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Zhao S, Chen Y, Wang Q, Zhu B, Wei Z, Wang Z, Wang J, Zou Y, Hu W, Liu C, Yu T, Han P, Yang L, Wang H, Xia C, Liu Q, Wang W, Gao H, Li C, Lian K. Benefits of successful percutaneous coronary intervention in chronic total occlusion patients with diabetes. Cardiovasc Diabetol 2022; 21:271. [PMID: 36471410 PMCID: PMC9724402 DOI: 10.1186/s12933-022-01708-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetes was commonly seen in chronic total occlusion (CTO) patients but data regarding the impact of successful percutaneous coronary intervention (PCI) on clinical outcome of CTO patients with diabetes was controversial. And importantly, no studies have compared quality of life (QOL) after CTO-PCI in patients with and without diabetes. METHODS Consecutive patients undergoing elective CTO-PCI were prospectively enrolled from Apr. 2018 to May 2021. Patients were subdivided into 2 groups: Diabetes and No Diabetes. Detailed baseline characteristics, assessment of symptoms and QOL, angiographic and procedural details, in-hospital complications, and 1 month and 1 year follow-up data were collected. These data were analyzed accordingly for risk predictors of clinical outcome in patients who have diabetes and received successful CTO-PCI. RESULTS A total of 1076 patients underwent CTO-PCI attempts. Diabetes was present in 374 (34.76%) patients, who had more hypertension, previous PCI and stroke. Regarding the coronary lesions, diabetic patients suffered more LCX lesion, multivessel disease, number of lesions per patient, blunt stump, calcification and higher J-CTO score (p < 0.05). In-hospital major adverse cardiac event (MACE) (4.13% vs. 5.35%; p = 0.362) was similar in the two groups. At 1 month and 1 year follow-up after successful CTO-PCI, the incidence of MACE and all-cause mortality were also similar in the two groups (p > 0.05). Number of lesions per patient was an independent risk factor of MACE and all-cause mortality (p < 0.001) 1 year after successful CTO-PCI. Symptom and QOL were markedly improved regardless of diabetes both at 1 month and 1 year follow-up, and importantly, patients with diabetes showed similar degrees of improvement to those without diabetes (P > 0.05). CONCLUSIONS Successful CTO-PCI could represent an effective strategy improving clinical outcome, symptoms and QOL in CTO patients with diabetes.
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Affiliation(s)
- Shuai Zhao
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Yan Chen
- Department of Cardiology, No.971 Hospital of the PLA Navy, Qingdao, 266071 Shandong People’s Republic of China
| | - Qingyi Wang
- grid.233520.50000 0004 1761 4404Department of Foreign Languages, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Boda Zhu
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China ,Primary Flight Training Base, Air Force Aviation University, Harbin, 150100 Hei Longjiang People’s Republic of China
| | - Zhihong Wei
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Ziwei Wang
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Jiayi Wang
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Yiming Zou
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Wentao Hu
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Cheng Liu
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Tiantong Yu
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Peng Han
- Department of Cardiology, 981 Hospital of Joint Logistics Support Force, Chengde, 067000 Hebei People’s Republic of China
| | - Li Yang
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Huan Wang
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Chenhai Xia
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Qiling Liu
- grid.449637.b0000 0004 0646 966XDepartment of Epidemiology and Medical Statistical, School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, 712046 Shaanxi People’s Republic of China
| | - Wei Wang
- grid.233520.50000 0004 1761 4404Department of Pharmaceutics and Pharmacy Administration, School of Pharmacy, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Haokao Gao
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Chengxiang Li
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Kun Lian
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
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Pei J, Wang X, Xing Z. Traditional Cardiovascular Risk Factors and Coronary Collateral Circulation: A Meta-Analysis. Front Cardiovasc Med 2021; 8:743234. [PMID: 34805302 PMCID: PMC8595282 DOI: 10.3389/fcvm.2021.743234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Patients with well-developed coronary collateral circulation (CC) usually have low mortality, improved cardiac function, and reduced infarct size. Currently, there is conflicting evidence on the association between traditional cardiovascular risk factors (diabetes, hypertension, and smoking habit) and CC. Design: We performed a meta-analysis of case-control studies to better understand such associations. Data Sources: We searched the MEDINE, EMBASE, and Science Citation Index databases to identify relevant studies. Eligibility Criteria for Selecting Studies: Case control studies reporting data on risk factors (smoking habit, hypertension, and diabetes mellites) in comparing cases between poor CC and well-developed CC groups. Well-developed CC was the primary outcome of this meta-analysis Data Extraction and Synthesis: Relevant data were extracted by two independent investigators. We derived pooled odds ratios (ORs) with random effects models. We performed quality assessments, publication bias, and sensitivity analysis to ensure the reliability of our results. Results: In total, 18 studies that had 4,746 enrolled patients were analyzed. Our results showed that hypertension and smoking habit did not (OR = 0.94, 95% CI: 0.75–1.17, p = 0.564 and OR = 1.00, 95% CI: 0.84–1.18, p = 0.970, respectively), and diabetes did (OR = 0.50, 95% CI: 0.38–0.67, p = 0.00001) affect the development of CC. Conclusion: Unlike hypertension and smoking habit, diabetes was associated with poor CC formation. Trial Registration Number:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=87821, identifier: CRD42018087821.
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Affiliation(s)
- Junyu Pei
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaopu Wang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China.,Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha, China
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3
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Wang P, Yuan D, Jia S, Zhu P, Zhang C, Liu Y, Li T, Jiang L, Song Y, Xu J, Tang X, Zhao X, Xu B, Yang Y, Yuan J, Gao R. 5-Year Clinical Outcomes of Successful Recanalisation for Coronary Chronic Total Occlusions in Patients With or Without Type 2 Diabetes Mellitus. Front Cardiovasc Med 2021; 8:691641. [PMID: 34485399 PMCID: PMC8414521 DOI: 10.3389/fcvm.2021.691641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite substantial improvement in chronic total occlusions (CTO) revascularization technique, the long-term clinical outcomes in diabetic patients with revascularized CTO remain controversial. Our study aimed to investigate the 5-year cardiovascular survival for patients with or without type 2 diabetes mellitus (DM) who underwent successful percutaneous coronary intervention (PCI) for CTO. Methods: Data of the current analysis derived from a large single-center, prospective and observational cohort study, including 10,724 patients who underwent PCI in 2013 at Fuwai Hospital. Baseline, angiographic and follow-up data were collected. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), which consisted of death, recurrent myocardial infarction (MI), stroke and target vessel revascularization (TVR). The secondary endpoint was all-cause mortality. Cox regression analysis and propensity-score matching was performed to balance the baseline confounders. Results: A total of 719 consecutive patients with ≥1 successful CTO-PCI were stratified into diabetic (n = 316, 43.9%) and non-diabetic (n = 403, 56.1%) group. During a median follow-up of 5 years, the risk of MACCE (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.08-2.00, P = 0.013) was significantly higher in the diabetic group than in the non-diabetic group, whereas the adjusted risk of all-cause mortality (HR 2.37, 95% CI 0.94-5.98, P = 0.068) was similar. In the propensity score matched population, there were no significant differences in the risk of MACCE (HR 1.27, 95% CI 0.92-1.75, P = 0.155) and all-cause mortality (HR 2.56, 95% CI 0.91-7.24, P = 0.076) between groups. Subgroup analysis and stratification analysis revealed consistent effects on 5-year MACCE across various subgroups. Conclusions: In patients who received successful CTO-PCI, non-diabetic patients were related to better long-term survival benefit in terms of MACCE. The risk of 5-year MACCE appeared to be similar in less-controlled and controlled diabetic patients after successful recanalization of CTO. Further randomized studies are warranted to confirm these findings.
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Affiliation(s)
- Peizhi Wang
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Deshan Yuan
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sida Jia
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei Zhu
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ce Zhang
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Liu
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianyu Li
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jiang
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Song
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingjing Xu
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofang Tang
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueyan Zhao
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinqing Yuan
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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4
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Latif A, Ahsan MJ, Kabach A, Kapoor V, Mirza M, Ahsan MZ, Kearney K, Panaich S, Cohen M, Goldsweig AM. Impact of diabetes mellitus on outcomes of percutaneous coronary intervention in chronic total occlusions: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:68-75. [PMID: 34226150 DOI: 10.1016/j.carrev.2021.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with diabetes mellitus (DM) have a high prevalence of coronary chronic total occlusions (CTOs). We conducted a systematic review and meta-analysis to characterize outcomes after CTO percutaneous coronary intervention (PCI) in patients without or with DM. METHODS PubMed, EMBASE, Cochrane, and Google Scholar were queried for studies comparing non-DM vs. DM patients undergoing attempted CTO PCI. The primary outcome was all-cause mortality at longest follow-up (at least 6 months). Secondary outcomes were major adverse cardiovascular events (MACE) which is a composite endpoint including myocardial infarction, cardiac or all-cause mortality and any revascularization in patients after CTO PCI, target vessel revascularization (TVR), myocardial infarction (MI), Japanese chronic total occlusion (J-CTO) score and prevalence of multivessel (MV) CTO disease. We used a random effects model to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Sixteen studies, including 2 randomized control trials and 14 observational studies, met inclusion criteria. At longest follow-up, all-cause mortality (OR 0.54 [95% CI 0.37-0.80], p < 0.0001) and MACE (OR 0.82 [95% CI 0.72-0.93], p < 0.00001) were significantly lower in non-DM CTO patients. MV CTO disease was less prevalent in patients without DM (OR 0.80 [95% CI 0.69-0.93], p = 0.004). However, there were no differences in MI, TVR and J-CTO score. CONCLUSIONS Non-diabetics undergoing CTO PCI have lower all-cause mortality and MACE than diabetics. Future research may determine if DM control improves diabetics' CTO PCI outcomes.
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Affiliation(s)
- Azka Latif
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE.
| | | | - Amjad Kabach
- Division of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, NE
| | - Vikas Kapoor
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE
| | - Mohsin Mirza
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE
| | - Mohammad Zoraiz Ahsan
- Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Kathleen Kearney
- Division of Cardiovascular Medicine, University of Washington, Seattle, WA
| | - Sidakpal Panaich
- Division of Cardiovascular Medicine, University of Iowa, Iowa, IA
| | - Mauricio Cohen
- Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, FL
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5
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Scotti A, Godino C, Munafò A, Pivato CA, Chiarito M, Fiore G, Di Maio S, Vergara P, Della Bella P, Carlino M, Margonato A, Colombo A. Cardiac and sudden death after chronic total occlusion percutaneous coronary intervention: Prognostic role of the target vessel. Catheter Cardiovasc Interv 2021; 97:E789-E800. [PMID: 33332744 DOI: 10.1002/ccd.29425] [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: 11/13/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The role of the target vessel in percutaneous revascularization of chronic total occlusion (CTO) is unclear. OBJECTIVE We sought to assess the long-term results of percutaneous coronary intervention (PCI) for CTO lesions in each coronary artery and to investigate the impact of successful revascularization and previous myocardial infarction (MI) in the territory of the target vessel. METHODS AND RESULTS Cohort observational study on 1,124 patients who have undergone CTO PCI attempt: 371 on left anterior descending artery (LAD), 485 right coronary artery, and 268 left circumflex. Patients were further stratified by successfully revascularized and not-revascularized CTO (CTO-NR). Vessels affected by a previous MI were defined as infarct-related artery (IRA). The primary endpoint was cardiac death; the secondary endpoint was the combined rate of sudden cardiac-death and sustained ventricular-arrhythmias (SCD/SVAs). Propensity score-matching was performed to evaluate LAD versus NON-LAD CTO. Up to 12-year follow-up, the clinical benefit associated with successful PCI was consistent across the three groups. CTO-NR had the greatest association with cardiac death and SCD/SVAs in each coronary artery and in IRA-CTO patients. CONCLUSIONS Unsuccessful percutaneous CTO revascularization was associated with lower cardiac survival and freedom from SCD/SVAs, irrespective of the vessel treated. This result was mainly driven by patients with an IRA CTO.
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Affiliation(s)
- Andrea Scotti
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.,Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Munafò
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo A Pivato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Cardio Center, Humanitas Research Hospital, Milan, Italy
| | - Mauro Chiarito
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Cardio Center, Humanitas Research Hospital, Milan, Italy
| | - Giorgio Fiore
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Silvana Di Maio
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Vergara
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Paolo Della Bella
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Mauro Carlino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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6
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Zhu Y, Meng S, Chen M, Liu K, Jia R, Li H, Zhu H, Jin Z. Long-term prognosis of chronic total occlusion treated by successful percutaneous coronary intervention in patients with or without diabetes mellitus: a systematic review and meta-analysis. Cardiovasc Diabetol 2021; 20:29. [PMID: 33516214 PMCID: PMC7847176 DOI: 10.1186/s12933-021-01223-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Therefore, the purpose of our study was to investigate the clinical outcomes of CTO-PCI in patients with or without DM. Methods All relevant articles published in electronic databases (PubMed, Embase, and the Cochrane Library) from inception to August 7, 2020 were identified with a comprehensive literature search. Additionally, we defined major adverse cardiac events (MACEs) as the primary endpoint and used risk ratios (RRs) with 95% confidence intervals (CIs) to express the pooled effects in this meta-analysis. Results Eleven studies consisting of 4238 DM patients and 5609 non-DM patients were included in our meta-analysis. For DM patients, successful CTO-PCI was associated with a significantly lower risk of MACEs (RR = 0.67, 95% CI 0.55–0.82, p = 0.0001), all-cause death (RR = 0.46, 95% CI 0.38–0.56, p < 0.00001), and cardiac death (RR = 0.35, 95% CI 0.26–0.48, p < 0.00001) than CTO-medical treatment (MT) alone; however, this does not apply to non-DM patients. Subsequently, the subgroup analysis also obtained consistent conclusions. In addition, our study also revealed that non-DM patients may suffer less risk from MACEs (RR = 1.26, 95% CI 1.02–1.56, p = 0.03) than DM patients after successful CTO-PCI, especially in the subgroup with a follow-up period of less than 3 years (RR = 1.43, 95% CI 1.22–1.67, p < 0.0001). Conclusions Compared with CTO-MT alone, successful CTO-PCI was found to be related to a better long-term prognosis in DM patients but not in non-DM patients. However, compared with non-DM patients, the risk of MACEs may be higher in DM patients after successful CTO-PCI in the drug-eluting stent era, especially during a follow-up period shorter than 3 years.
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Affiliation(s)
- Yong Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Shuai Meng
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| | - Maolin Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Kesen Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Ruofei Jia
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| | - Hong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Huagang Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Zening Jin
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China.
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7
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Ebisawa S, Kohsaka S, Muramatsu T, Kashima Y, Okamura A, Yamane M, Sakurada M, Matsuno S, Kijima M, Habara M. Derivation and validation of the J-CTO extension score for pre-procedural prediction of major adverse cardiac and cerebrovascular events in patients with chronic total occlusions. PLoS One 2020; 15:e0238640. [PMID: 32915843 PMCID: PMC7485776 DOI: 10.1371/journal.pone.0238640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022] Open
Abstract
We developed a prediction model of long-term risk after percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) based on pre-procedural clinical information. A total of 4,139 eligible patients, who underwent CTO-PCI at 52 Japanese centers were included. Specifically, 1,909 patients with 1-year data were randomly divided into the derivation (n = 1,273) and validation (n = 636) groups. Major adverse cardiac and cardiovascular event (MACCE) was the primary endpoint, including death, stroke, revascularization, and non-fatal myocardial infarction. We assessed the performance of our model using the area under the receiver operating characteristic curve (AUC) and assigned a simplified point-scoring system. One-hundred-thirty-eight (10.8%) patients experienced MACCE in the derivation cohort with hemodialysis (HD: odds ratio [OR] = 2.55), left ventricular ejection fractions (LVEF) <35% (OR = 2.23), in-stent occlusions (ISO: OR = 2.27), and diabetes mellitus (DM: OR = 1.72). The AUC of the derivation model was 0.650. The model’s performance was similar in the validation cohort (AUC, 0.610). When assigned a point for each associated factor (HD = 3, LVEF <35%, ISO = 2, and DM = 1 point), the average predicted versus the observed MACCE probability using the Japan-CTO extension score for the low, moderate, high, and very high risk groups was 8.1% vs. 7.3%, 16.9% vs. 15.9%, 22.0% vs. 26.1%, and 56.2% vs. 44.4%, respectively. This novel risk model may allow for the estimation of long-term risk and be useful in disseminating appropriate revascularization procedures.
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Affiliation(s)
- Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- * E-mail:
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Yoshifumi Kashima
- Division of Cardiology, Sapporo Cardio Vascular Clinic, Hokkaido, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Masahisa Yamane
- Cardiology Department, Saitama Sekishinkai Hospital, Saitama, Japan
| | - Masami Sakurada
- Department of Cardiology, Tokorozawa Heart Center, Saitama, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Mikihiro Kijima
- Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
| | - Maoto Habara
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
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8
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Tsai CT, Huang WC, Teng HI, Tsai YL, Lu TM. Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus. Cardiovasc Diabetol 2020; 19:119. [PMID: 32738906 PMCID: PMC7395357 DOI: 10.1186/s12933-020-01093-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetes mellitus is one of the risk factors for coronary artery disease and frequently associated with multivessels disease and poor clinical outcomes. Long term outcome of successful revascularization of chronic total occlusions (CTO) in diabetes patients remains controversial. METHODS AND RESULTS From January 2005 to December 2015, 739 patients who underwent revascularization for CTO in Taipei Veterans General Hospital were included in this study, of which 313 (42%) patients were diabetes patients. Overall successful rate of revascularization was 619 (84%) patients whereas that in diabetics and non-diabetics were 265 (84%) and 354 (83%) respectively. Median follow up was 1095 days (median: 5 years, interquartile range: 1-10 years). During 3 years follow-up period, 59 (10%) in successful group and 18 (15%) patients in failure group died. Although successful revascularization of CTO was non-significantly associated with better outcome in total cohort (hazard ratio (HR): 0.593, 95% confidence interval (CI) 0.349-0.008, P: 0.054), it might be associated with lower risk of all-cause mortality (HR: 0.307, 95% CI 0.156-0.604, P: 0.001) and CV mortality (HR: 0.266, 95% CI 0.095-0.748, P: 0.012) in diabetics (P: 0.512). In contrast, successful CTO revascularization didn't improve outcomes in non-diabetics (all P > 0.05). In multivariate cox regression analysis, successful CTO revascularization remained an independent predictor for 3-years survival in diabetic subgroup (HR: 0.289, 95% CI 0.125-0.667, P: 0.004). The multivariate analysis result was similar after propensity score matching (all-cause mortality, HR: 0.348, 95% CI 0.142-0.851, P: 0.021). CONCLUSIONS Successful CTO revascularization in diabetes may be related to better long term survival benefit but not in non-diabetic population.
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Affiliation(s)
- Chuan-Tsai Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-I Teng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Lin Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tse-Min Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan. .,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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9
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Guo L, Wang J, Ding H, Meng S, Zhang X, Lv H, Zhong L, Wu J, Xu J, Zhou X, Huang R. Long-term outcomes of medical therapy versus successful recanalisation for coronary chronic total occlusions in patients with and without type 2 diabetes mellitus. Cardiovasc Diabetol 2020; 19:100. [PMID: 32622353 PMCID: PMC7335447 DOI: 10.1186/s12933-020-01087-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022] Open
Abstract
Background In this study, we compared the outcomes of medical therapy (MT) with successful percutaneous coronary intervention (PCI) in chronic total occlusions (CTO) patients with and without type 2 diabetes mellitus. Methods A total of 2015 patients with CTOs were stratified. Diabetic patients (n = 755, 37.5%) and non-diabetic patients (n = 1260, 62.5%) were subjected to medical therapy or successful CTO-PCI. We performed a propensity score matching (PSM) to balance the baseline characteristics. A comparison of the major adverse cardiac events (MACE) was done to evaluate long-term outcomes. Results The median follow-up duration was 2.6 years. Through multivariate analysis, the incidence of MACE was significantly higher among diabetic patients compared to the non-diabetic patients (adjusted hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.09–1.61, p = 0.005). Among the diabetic group, the rate of MACE (adjusted HR 0.61, 95% CI 0.42–0.87, p = 0.006) was significantly lower in the successful CTO-PCI group than in the MT group. Besides, in the non-diabetic group, the prevalence of MACE (adjusted HR 0.85, 95% CI 0.64–1.15, p = 0.294) and cardiac death (adjusted HR 0.94, 95% CI 0.51–1.70, p = 0.825) were comparable between the two groups. Similar results as with the early detection were obtained in propensity-matched diabetic and non-diabetic patients. Notably, there was a significant interaction between diabetic or non-diabetic with the therapeutic strategy on MACE (p for interaction = 0.036). Conclusions For treatment of CTO, successful CTO-PCI highly reduces the risk of MACE in diabetic patients when compared with medical therapy. However, this does not apply to non-diabetic patients.
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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.
| | - Junjie Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Huaiyu Ding
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Shaoke Meng
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Xiaoyan Zhang
- Department of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang, People's Republic of China
| | - Haichen Lv
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Lei Zhong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Jian Wu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Jiaying Xu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Xuchen Zhou
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Rongchong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.,Department of Cardiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People's Republic of China
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10
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Scoring System for Identification of "Survival Advantage" after Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion. J Clin Med 2020; 9:jcm9051319. [PMID: 32370276 PMCID: PMC7291306 DOI: 10.3390/jcm9051319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Percutaneous coronary intervention (PCI) is widely used in patients with chronic total occlusion (CTO), but its benefit in improving long-term outcomes is controversial. We aimed to develop a prediction score for grading “survival advantage” conferred by successful results of CTO-PCI and a scoring system for prediction of the influence of CTO-PCI results on major adverse cardiac and cerebrovascular events (MACCEs). Methods: Follow-up data of 2625 patients who underwent CTO-PCI at 65 Japanese centers were analyzed. An integer scoring system was developed by including statistical effect modifiers on the association between successful CTO-PCI and one-year mortality. Results: Follow-up at 12 months was completed in 2034 patients. During follow-up, 76 deaths (3.7%) occurred. Patients with successful CTO-PCI had a better one-year survival than patients with failed CTO-PCI (log rank P = 0.016). Effect modifiers for the association between successful procedure and one-year mortality included diabetes (P interaction = 0.043), multivessel disease (P interaction = 0.175), Canadian Cardiovascular Society class ≥2 (P interaction = 0.088), and prior myocardial infarction (MI) (P interaction = 0.117). Each component was assigned a single point and summed to develop the scoring system. The patients were then categorized to specify the prediction of survival advantage by successful PCI: ≤2 (normal) and ≥3 (distinct). The differences in one-year mortality between patients with successful and failed treatment were −0.7% and 11.3% for normal and distinct score categories, respectively. In the scoring system for MACCE, score components were prior MI (P interaction = 0.19), left anterior descending artery (LAD)-CTO (P interaction = 0.079), and reattempt of CTO-PCI (P interaction = 0.18). The differences in one-year MACCEs between successful and failed patients for each score category (0, 1, and ≥2) were −1.7%, 7.5%, and 15.1%, respectively. Conclusions: The novel scoring system assessing the advantage of successful PCI can be easily applied in patients with CTO. It is a valid instrument for clinical decision-making while assessing the survival advantage of CTO-PCI and the influence of procedural results on MACCEs.
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11
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Flores-Umanzor EJ, Cepas-Guillen PL, Vázquez S, Fernandez-Valledor A, Ivey-Miranda J, Izquierdo M, Caldentey G, Jimenez-Britez G, Regueiro A, Freixa X, Farrero M, Ferreira-González I, Martin-Yuste V, Sabaté M. Survival benefit of revascularization versus optimal medical therapy alone for chronic total occlusion management in patients with diabetes. Catheter Cardiovasc Interv 2020; 97:376-383. [PMID: 32096926 DOI: 10.1002/ccd.28815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/12/2020] [Accepted: 02/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) is common in patients with diabetes mellitus. Data on the long-term outcomes after treatment of CTOs in this high-risk population are scarce. AIM To compare the long-term clinical outcomes of CTO revascularization either by coronary artery bypass graft (CABG) or successful percutaneous coronary intervention (PCI) versus optimal medical treatment (MT) alone in patients with diabetes. METHODS AND RESULTS A total of 538 consecutive patients with diabetes and at least one CTO were identified from 2010 to 2014 in our center. In the present analysis, patients were stratified according to the CTO treatment strategy that was selected. MT was selected in 61% of patients whereas revascularization in the remaining 39%. Patients undergoing revascularization were younger, had higher left ventricular ejection fraction (LVEF), lower ACEF score, and more positive myocardial ischemia detection results compared to the MT group (p < .001).Patients referred for CABG had higher rates of left main disease compared to the PCI and MT groups (32% vs. 3% and 11%, respectively; p < .001). Complete revascularization was more often achieved in the CABG group, compared to the PCI group (62% vs. 32% p < .001). Multivariable analysis showed that revascularization with CABG was associated with lower rates of all-cause and cardiac mortality rates compared to MT, [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.25-0.70, p < .001 and HR 0.40, 95% CI 0.20-81, p = .011, respectively]. Successful CTO-PCI showed a trend towards benefit in all-cause mortality (HR 0.58, 95% CI 0.33-1.04, p = .06). CONCLUSION In our registry, CTO revascularization in diabetic patients, especially with CABG, was associated with lower long-term mortality rates as compared to MT alone.
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Affiliation(s)
- Eduardo J Flores-Umanzor
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Sara Vázquez
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Andrea Fernandez-Valledor
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan Ivey-Miranda
- Hospital de Cardiología Siglo XXI, Instituto Mexicano del Seguro Social, México City, Mexico
| | - Marc Izquierdo
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Guillem Caldentey
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Cardiology Department, Hospital del Mar (Consorci Mar Parc de Salut de Barcelona), Barcelona, Spain
| | - Gustavo Jimenez-Britez
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ander Regueiro
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Marta Farrero
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d'hebron Hospital, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Victoria Martin-Yuste
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Service de Cardiologie, Centre Hospitalier de Saintonge, Saintes, France
| | - Manel Sabaté
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
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12
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Yan Y, Zhang M, Yuan F, Liu H, Wu D, Fan Y, Guo X, Xu F, Zhang M, Zhao Q, Lyu S. Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study. Cardiovasc Diabetol 2019; 18:108. [PMID: 31434572 PMCID: PMC6702731 DOI: 10.1186/s12933-019-0911-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background The territory of the right coronary artery (RCA) is smaller than that of the left anterior descending artery. Previous studies have reported conflicting results when considering whether stable RCA-chronic total occlusion (CTO) should be reopened. The coexistence of diabetic and coronary artery diseases represents a severe situation. Therefore, we aimed to determine if stable RCA-CTO in diabetic patients was necessary to be reopened. To our knowledge, no studies have focused on this topic to date. Methods We enrolled diabetic patients with RCA-CTO who had clinical presentations of symptomatic stable angina or silent ischemia. RCA-CTO was treated with either successful revascularization (the CTO-SR group) or medical therapy (the CTO-MT group). The primary endpoint was all-cause death. Both Cox regression and propensity score matching analyses were used. Sensitivity analysis was performed based on subgroup populations and relevant baseline variables. Results A total of 943 patients were included: 443 (46.98%) patients in the CTO-MT group and 500 (53.02%) patients in the CTO-SR group. After a mid-term follow-up (CTO-SR: 48 months; CTO-MT: 42 months), we found that CTO-SR was superior to CTO-MT in terms of all-cause death (adjusted hazard ratio [HR] [model 1]: 0.429, 95% conference interval [CI] 0.269–0.682; adjusted HR [model 2]: 0.445, 95% CI 0.278–0.714). The superiority of CTO-SR was consistent for cardiac death, possible/definite cardiac death, repeat revascularization, target vessel revascularization (TVR) and repeat nonfatal myocardial infarction. Subgroup analysis confirmed the mortality benefit of CTO-SR by percutaneous coronary intervention (the successful CTO-PCI subgroup, 309 patients in total). While CTO-SR by coronary artery bypass grafting (the CTO-CABG subgroup, 191 patients in total) offered patients more benefit from repeat revascularization and TVR than that offered by successful CTO-PCI. Conclusions For stable RCA-CTO patients with diabetes, successful revascularization offered patients more clinical benefits than medical therapy. CTO-CABG might be a more recommended way to accomplish revascularization. Trial registration This study was not registered in an open access database Electronic supplementary material The online version of this article (10.1186/s12933-019-0911-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yunfeng Yan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Mingduo Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Fei Yuan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Hong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Di Wu
- Department of Cardiology, Emergency General Hospital, 29 Xibahe Nanli, Chaoyang District, Beijing, China
| | - Yudong Fan
- Department of Cardiology, Emergency General Hospital, 29 Xibahe Nanli, Chaoyang District, Beijing, China
| | - Xinjing Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Feng Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Min Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Quanming Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Shuzheng Lyu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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13
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Shinouchi K, Ueda Y, Kato T, Nishida H, Ozaki T, Kosugi S, Iida Y, Toriyama C, Ohashi T, Nakamura M, Fukushima T, Horiuchi K, Mishima T, Abe H, Awata M, Date M, Uematsu M, Koretsune Y. Relation of Chronic Total Occlusion to In-Hospital Mortality in the Patients With Sudden Cardiac Arrest Due to Acute Coronary Syndrome. Am J Cardiol 2019; 123:1915-1920. [PMID: 30967290 DOI: 10.1016/j.amjcard.2019.02.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
Abstract
Although the presence of chronic total occlusion (CTO) has been associated with long-term mortality in the patients with ST-segment elevation myocardial infarction, the influence of having CTO on in-hospital mortality in sudden cardiac arrest (SCA)-acute coronary syndrome (ACS) patients has not been reported. Therefore, we examined the association between the presence of CTO and in-hospital mortality in those patients. Consecutive 106 SCA-ACS patients who received coronary angiography were retrospectively included. The factors associated with in-hospital mortality were analyzed. Among 106 patients, 40 (38%) patients died during hospitalization. Multivariate analysis revealed presence of CTO dependent on infarct-related artery (IRA-dependent-CTO) (hazard ratio [HR] = 2.88, p = 0.004), diabetes mellitus (HR = 2.04, p = 0.044), percutaneous cardiopulmonary support use (HR = 2.22, p = 0.045), successful recanalization (HR = 0.31, p = 0.004), and peak creatine kinase muscle-brain fraction (HR = 1.11, p < 0.001) were significantly associated with mortality. In conclusion, presence of IRA-dependent-CTO was significantly associated with in-hospital mortality in SCA-ACS patients.
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Affiliation(s)
- Kazuya Shinouchi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan.
| | - Taishi Kato
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hiroki Nishida
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tatsuhisa Ozaki
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shumpei Kosugi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yoshinori Iida
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Chieko Toriyama
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takuya Ohashi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masayuki Nakamura
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takashi Fukushima
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kohei Horiuchi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tsuyoshi Mishima
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Haruhiko Abe
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masaki Awata
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Motoo Date
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masaaki Uematsu
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yukihiro Koretsune
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
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14
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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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15
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Roffi M, Iglesias JF. CTO PCI in Patients With Diabetes Mellitus: Sweet Perspectives. JACC Cardiovasc Interv 2019; 10:2182-2184. [PMID: 29122131 DOI: 10.1016/j.jcin.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Marco Roffi
- Cardiology Division, Geneva University Hospital, Geneva, Switzerland.
| | - Juan F Iglesias
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
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16
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Mitomo S, Demir OM, Colombo A, Nakamura S, Chieffo A. What the surgeon needs to know about percutaneous coronary intervention treatment of chronic total occlusions. Ann Cardiothorac Surg 2018; 7:533-545. [PMID: 30094219 DOI: 10.21037/acs.2018.06.04] [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: 01/09/2023]
Abstract
Chronic total occlusion (CTO) accounts for 10-20% of lesions identified in coronary artery disease (CAD) patients. CTO percutaneous coronary intervention (PCI) is one of the most challenging of lesion subsets due to its technical difficulty, requiring specific operator expertise and equipment. There has been increased interest on CTO PCI evolving with the development of novel techniques and dedicated devices. Furthermore, in order to effectively and systematically utilize these techniques and devices, CTO PCI algorithms have been established. All of these developments have resulted in procedural success rates increasing to approximately 90%. In this review, we outline the evidence base for CTO PCI, conventional and contemporary CTO PCI techniques, CTO algorithms and outline integrated management strategies between cardiac surgeons and interventional cardiologists.
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Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Ozan M Demir
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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17
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Shen Y, Ding FH, Dai Y, Wang XQ, Zhang RY, Lu L, Shen WF. Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol 2018; 17:26. [PMID: 29422093 PMCID: PMC5804044 DOI: 10.1186/s12933-018-0671-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The extent of coronary collateral formation is a primary determinant of the severity of myocardial damage and mortality after coronary artery occlusion. Type 2 diabetes mellitus (T2DM) represents an important risk factor for impaired collateral vessel growth. However, the mechanism of reduced coronary collateralization in type 2 diabetic patients remains unclear. METHODS With the reference to the recent researches, this review article describes the pathogenic effects of T2DM on collateral development and outlines possible clinical and biochemical markers associated with reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion (CTO). RESULTS Diffuse coronary atherosclerosis in T2DM reduces pressure gradient between collateral donor artery and collateral recipient one, limiting collateral vessel growth and function. An interaction between advanced glycation end-products and their receptor activates several intracellular signaling pathways, enhances oxidative stress and aggravates inflammatory process. Diabetic condition decreases pro-angiogenic factors especially vascular endothelial growth factor and other collateral vessel growth related parameters. Numerous clinical and biochemical factors that could possibly attenuate the development of coronary collaterals have been reported. Increased serum levels of glycated albumin, cystatin C, and adipokine C1q tumor necrosis factor related protein 1 were associated with poor coronary collateralization in type 2 diabetic patients with stable coronary artery disease and CTO. Diastolic blood pressure and stenosis severity of the predominant collateral donor artery also play a role in coronary collateral formation. CONCLUSIONS T2DM impairs collateral vessel growth through multiple mechanisms involving arteriogenesis and angiogenesis, and coronary collateral formation in patients with T2DM and CTO is influenced by various clinical, biochemical and angiographic factors. This information provides insights into the understanding of coronary pathophysiology and searching for potential new therapeutic targets in T2DM.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Yang Dai
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
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