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Shamkhani W, Rashid M, Mamas M. Complex, high-risk percutaneous coronary intervention types, trends, and in-hospital outcomes among different age groups: An insight from a national registry. Catheter Cardiovasc Interv 2022; 100:711-720. [PMID: 36054239 PMCID: PMC9826050 DOI: 10.1002/ccd.30366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Complex, high-risk percutaneous coronary intervention (PCI) (CHiP) is increasingly being undertaken in octogenarians. However, limited data exist on CHiP types, trends, and outcomes in the octogenarian. METHODS This is a retrospective cohort study from a national registry dataset on CHiP undertaken in patients with stable angina in England and Wales (January 2006 and December 2017) according to three age groups (group 1 [G1]: < 65 years; group 2 [G2]: 65-79 years; and group 3 [G3]: ≥80 years). RESULTS Of 424,290 elective PCI procedures, 138,831 (33.0%) were CHiP [G1: 46,832 (33.7%); G2: 59,544 (42.9%); G3: 32,455 (23.4%)]. Among CHiP types, chronic total occlusion (CTO) (49.2%), prior coronary artery bypass graft (CABG) (30.4%), and severe vascular calcification (21.8%) were common in G1; prior CABG (42.9%), CTO (32.9%), and severe vascular calcifications (27%) were common in G2; prior CABG (15.8%), severe vascular calcification (15.5%), and chronic renal failure (11.1%) were common CHiP among the octogenarians. The older age groups had higher adjusted odds (aOR) for adverse outcomes [G2: mortality, aOR 1.7, 95% confidence interval (CI): (1.3-2.3); major bleeding, aOR 1.3, 95% CI (1.1-1.5); MACCE, aOR 1.2, 95% CI (1.0-1.3); G3: mortality, aOR 2.6, 95%CI (1.9-3.6); major bleeding, aOR 1.4, 95% CI (1.1-1.7); MACCE, aOR 1.3, 95% CI (1.1-1.5)]. CONCLUSION There were significant differences in the types of CHiP cases undertaken and clinical outcomes across age groups.
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Affiliation(s)
- Warkaa Shamkhani
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health SciencesKeele UniversityStoke‐on‐TrentUK,Royal Stoke University HospitalStoke‐on‐TrentUK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health SciencesKeele UniversityStoke‐on‐TrentUK,Royal Stoke University HospitalStoke‐on‐TrentUK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health SciencesKeele UniversityStoke‐on‐TrentUK,Royal Stoke University HospitalStoke‐on‐TrentUK
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Guo L, Lv HC, Huang RC. Percutaneous Coronary Intervention in Elderly Patients with Coronary Chronic Total Occlusions: Current Evidence and Future Perspectives. Clin Interv Aging 2020; 15:771-781. [PMID: 32546995 PMCID: PMC7264026 DOI: 10.2147/cia.s252318] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022] Open
Abstract
The proportion of the elderly in the total population of the world is growing, and the number of elderly patients with coronary chronic total occlusions (CTO) is huge. The elderly patients often have more extensive coronary artery disease, more severe ischemic burden and higher risk of cardiovascular events, as compared to younger patients, and thereby they might greatly benefit from coronary revascularization, even though they may have higher risk of operative complications. Most interventional cardiologists are more likely to be reluctant to operate complex percutaneous coronary intervention (PCI) in elderly patients. The latest refinements in dedicated CTO-PCI equipment and techniques have led to high rates of success and low complications rates and have made the CTO-PCI procedures safe and effective among the elderly patients. However, up to now, there is no widely recognized consensus or guideline on treatment strategy of elderly CTO patients, and the prognosis in this population is unknown. In this review, we aim to provide an overview of the current evidence and future perspectives on PCI in elderly patients with CTOs.
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Affiliation(s)
- Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Hai-Chen Lv
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Rong-Chong Huang
- Department of Cardiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People’s Republic of China
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Guo L, Lv H, Zhong L, Wu J, Ding H, Xu J, Huang R. Comparison of long-term outcomes of medical therapy and successful recanalisation for coronary chronic total occlusions in elderly patients: a report of 1,294 patients. Cardiovasc Diagn Ther 2019; 9:586-595. [PMID: 32038948 DOI: 10.21037/cdt.2019.11.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Little is known about the long-term outcomes of medical therapy (MT) versus successful percutaneous coronary intervention (PCI) in elderly patients with coronary chronic total occlusions (CTOs). Methods There were 1,294 consecutive patients with 1,520 CTOs included (2007 to 2016) and were divided into the younger group (age <65 years; n=664, 51.3%) and the older group (age ≥65 years; n=630, 48.7%). In the older group, 630 patients were divided into MT group (n=421) and successful CTO-PCI group (n=209) according to the initial treatment strategy. In the younger group, they were divided into two groups: 379 patients in the MT group and 285 patients in the successful CTO-PCI group. We performed propensity score matching to minimize any selection bias. The primary end point was cardiac mortality. The secondary end point was major adverse cardiac event (MACE). Results After 3.6 (IQR, 2.1-5.0) years follow-up, no significant difference was observed between the MT and successful CTO-PCI groups in terms of cardiac mortality (MT vs. successful CTO-PCI: 9.3% vs. 5.0%, P=0.378) and MACE (28.3% vs. 15.1%, P=0.070) in the older group. After propensity score matching analysis (120 pairs), the risk of cardiac mortality (6.7% vs. 8.3%, P=0.624) was found to be comparable between the two groups. In the younger group, the occurrence of cardiac death (MT vs. successful CTO-PCI: 3.7% vs. 1.4%, P=0.072) was similar, whereas the MACE rate (27.7% vs. 17.9%, P=0.003) was significantly higher in MT group. After multivariate analysis, previous myocardial infarction (MI) [hazard ratio (HR) 1.70, 95% confidence interval (CI): 1.16-2.49, P=0.006], CTO in right coronary artery (HR 1.55, 95% CI: 1.07-2.25, P=0.020), multivessel disease (HR 2.02, 95% CI: 1.10-3.72, P=0.024) and calcification (HR 1.61, 95% CI: 1.07-2.42, P=0.023) were independent predictors of MACE in elderly. Conclusions In the treatment of elderly patients with CTOs, successful CTO-PCI compared with MT alone didn't reduce the risk of cardiac death or MACE.
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Affiliation(s)
- Lei Guo
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Haichen Lv
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Lei Zhong
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Jian Wu
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Huaiyu Ding
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Jiaying Xu
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
| | - Rongchong Huang
- Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116044, China
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Iannaccone G, Scarparo P, Wilschut J, Daemen J, Den Dekker W, De Jaegere P, Zijlstra F, Van Mieghem NM, Diletti R. Current approaches for treatment of coronary chronic occlusions. Expert Rev Med Devices 2019; 16:941-954. [PMID: 31594416 DOI: 10.1080/17434440.2019.1676729] [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: 10/25/2022]
Abstract
Introduction: Coronary chronic total occlusions (CTO) represent a challenging subset in interventional cardiology.Areas covered: During the last decade, improvements in materials, techniques, and meticulous pre-procedural lesion assessment have increased the success rate in CTO lesions. Several scores have been developed to address overall lesion evaluation and help select the most appropriate treatment strategy. In addition, specific algorithms such as the hybrid algorithm have been introduced to provide a framework for CTO operators and a rapid management of the various challenging aspects of the procedure. The hybrid approach requires operator's ability to switch from one treatment strategy to another when the first one appears to be unsuccessful. Adequate training and operators' experience remain crucial to improve the likelihood of success.Expert opinion: The aim of this review is to provide insights and guidance for operators on current approaches for treatment of CTO and complication management.
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Affiliation(s)
- Giulia Iannaccone
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paola Scarparo
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Peter De Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Flores‐Umanzor EJ, Vázquez S, Cepas‐Guillen P, Ivey‐Miranda J, Caldentey G, Jimenez‐Britez G, Regueiro A, Freixa X, Andrea R, Ferreira‐González I, Sabaté M, Martin‐Yuste V. Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients. Catheter Cardiovasc Interv 2019; 94:527-535. [DOI: 10.1002/ccd.28163] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/09/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - Sara Vázquez
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Pedro Cepas‐Guillen
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Juan Ivey‐Miranda
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Guillem Caldentey
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Gustavo Jimenez‐Britez
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Ander Regueiro
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Xavier Freixa
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Rut Andrea
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Ignacio Ferreira‐González
- Cardiology DepartmentVall d'hebron Hospital, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Manel Sabaté
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Victoria Martin‐Yuste
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
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Duration of dual antiplatelet therapy in patients treated with percutaneous coronary intervention for coronary chronic total occlusion. PLoS One 2017; 12:e0176737. [PMID: 28475584 PMCID: PMC5419557 DOI: 10.1371/journal.pone.0176737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/14/2017] [Indexed: 11/19/2022] Open
Abstract
Background The duration of dual antiplatelet therapy (DAPT) after drug-eluting stent implantation in coronary chronic total occlusion (CTO) remains unclear. Methods We retrospectively analyzed a total of 512 patients treated with percutaneous coronary intervention (PCI) in the Samsung Medical Center CTO registry. Patients were separated into ≤ 12-month (199, 38.9%) vs. > 12 month (313, 61.1%) based on DAPT duration with aspirin and clopidogrel. The primary outcome was major adverse cardiac and cerebrovascular event (MACCE) during follow-up. Results Median follow-up duration was 67 (interquartile range: 51–84) months. MACCE occurred in 43 patients (21.6%) in the ≤ 12-month and 55 patients (17.6%) in the > 12-month groups. In the propensity-matched population, the rate of MACCE did not differ significantly between the ≤ 12-month and > 12-month group (19.4% vs. 18.8%; hazard ratio [HR], 0.95; 95% confidential interval [CI], 0.52–1.76, p = 0.88). Moreover, moderate or severe bleeding according to BARC criteria (type 2, 3 or 5) was also similar between the ≤ 12-month and > 12-month group (2.5% vs. 1.9%; HR, 1.00; 95% CI, 0.20–4.96, p = 0.99). Conclusion Among patients treated with PCI for CTO, DAPT with durations of ≤ 12-month showed similar long-term clinical outcomes compared to > 12-month DAPT.
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Clinical impact of complete revascularization in elderly patients with multi-vessel coronary artery disease undergoing percutaneous coronary intervention: A sub-analysis of the SHINANO registry. Int J Cardiol 2017; 230:413-419. [DOI: 10.1016/j.ijcard.2016.12.093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/09/2016] [Accepted: 12/16/2016] [Indexed: 12/20/2022]
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Kai H, Kimura T, Fukuda K, Fukumoto Y, Kakuma T, Furukawa Y. Impact of Low Diastolic Blood Pressure on Risk of Cardiovascular Death in Elderly Patients With Coronary Artery Disease After Revascularization – The CREDO-Kyoto Registry Cohort-1 –. Circ J 2016; 80:1232-41. [DOI: 10.1253/circj.cj-15-1151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hisashi Kai
- Department of Cardiology, Kurume University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kenji Fukuda
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine
- Department of Cerebrovascular Medicine, St. Mary’s Hospital
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine
| | | | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital
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Yang JH, Kim BS, Jang WJ, Ahn J, Park TK, Song YB, Hahn JY, Choi JH, Lee SH, Gwon HC, Choi SH. Optimal Medical Therapy vs. Percutaneous Coronary Intervention for Patients With Coronary Chronic Total Occlusion – A Propensity-Matched Analysis –. Circ J 2016; 80:211-7. [DOI: 10.1253/circj.cj-15-0673] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Bum Sung Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center
| | - Woo Jin Jang
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | - Joonghyun Ahn
- Samsung Biomedical Research Institute, Samsung Medical Center
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Sang Hoon Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
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