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Cilia L, Megaly M, Davies R, Tehrani BN, Batchelor WB, Truesdell AG. A non-interventional cardiologist's guide to coronary chronic total occlusions. Front Cardiovasc Med 2024; 11:1350549. [PMID: 38380179 PMCID: PMC10876789 DOI: 10.3389/fcvm.2024.1350549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Coronary chronic total occlusions (CTO) are present in up to one-third of patients with coronary artery disease (CAD). It is thus essential for all clinical cardiologists to possess a basic awareness and understanding of CTOs, including optimal evaluation and management. While percutaneous coronary intervention (PCI) for CTO lesions has many similarities to non-CTO PCI, there are important considerations pertaining to pre-procedural evaluation, interventional techniques, procedural complications, and post-procedure management and follow-up unique to patients undergoing this highly specialized intervention. Distinct from other existing topical reviews, the current manuscript focuses on key knowledge relevant to non-interventional cardiologists.
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Affiliation(s)
- Lindsey Cilia
- Virginia Heart, Falls Church, VA, United States
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Michael Megaly
- Willis Knighton Medical Center, Shreveport, LA, United States
| | | | - Behnam N. Tehrani
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Wayne B. Batchelor
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Alexander G. Truesdell
- Virginia Heart, Falls Church, VA, United States
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
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Tsoulou V, Vasilopoulos G, Kapadochos T, Pavlatou N, Kalogianni A, Toulia G, Dousis E, Panoutsopoulos G, Kourakos M, Polikandrioti M. Quality of Life in Patients Undergoing Percutaneous Coronary Intervention. Clin Pract 2023; 13:621-637. [PMID: 37218808 DOI: 10.3390/clinpract13030057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) is a non-surgical invasive procedure to treat coronary artery occlusion. The quality of life (QoL) is a way to measure the impact of illness and additionally its treatments to traditional measures of clinical outcomes. PURPOSE The aim of the present study was to explore the levels of QoL pre-PCI, 6 and 12 months after PCI, as well as the factors associated with the QoL pre-PCI. METHODS In the present study, 100 patients undergoing PCI were enrolled. Data were collected through the completion of the SF-36 Health Survey (SF-36), which included participants' characteristics. The statistical significance level was p < 0.05. RESULTS Patients had moderate levels of QoL at baseline, with a median general health score of 45 (IQR: 30-65). A gradual statistically significant increase in scores was observed in all subcategories of the patients' QoL at 6 and 12 months after PCI (p < 0.001). A greater increase in scores was observed in physical functioning, physical role, emotional role and social functionality. In terms of the pre-PCI phase, it was found that physical functionality was statistically significantly associated with educational level (p = 0.005), occupation (p = 0.026) and whether the patients had children (p = 0.041). The physical and emotional role was significantly associated with gender (p = 0.046 and p = 0.040) and educational level (p = 0.030 and p = 0.001). Energy-fatigue was significantly associated with gender (p = 0.001), age (p = 0.028), marital status (p = 0.001), educational level (p = 0.001), whether the patients had children (p= 0.012) and other diseases (p = 0.001). Emotional well-being was significantly associated with family history of coronary artery disease (p = 0.011) and the frequency of physical exercise (p = 0.001). Social functioning was significantly associated with gender (p = 0.033), marital status (p = 0.034) and educational level (p = 0.002). Pain was not found to be significantly associated with patients' demographics. General health was significantly associated with gender (p = 0.003), age (p = 0.043), educational level (p = 0.001), other diseases (p = 0.005) and the frequency of physical exercise (p = 0.001). CONCLUSION Information about the QoL of PCI and its determinants is important to define an effective and comprehensive care plan.
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Affiliation(s)
- Vasiliki Tsoulou
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | | | | | - Niki Pavlatou
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | | | - Georgia Toulia
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | - Evangellos Dousis
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | - George Panoutsopoulos
- Department of Nutritional Science and Dietetics, University of Peloponnese, 24100 Kalamata, Greece
| | - Michael Kourakos
- Department of Nursing, University of Ioannina, 45110 Ioannina, Greece
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Kim D, Seo J, Ha KH, Kim DJ. Maintaining Physical Activity Is Associated with Reduced Major Adverse Cardiovascular Events in People Newly Diagnosed with Diabetes. J Obes Metab Syndr 2022; 31:187-195. [PMID: 35618658 PMCID: PMC9284577 DOI: 10.7570/jomes22007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/26/2022] [Accepted: 04/13/2022] [Indexed: 11/02/2022] Open
Abstract
Background We investigated the association between changes in physical activity and the risk of a major adverse cardiovascular event (MACE) in people with newly diagnosed diabetes. Methods Using a nationwide database, we identified 8,596 people with newly diagnosed diabetes who underwent national health examinations within a year before and after a diabetes diagnosis. Cox proportional hazards models, hazard ratios (HRs) and 95% confidence intervals (CIs) for MACE risks were calculated according to changes in physical activity before and after a diagnosis of diabetes. Results During a median follow-up of 2.3 years, study participants who engaged in sustained physical activity after a diagnosis of diabetes had a 34% lower MACE risk compared to those with sustained inactivity (HR, 0.66; 95% CI, 0.44-0.98). An advantage was observed in those with a history of cardiovascular disease, although this was of borderline statistical significance (HR, 0.63; 95% CI, 0.40-1.01; P=0.054). In people considered obese, physical activity was significantly associated with a decreased risk of a MACE, regardless of the period preceding and following the diabetes diagnosis. Those who became inactive to active had the lowest risk of a MACE (HR, 0.38; 95% CI, 0.18-0.79). Conclusion Maintaining active physical activity before and after a diagnosis of diabetes is essential to preventing cardiovascular disease. Early intervention strategies are necessary to promote physical activity and exercise routines after a diagnosis of diabetes in people with obesity and those with pre-existing cardiovascular disease.
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Affiliation(s)
- Duhoe Kim
- Ajou University Hospital, Suwon, Korea
| | | | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
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Impact of Chronic Kidney Disease on Chronic Total Occlusion Revascularization Outcomes: A Meta-Analysis. J Clin Med 2021; 10:jcm10030440. [PMID: 33498733 PMCID: PMC7865303 DOI: 10.3390/jcm10030440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: To examine the impact of revascularization and associated clinical outcomes of chronic kidney disease (CKD) chronic total occlusion (CTO) and non-CKD CTO groups. Background: The influence of CKD on clinical outcomes after percutaneous coronary intervention (PCI) for CTO lesions is unknown, and there is no systemic review of this topic to date. Methods: We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials Databases for articles published between 1 January 2010 and 31 March 2020. CKD was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease formula. Data included demographics, lesion distributions, incidence of contrast-induced nephropathy (CIN), acute kidney injury (AKI), procedural success rate, mortality, and target lesion revascularization (TLR)/target vessel revascularization (TVR). Results: Six studies were ultimately included in this systematic review. A high prevalence (25.5%; range, 19.6–37.9%) of CKD was noted in the CTO population. In the non-CKD group, outcomes were better: less incidence of CIN or AKI (odds ratio (OR), 2.860; 95% confidence interval (CI), 1.775–4.608), higher procedural success rate (OR, 1.382; 95% CI, 1.036–1.843), and lower long-term mortality (OR, 4.502; 95% CI, 3.561–5.693). The incidence of TLR/TVR (OR, 1.118; 95% CI, 0.888–1.407) did not differ between groups. Conclusions: In the CKD CTO PCI population, a lower procedural success rate, a higher incidence of CIN or AKI, and higher in-hospital and long-term mortality rate were noted due to more complex lesions and more comorbidities. However, the incidence of TLR/TVR did not differ between groups.
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Abuzeid W, Zivkovic N, Elbaz-Greener G, Yaranton B, Patel V, Strauss B, Wijeysundera HC. Association Between Revascularization and Quality of Life in Patients With Coronary Chronic Total Occlusions: A Systematic Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 25:47-54. [PMID: 33132085 DOI: 10.1016/j.carrev.2020.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/20/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Percutaneous revascularization of coronary chronic total occlusions (CTO) has increased due to advances in technology and operator expertise. Quality of life (QoL) remains an important but understudied outcome following CTO revascularization. Our aim is to conduct a systematic review of the impact of CTO revascularization on QoL. METHODS We searched three databases (Ovid MEDLINE, EMBASE, EBM reviews) from January 1st, 1990 to May 17th, 2020. Studies reporting on the following QoL metrics post CTO revascularization were included: QoL subscale of the Seattle Angina Questionnaire (SAQ-QoL). The ROBINS-I tool and Cochrane risk of bias tool were used to critically assess for risk of bias. RESULTS We identified 1476 articles, of which 21 articles met inclusion criteria. Three categories of studies were identified with distinct patient populations. In the first category (1 study), CTO patients treated with either PCI or CABG compared to medical therapy had a significant improvement in SAQ-QoL compared to baseline (PCI 54.2 to 74.3; CABG 56.1 to 78.0; p < 0.05). In the second category (1 study), CTO patients compared to non-CTO patients had similar improvements in SAQ-QoL post PCI (CTO baseline 53.2 to 80.3; non-CTO baseline 56.5 to 80.6; p < 0.05). Finally, a third category with only CTO patients treated with PCI to the CTO vessel included 19 studies, all of which on average showed a significant improvement in SAQ-QoL post successful PCI, compared to non-successful PCI. CONCLUSION Despite the limited literature, revascularization of CTO vessel was generally associated with improvement in QoL. BRIEF SUMMARY Quality of life (QoL) is an important but understudied outcome following CTO revascularization. We conducted a systematic review of the impact of CTO revascularization on QoL. Despite the limitations of a lack of enough randomized control trials and the small number of studies, our systematic review highlights a trend of improvement in QoL indices after revascularization of CTO.
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Affiliation(s)
- Wael Abuzeid
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Division of Cardiology, Kingston Health Sciences Center, Queen's University, Ontario, Canada.
| | - Nevena Zivkovic
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Gabby Elbaz-Greener
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Brynne Yaranton
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Vaidehi Patel
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Bradley Strauss
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
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Peri-Okonny PA, Spertus JA, Grantham JA, Gosch K, Kirtane A, Sapontis J, Lombardi W, Karmpaliotis D, Moses J, Nicholson W, Salisbury AC. Physical Activity After Percutaneous Coronary Intervention for Chronic Total Occlusion and Its Association With Health Status. J Am Heart Assoc 2020; 8:e011629. [PMID: 30922149 PMCID: PMC6509725 DOI: 10.1161/jaha.118.011629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Patients with chronic total occlusion (CTO) may not participate in regular exercise because of refractory angina. Exercise participation after percutaneous coronary intervention (PCI) for CTO (CTO PCI) and the association of exercise with health status after CTO PCI is unknown. Methods and Results Overall, 1000 patients enrolled in the Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion OPEN CTO is a registry were asked about participation in regular exercise at baseline and 12 months after CTO PCI, and the frequency of exercise (<1, 1–2, ≥3 times/week) was collected among exercisers. Health status was assessed using the Seattle Angina Questionnaire (SAQ). Multivariable regression assessed 12‐month health status change across 4 groups defined by exercise frequency at baseline and 12 months after CTO PCI (no regular exercise at baseline and 12 months, reduced, increased, and consistent exercise at 12 months). Among 869 patients with complete exercise data, the proportion that exercised regularly increased from 33.5% at baseline to 56.6% 12 months after CTO PCI (P<0.01). Predictors of regular exercise at 12 months included baseline exercise, smoking, baseline and increase in SAQ scores for angina frequency, physical limitation, quality of life, and summary. After multivariable adjustment, consistent or increased exercise frequency was associated with significantly greater improvement in SAQ scores for angina frequency, physical limitation, quality of life, and summary (P<0.01). Conclusions Participation in regular exercise increased significantly 12 months after CTO PCI, and patients who had greater health status benefit after PCI were more likely to exercise regularly at 12 months. CTO PCI may enable coronary artery disease patients with limiting symptoms to engage in regular exercise and to support better long‐term outcomes.
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Affiliation(s)
| | - John A Spertus
- 1 Saint Luke's Mid America Heart Institute Kansas City MO.,2 University of Missouri-Kansas City Kansas City MO
| | - J Aaron Grantham
- 1 Saint Luke's Mid America Heart Institute Kansas City MO.,2 University of Missouri-Kansas City Kansas City MO
| | - Kensey Gosch
- 1 Saint Luke's Mid America Heart Institute Kansas City MO
| | | | | | | | | | | | | | - Adam C Salisbury
- 1 Saint Luke's Mid America Heart Institute Kansas City MO.,2 University of Missouri-Kansas City Kansas City MO
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Hirai T, Jacob D, Main ML, Grantham JA. A case of robotic assisted percutaneous coronary intervention of the left main coronary artery in a patient with very late baffle stenosis after surgical correction of anomalous left coronary artery from the pulmonary artery. Catheter Cardiovasc Interv 2020; 95:920-923. [PMID: 31250510 DOI: 10.1002/ccd.28382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 11/09/2022]
Abstract
A 34-year-old woman with history of surgical correction (Takeuchi procedure) of anomalous left coronary artery from the pulmonary artery (ALCAPA) presented with reduced left ventricular ejection fraction of 48% and severe ischemia quantified as 21% by stress Positron Emission Tomography (PET) scan. A coronary angiogram revealed ostial 90% stenosis of the left main coronary artery (LMCA). A guidewire (Sion Blue, Asahi Intecc USA, Inc., Santa Ana, CA) was navigated robotically and after pre-dilation with 3.5 × 15 mm cutting balloon, the lesion length was measured by marking the distal end of the lesion with the balloon marker and withdrawing back robotically to the ostium of the LMCA. A 3.5 × 16 mm drug-eluting stent was deployed robotically after intravascular ultrasound (IVUS) with good results. The main advantage of robotic percutaneous coronary intervention includes the precise measurement and positioning of the stent. Since the guide catheter and balloon can be adjusted without guide catheter and device interaction, precise placement of stent is possible by advancing the device distal to the lesion, positioning the guide catheter just proximal to the proximal edge of the stent and pulling the guidecatheter and device back as a unit. Final IVUS after post-dilation with 4.0 noncompliant and 5.0 compliant balloon revealed precise placement at the ostium and full stent expansion.
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Affiliation(s)
- Taishi Hirai
- Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,Department of Medicine, Division of Cardiology, University of Missouri Kansas City, Kansas City, Missouri
| | - Dany Jacob
- Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,Department of Medicine, Division of Cardiology, University of Missouri Kansas City, Kansas City, Missouri
| | - Michael L Main
- Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,Department of Medicine, Division of Cardiology, University of Missouri Kansas City, Kansas City, Missouri
| | - J Aaron Grantham
- Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,Department of Medicine, Division of Cardiology, University of Missouri Kansas City, Kansas City, Missouri
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