%) had previous CABG; they were older and had a greater prevalence of comorbidities. Procedural success was achieved in 75% and 84% of patients in the previous CABG and the non-CABG groups (p <0.001), respectively. All-cause mortality was 16% and 11% in the previous CABG and the non-CABG groups (p = 0.002), and differences were mitigated after adjustment for baseline characteristics (adjusted hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.86 to 1.74, p = 0.27). All-cause death was significantly reduced in patients with procedural success, both in the previous CABG (11% vs 32%, adjusted HR 0.43, 95% CI 0.24 to 0.77, p = 0.005) and the non-CABG groups (10% vs 20%, adjusted HR 0.63, 95% CI 0.45 to 0.86, p = 0.004), with similar mortality benefits associated with successful revascularization in both groups (interaction p = 0.24). In conclusion, the relative survival benefit of successful recanalization of CTO is independent of previous CABG. However, owing to a greater baseline risk, the absolute survival benefit of successful CTO procedures is more pronounced in patients with previous CABG than in non-CABG patients.
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Karatasakis A, Danek BA, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Bahadorani JN, Lombardi WL, Wyman RM, Grantham JA, Kandzari DE, Lembo NJ, Doing AH, Toma C, Moses JW, Kirtane AJ, Parikh MA, Ali ZA, Garcia S, Kalsaria P, Karacsonyi J, Alame AJ, Thompson CA, Banerjee S, Brilakis ES. Comparison of various scores for predicting success of chronic total occlusion percutaneous coronary intervention. Int J Cardiol 2016; 224:50-56. [DOI: 10.1016/j.ijcard.2016.08.317] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
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[Chronic coronary occlusions : When and how should revascularization be performed?]. Herz 2016; 41:585-590. [PMID: 27484494 DOI: 10.1007/s00059-016-4464-y] [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: 10/21/2022]
Abstract
Chronic occlusion of coronary arteries also known as chronic total occlusions (CTO) are found in approximately 20 % of patients undergoing percutaneous coronary interventions (PCI) and in approximately 50 % of patients after coronary artery bypass grafts (CABG). As a result of technical advancements in retrograde recanalization techniques specialized centers can now achieve success rates of over 85 %, regardless of the CTO anatomy. Given the complexity of retrograde CTO techniques, a consensus paper issued by the Euro CTO Club requires interventional cardiologists to have sufficient experience in antegrade approaches (>300 antegrade CTO cases and >50 per year) with an additional training program (25 retrograde cases each as first and second operating surgeon) before becoming a qualified independent retrograde surgeon. The increased investment in time and technical resources can only be justified if the patient has a clear clinical benefit. This technical advancement and the progressively clearer evidence that complete revascularization can be achieved in patients with multivessel coronary artery disease have attracted growing interest in recent years from interventional cardiologists in the recanalization of CTO.
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Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis D, Wyman MR, Alaswad K, Lombardi W, Grantham JA, Moses J, Christakopoulos G, Tarar MNJ, Rangan BV, Lembo N, Garcia S, Cipher D, Thompson CA, Banerjee S, Brilakis ES. Development and Validation of a Novel Scoring System for Predicting Technical Success of Chronic Total Occlusion Percutaneous Coronary Interventions: The PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score. JACC Cardiovasc Interv 2016; 9:1-9. [PMID: 26762904 DOI: 10.1016/j.jcin.2015.09.022] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/10/2015] [Accepted: 09/10/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study sought to develop a novel parsimonious score for predicting technical success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) performed using the hybrid approach. BACKGROUND Predicting technical success of CTO PCI can facilitate clinical decision making and procedural planning. METHODS We analyzed clinical and angiographic parameters from 781 CTO PCIs included in PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) using a derivation and validation cohort (2:1 sampling ratio). Variables with strong association with technical success in multivariable analysis were assigned 1 point, and a 4-point score was developed from summing all points. The PROGRESS CTO score was subsequently compared with the J-CTO (Multicenter Chronic Total Occlusion Registry in Japan) score in the validation cohort. RESULTS Technical success was 92.9%. On multivariable analysis, factors associated with technical success included proximal cap ambiguity (beta coefficient [b] = 0.88), moderate/severe tortuosity (b = 1.18), circumflex artery CTO (b = 0.99), and absence of "interventional" collaterals (b = 0.88). The resulting score demonstrated good calibration and discriminatory capacity in the derivation (Hosmer-Lemeshow chi-square = 2.633; p = 0.268, and receiver-operator characteristic [ROC] area = 0.778) and validation (Hosmer-Lemeshow chi-square = 5.333; p = 0.070, and ROC area = 0.720) subset. In the validation cohort, the PROGRESS CTO and J-CTO scores performed similarly in predicting technical success (ROC area 0.720 vs. 0.746, area under the curve difference = 0.026, 95% confidence interval = -0.093 to 0.144). CONCLUSIONS The PROGRESS CTO score is a novel useful tool for estimating technical success in CTO PCI performed using the hybrid approach.
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Affiliation(s)
- Georgios Christopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Robert W Yeh
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | - Georgios Christakopoulos
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Muhammad Nauman J Tarar
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bavana V Rangan
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Daisha Cipher
- College of Health Innovation, University of Texas at Arlington, Arlington, Texas
| | | | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emmanouil S Brilakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
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Nakahashi T, Sakata K, Nomura A, Yakuta Y, Gamou T, Terai H, Horita Y, Ikeda M, Namura M, Takamura M, Kawashiri MA, Yamagishi M, Hayashi K. Impact of Baseline Angiographic Complexities Determined by Coronary Artery Bypass Grafting SYNTAX Score on the Prediction of Outcome After Percutaneous Coronary Intervention. Am J Cardiol 2016; 118:974-9. [PMID: 27521219 DOI: 10.1016/j.amjcard.2016.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 12/13/2022]
Abstract
Although Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score based on angiographic scoring system was developed in patients with previous coronary artery bypass grafting (CABG), few data exist regarding its prognostic utility in patients undergoing percutaneous coronary intervention (PCI). We examined 272 patients with previous CABG (217 men; mean age, 70.4 ± 9.7 years) undergoing PCI. Severity of the coronary anatomy was evaluated using CABG-SYNTAX score. The primary end point of this study was cardiovascular death. The baseline CABG-SYNTAX score ranged from 2 to 53.5, with an average of 26.0 ± 10.2. In the index procedures, PCI for the native coronary accounted for nearly all patients (88%). During follow-up (median 4.1 years), 40 cardiovascular deaths had occurred. In multivariate analysis, age >75 years (hazard ratio [HR] 2.82, 95% CI 1.45 to 5.52), left ventricular ejection fraction <40% (HR 2.99, 95% CI 1.39 to 6.07), end-stage renal disease (HR 2.90, 95% CI 1.15 to 6.75), peripheral artery disease (HR 2.20, 95% CI 1.10 to 4.64), and CABG-SYNTAX score >25 (HR 2.37, 95% CI 1.19 to 5.05) were independent predictors of cardiovascular death. After creating a composite risk score in consideration of identified predictors, the freedom from cardiovascular death at 5 years was 98%, 86%, and 58% in the low (0 to 1), medium (2), and high (3 to 5) scores, respectively (p <0.001). The area under the receiver-operating characteristic curve for cardiovascular death for the CABG-SYNTAX and composite risk scores were 0.66 and 0.77, respectively (p <0.05). In conclusion, the combination of angiographic and clinical characteristics is useful for risk stratification in patients with previous CABG undergoing PCI.
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Dautov R, Manh Nguyen C, Altisent O, Gibrat C, Rinfret S. Recanalization of Chronic Total Occlusions in Patients With Previous Coronary Bypass Surgery and Consideration of Retrograde Access via Saphenous Vein Grafts. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.115.003515. [DOI: 10.1161/circinterventions.115.003515] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/26/2016] [Indexed: 11/16/2022]
Abstract
Background—
The prevalence of native coronary chronic total occlusions (CTOs) after coronary artery bypass grafts (CABGs) is higher than in non-CABG population. We examined outcomes of CTO percutaneous coronary intervention (PCI) post-CABG versus without CABG. Then, we looked at feasibility and outcomes of retrograde CTO PCI via patent or occluded saphenous vein graft.
Methods and Results—
We compared patient and procedural characteristics of 470 CTO cases treated from January 2010 to December 2015 depending on history of CABG. We assessed major adverse cardiac events, including cardiac death, myocardial infarction, ischemia-driven target-vessel revascularization, or reocclusion 1 year after successful CTO PCI in patients treated before February 2015. Post-CABG patients (175 cases) had a higher J-CTO score (2.5 versus 2.1;
P
=0.002). In-hospital complications were similar, although the incidence of contrast-induced nephropathy was higher in post-CABG patients (4.6% versus 1%;
P
=0.01). With multivariable analysis, post-CABG status was associated with higher incidence of 1-year major adverse cardiac event (hazards ratio=2.2;
P
=0.02). As a second level analysis, we looked at the feasibility and safety of CTO PCI via saphenous vein grafts (19% of post-CABG cases) versus collateral channels (36%) versus with an antegrade-only approach (45%), and assessed short-term outcomes and complications. High success was achieved in the saphenous vein graft group. In-hospital events were similar in the 3 groups.
Conclusions—
Post-CABG CTO PCI is associated with similar high success and low complications compared with CTO PCI in patients who never had CABG. However, it is associated with higher recurrent events at 1 year. To achieve high success rate, use of saphenous vein grafts as retrograde conduits seems to be safe and effective.
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Affiliation(s)
- Rustem Dautov
- From the Quebec Heart and Lung Institute, Laval University, Canada (R.D., C.M.N., O.A.); Quebec Heart and Lung Institute Research Centre, Canada (R.D., C.M.N., O.A., C.G., S.R.); and McGill University Health Centre, McGill University, Montreal, Quebec, Canada (R.D., S.R.)
| | - Can Manh Nguyen
- From the Quebec Heart and Lung Institute, Laval University, Canada (R.D., C.M.N., O.A.); Quebec Heart and Lung Institute Research Centre, Canada (R.D., C.M.N., O.A., C.G., S.R.); and McGill University Health Centre, McGill University, Montreal, Quebec, Canada (R.D., S.R.)
| | - Omar Altisent
- From the Quebec Heart and Lung Institute, Laval University, Canada (R.D., C.M.N., O.A.); Quebec Heart and Lung Institute Research Centre, Canada (R.D., C.M.N., O.A., C.G., S.R.); and McGill University Health Centre, McGill University, Montreal, Quebec, Canada (R.D., S.R.)
| | - Claire Gibrat
- From the Quebec Heart and Lung Institute, Laval University, Canada (R.D., C.M.N., O.A.); Quebec Heart and Lung Institute Research Centre, Canada (R.D., C.M.N., O.A., C.G., S.R.); and McGill University Health Centre, McGill University, Montreal, Quebec, Canada (R.D., S.R.)
| | - Stéphane Rinfret
- From the Quebec Heart and Lung Institute, Laval University, Canada (R.D., C.M.N., O.A.); Quebec Heart and Lung Institute Research Centre, Canada (R.D., C.M.N., O.A., C.G., S.R.); and McGill University Health Centre, McGill University, Montreal, Quebec, Canada (R.D., S.R.)
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Sakakura K, Yahagi K, Virmani R, Joner M. Pathology of Coronary Chronic Total Occlusion. Int Cardiovasc Res J 2016. [DOI: 10.17795/icrj-10(2)55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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45
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Lin MM, Wang JH. Successful Revascularization of an LCx CTO Lesion by Retrograde Approach From an Acute Thrombotic SVG Without Protection Device in an ACS Patient. Int Heart J 2016; 57:372-5. [PMID: 27170471 DOI: 10.1536/ihj.15-328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe a patient who underwent coronary artery bypass grafting (CABG) surgery with the presentation of acute coronary syndrome (ACS). The diagnostic coronary angiogram showed acute thrombotic and occluded saphenous vein graft (SVG) and proximal right coronary artery (RCA) drug eluting stent (DES) instent restenosis (ISR) with chronic total occlusion (CTO). Our strategy was to recanalize the native left circumflex coronary artery (LCx) CTO instead of SVG or RCA instent CTO. After heparinization for 5 days, the LCx antegrade approach and the retrograde approach from left anterior descending coronary artery (LAD) septal branches were first attempted but failed, and the LCx CTO was successfully revascularized retrogradely via the acute thrombotic SVG without an embolic protection device (EPD).
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Affiliation(s)
- Mei Mei Lin
- Department of Cardiology, Buddhist Tzu Chi General Hospital
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46
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Wilson WM, Walsh SJ, Yan AT, Hanratty CG, Bagnall AJ, Egred M, Smith E, Oldroyd KG, McEntegart M, Irving J, Strange J, Douglas H, Spratt JC. Hybrid approach improves success of chronic total occlusion angioplasty. Heart 2016; 102:1486-93. [DOI: 10.1136/heartjnl-2015-308891] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/16/2016] [Indexed: 11/04/2022] Open
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47
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Danek BA, Karatasakis A, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel MP, Bahadorani J, Lombardi WL, Wyman RM, Grantham JA, Kandzari DE, Lembo NJ, Doing AH, Toma C, Moses JW, Kirtane AJ, Ali ZA, Parikh M, Garcia S, Nguyen-Trong PK, Karacsonyi J, Alame AJ, Kalsaria P, Thompson C, Banerjee S, Brilakis ES. Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry. Can J Cardiol 2016; 32:1433-1439. [PMID: 27476986 DOI: 10.1016/j.cjca.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/12/2016] [Accepted: 04/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres. RESULTS Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs 89.6% vs 93.0%; P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; P = 0.31) for older vs younger occlusions. CONCLUSIONS Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success.
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Affiliation(s)
- Barbara A Danek
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aris Karatasakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mitul P Patel
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California, USA
| | - John Bahadorani
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California, USA
| | | | | | | | | | | | | | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Ziad A Ali
- Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Santiago Garcia
- Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota, USA
| | - Phuong-Khanh Nguyen-Trong
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Judit Karacsonyi
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aya J Alame
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pratik Kalsaria
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emmanouil S Brilakis
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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48
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Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients With Prior Coronary Artery Bypass Graft Surgery: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. JACC Cardiovasc Interv 2016; 9:884-93. [PMID: 27085582 DOI: 10.1016/j.jcin.2016.01.034] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/14/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to examine the frequency, associations, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) in the Veterans Affairs (VA) integrated health care system. BACKGROUND Patients with prior CABG surgery often undergo PCI, but the association between PCI target vessel and short- and long-term outcomes has received limited study. METHODS A national cohort of 11,118 veterans with prior CABG who underwent PCI between October 2005 and September 2013 at 67 VA hospitals was examined, and the outcomes of patients who underwent native coronary versus bypass graft PCI were compared. Logistic regression with generalized estimating equations was used to adjust for correlation between patients within hospitals. Cox regressions were modeled for each outcome to determine the variables with significant hazard ratios (HRs). RESULTS During the study period, patients with prior CABG represented 18.5% of all patients undergoing PCI (11,118 of 60,171). The PCI target vessel was a native coronary artery in 73.4% and a bypass graft in 26.6%: 25.0% in a saphenous vein graft and 1.5% in an arterial graft. Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher risk characteristics and more procedure-related complications. During a median follow-up period of 3.11 years, bypass graft PCI was associated with significantly higher mortality (adjusted HR: 1.30; 95% confidence interval: 1.18 to 1.42), myocardial infarction (adjusted HR: 1.61; 95% confidence interval: 1.43 to 1.82), and repeat revascularization (adjusted HR: 1.60; 95% confidence interval: 1.50 to 1.71). CONCLUSIONS In a national cohort of veterans, almost three-quarters of PCIs performed in patients with prior CABG involved native coronary artery lesions. Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of short- and long-term major adverse events, including more than double the rate of in-hospital mortality.
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49
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Brilakis ES, Karmpaliotis D, Vo MN, Carlino M, Galassi AR, Boukhris M, Alaswad K, Bryniarski L, Lombardi WL, Banerjee S. Update on Coronary Chronic Total Occlusion Percutaneous Coronary Intervention. Interv Cardiol Clin 2016; 5:177-186. [PMID: 28582202 DOI: 10.1016/j.iccl.2015.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly evolved during recent years. High success rates are being achieved by experienced centers and operators, but not at less-experienced centers. Use of CTO crossing algorithms can help improve the success and efficiency of these potentially lengthy procedures. There is a paucity of clinical trial data examining clinical outcomes of CTO PCI, which is critical for further adoption and refinement of the procedure. We provide a detailed overview of the clinical evidence and current available crossing strategies, with emphasis on recent developments and techniques.
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Affiliation(s)
- Emmanouil S Brilakis
- Department of Cardiovascular Diseases, VA North Texas Healthcare System, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
| | - Dimitri Karmpaliotis
- Department of Cardiovascular Diseases, NYP Columbia University, New York, NY, USA
| | - Minh N Vo
- St Boniface Hospital Cardiac Science Program, University of Manitoba, Winnipeg, Canada
| | - Mauro Carlino
- Department of Cardiovascular Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Alfredo R Galassi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Department of Cardiovascular Diseases, University of Zurich, Zurich, Switzerland
| | - Marouane Boukhris
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Khaldoon Alaswad
- Department of Cardiovascular Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Leszek Bryniarski
- Department of Cardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | | | - Subhash Banerjee
- Department of Cardiovascular Diseases, VA North Texas Healthcare System, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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50
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Sianos G, Konstantinidis NV, Di Mario C, Karvounis H. Theory and practical based approach to chronic total occlusions. BMC Cardiovasc Disord 2016; 16:33. [PMID: 26860695 PMCID: PMC4746803 DOI: 10.1186/s12872-016-0209-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 12/21/2022] Open
Abstract
Coronary chronic total occlusions (CTOs) represent the most technically challenging lesion subset that interventional cardiologists face. CTOs are identified in up to one third of patients referred for coronary angiography and remain seriously undertreated with percutaneous techniques. The complexity of these procedures and the suboptimal success rates over a long period of time, along with the perception that CTOs are lesions with limited scope for recanalization, account for the underutilization of CTO Percutaneous Coronary Intervention (PCI). During the last years, dedicated groups of experts in Japan, Europe and United States fostered the development and standardization of modern CTO recanalization techniques, achieving success rates far beyond 90%, while coping with lesions of increasing complexity. Numerous studies support the rationale of CTO revascularization following documentation of viability and ischemia in the territory distal to the CTO. Successful CTO PCI provide better tolerance in case of future acute coronary syndromes and can significantly improve angina and left ventricular function. Randomized trials are on the way to further explore the prognostic benefit of CTO revascularization. The following review reports on the theory and the most recent advances in the field of CTO recanalization, in an attempt to promote a more balanced approach in patients with chronically occluded coronary arteries.
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Affiliation(s)
- Georgios Sianos
- 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, 54636, Thessaloniki, Greece.
| | - Nikolaos V Konstantinidis
- 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, 54636, Thessaloniki, Greece.
| | - Carlo Di Mario
- National Institute for Health Research (NIHR) Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
| | - Haralambos Karvounis
- 1st Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, 54636, Thessaloniki, Greece.
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