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Alexandrou M, Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Rangan BV, Mastrodemos OC, Allana SS, Rao SV, Linzer M, Egred M, Milkas A, Sandoval Y, Burke MN, Brilakis ES. Burnout in cardiology: a narrative review. J Invasive Cardiol 2024; 36. [PMID: 38422526 DOI: 10.25270/jic/23.00292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The frequency of burnout is rising among cardiologists, affecting not only their well-being but also the quality of patient care. Computerization of practice, bureaucracy, excessive workload, lack of control/autonomy, hostile and hectic work environments, insufficient income, and work life imbalance are the main categories listed as contributing factors to cardiologists' burnout. Organization- and physician-directed interventions can be impactful; however, the effectiveness and feasibility of these interventions have rarely been assessed in cardiology. This review summarizes recent publications on burnout in cardiology, discusses the contributing factors and implications of burnout on physicians' health and patient safety, and explores possible interventions.
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Affiliation(s)
- Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Sunil V Rao
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Mark Linzer
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA; 4nstitute for Professional Worklife, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK; Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | | | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
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Simsek B, Zhang R, Morton C, Villanueva MS. Lemierre syndrome with pulmonary empyema caused by Prevotella intermedia. BMJ Case Rep 2024; 17:e258158. [PMID: 38490705 PMCID: PMC10946344 DOI: 10.1136/bcr-2023-258158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Lemierre syndrome is a rare disease that is most often caused by Fusobacterium necrophorum We present a case caused by Prevotella intermedia in a young, healthy man, complicated by multiple cavitary lung lesions, loculated pleural effusions requiring chest tube placement and trapezius abscess. Our case highlights (a) P. intermedia as a rare cause of Lemierre syndrome and (b) clinical response to appropriate antimicrobial therapy may be protracted.
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Affiliation(s)
- Bahadir Simsek
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Renee Zhang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher Morton
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Merceditas S Villanueva
- Department of Internal Medicine, Section of Infectious Disease, Yale University School of Medicine, New Haven, Connecticut, USA
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Kostantinis S, Mastrodemos O, Stanberry L, Sandoval Y, Allana SS, Mutlu D, Simsek B, Rempakos A, Karacsonyi J, Alexandrou M, Okeson BK, Burke MN, Rangan BV, Brilakis ES. Iso-osmolar vs low-osmolar contrast agents for coronary optical coherence tomography: a blinded prospective randomized controlled study. J Invasive Cardiol 2024. [PMID: 38446023 DOI: 10.25270/jic/23.00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND The impact of contrast type on coronary optical coherence tomography (OCT) imaging has received limited research. METHODS We conducted a blinded, prospective, single-center, randomized, controlled crossover study comparing iso-osmolar contrast media (IOCM) with low-osmolar contrast media (LOCM) in patients undergoing clinically indicated coronary OCT imaging. Patients were randomly assigned to undergo OCT imaging with either IOCM or LOCM as the initial contrast medium. Following a washout period, a second run of OCT imaging of the same coronary vessel was performed using the other contrast medium. RESULTS A total of 62 patients were randomized to IOCM first (n = 31) or LOCM first (n = 31). Mean patient age was 65.9 ± 11.2 years and 74.2% were male, with high prevalence of dyslipidemia (82.3%) and prior myocardial infarction (41.9%). Percutaneous coronary intervention was performed in 60 cases (96.8%) and the left anterior descending artery was the most common target vessel (53.3%). The contrast volume used for OCT imaging was similar for IOCM and LOCM (8.0 [6.9, 9.0] mL vs 8.0 [6.7, 9.0] mL; P = .89), as was the length of clear OCT images (70.0 [62.8, 74.0] mm for IOCM vs 70.0 [64.0, 74.0] mm for LOCM; P = .65). Electrocardiographic changes were observed in 11 runs with IOCM (ventricular repolarization changes in 9 runs and premature ventricular contractions [PVCs] in 2 runs) vs 12 runs with LOCM (ventricular repolarization changes in 9 runs and PVCs in 3 runs). CONCLUSIONS The use of IOCM in coronary OCT is associated with similar contrast volume and clear imaging length when compared with LOCM.
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Affiliation(s)
- Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Larissa Stanberry
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Deniz Mutlu
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Brynn K Okeson
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA..
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Can U, Coskun A, Canakci C, Simsek B, Karaca Y, Sabuncu K, Akca O. A new promising indicator in prostate cancer screening: Prostate-specific antigen fluctuation rate. Actas Urol Esp 2024:S2173-5786(24)00013-1. [PMID: 38369288 DOI: 10.1016/j.acuroe.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVES To evaluate whether PSA fluctuation can be used to predict the risk of prostate cancer. MATERIALS AND METHODS The study included 1244 patients who underwent prostate biopsy at Kartal Dr. Lutfi Kirdar City Hospital between 2013 and 2021 (848 in non-cancer; 396 in cancer). The patient's age, last two PSA values (PSA1 and PSA2) within three months before the biopsy, the duration between two PSAs (days), prostate size (g) and PSA density (PSAD) were all recorded. PSA fluctuation rate (PSAfr) was defined as the change rate between two PSA values. RESULTS PSAfr was significantly higher in the non-cancer group than in the prostate cancer group (15.2% (20.5) and 9.6% (14.4), P=.019). A Simple linear regression was used to examine the relationship between PSAfr and other factors such as age, PSA, PSAD, and prostate volume, but it was shown that these had no effect on PSA fluctuations. ROC analysis revealed a relatively low Area Under the Curve (AUC) for PSAfr (AUC, 0.584 (0.515-0.653)). However, the cut-off value of 12.35% was found to be significant, with a sensitivity of 58% and a specificity of 59% (P:.019, 95%CI). The odds ratio, adjusted for age, PSAD, and PSA2, was calculated as 0.545 (0.33-0.89) using logistic regression analysis to show the relationship between prostate cancer and PSAfr. As a result, those with high PSAfr were found to be 1.83 times less likely to be diagnosed with prostate cancer than those with low fluctuations. CONCLUSION PSAfr could be used in nomograms to predict prostate cancer risk and reduce the number of unnecessary biopsies.
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Affiliation(s)
- U Can
- Servicio de Urología, Hospital Urbano de Kartal Dr. Lutfi Kirdar, Estambul, Turkey.
| | - A Coskun
- Servicio de Urología, Hospital Urbano de Kartal Dr. Lutfi Kirdar, Estambul, Turkey
| | - C Canakci
- Servicio de Urología, Hospital Urbano de Kartal Dr. Lutfi Kirdar, Estambul, Turkey
| | - B Simsek
- Servicio de Urología, Hospital Liv-Ulus, Estambul, Turkey
| | - Y Karaca
- Servicio de Urología, Hospital de Formación e Investigación, Sancaktepe, Turkey
| | - K Sabuncu
- Servicio de Urología, Facultad de Medicina, Universidad de Medipol, Estambul, Turkey
| | - O Akca
- Servicio de Urología, Facultad de Medicina, Universidad de Bahcesehir, Estambul, Turkey
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Alexandrou M, Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Rangan BV, Mastrodemos OC, Kirtane AJ, Bortnick AE, Jneid H, Azzalini L, Milkas A, Alaswad K, Linzer M, Egred M, Rao SV, Allana SS, Sandoval Y, Brilakis ES. Sex differences in the well-being of interventional cardiologists. J Invasive Cardiol 2024; 36. [PMID: 38335507 DOI: 10.25270/jic/22.00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Several studies suggest differences in burnout and coping mechanisms between female and male physicians. We conducted an international, online survey exploring sex-based differences in the well-being of interventional cardiologists. Of 1251 participants, 121 (9.7%) were women. Compared with men, women were more likely to be single and under 50 years old, and they asked more often for development opportunities and better communication with administration. Overall burnout was similar between women and men, but women interventional cardiology attendings were more likely to think that they were achieving less than they should. Improved communication with administration and access to career development opportunities may help prevent or mitigate burnout in women interventional cardiologists.
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Affiliation(s)
- Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Anna E Bortnick
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hani Jneid
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mark Linzer
- Institute for Professional Worklife, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK; Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Sunil V Rao
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
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Alexandrou M, Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Rangan BV, Mastrodemos OC, Kirtane AJ, Bortnick AE, Jneid H, Azzalini L, Milkas A, Alaswad K, Linzer M, Egred M, Rao SV, Allana SS, Sandoval Y, Brilakis ES. Sex differences in the well-being of interventional cardiologists. J Invasive Cardiol 2024; 36. [PMID: 38335507 DOI: 10.25270/jic/23.00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Several studies suggest differences in burnout and coping mechanisms between female and male physicians. We conducted an international, online survey exploring sex-based differences in the well-being of interventional cardiologists. Of 1251 participants, 121 (9.7%) were women. Compared with men, women were more likely to be single and under 50 years old, and they asked more often for development opportunities and better communication with administration. Overall burnout was similar between women and men, but women interventional cardiology attendings were more likely to think that they were achieving less than they should. Improved communication with administration and access to career development opportunities may help prevent or mitigate burnout in women interventional cardiologists.
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Affiliation(s)
- Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Anna E Bortnick
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hani Jneid
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mark Linzer
- Institute for Professional Worklife, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK; Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Sunil V Rao
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
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Simsek B, Rempakos A, Kostantinis S, Alexandrou M, Karacsonyi J, Rangan BV, Mastrodemos OC, Mutlu D, Abi Rafeh N, Alaswad K, Avran A, Azzalini L, ElGuindy A, Egred M, Goktekin O, Gorgulu S, Jaber W, Kearney KE, Kirtane AJ, Lombardi WL, Mashayekhi K, McEntegart M, Nicholson W, Rinfret S, Allana SS, Sandoval Y, Nicholas Burke M, Brilakis ES. International survey of chronic total occlusion percutaneous coronary intervention operators. Catheter Cardiovasc Interv 2024; 103:12-19. [PMID: 37983649 DOI: 10.1002/ccd.30914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) practice has received limited study. AIM To examine the contemporary CTO PCI practice. METHODS We performed an online, anonymous, international survey of CTO PCI operators. RESULTS Five hundred forty-five CTO PCI operators and 190 interventional cardiology fellows with an interest in CTO PCI participated in this survey. Almost half were from the United States (41%), most (93%) were men, and the median h/week spent in the hospital was 58. Median annual case numbers were 205 (150-328) for PCIs and 20 (5-50) for CTO PCIs. Almost one-fifth (17%) entered CTO cases into registries, such as PROGRESS-CTO (55%) and EuroCTO (20%). More than one-third worked at academic institutions (39%), 31% trained dedicated CTO fellows, and 22% proctored CTO PCI. One-third (34%) had dedicated CTO PCI days. Most (51%) never discharged CTO patients the same day, while 17% discharged CTO patients the same day >50% of the time. After successful guidewire crossing, 38% used intravascular imaging >90% of the time. Most used CTO scores including J-CTO (81%), PROGRESS-CTO (35%), and PROGRESS-CTO complications scores (30%). Coronary artery perforation was encountered within the last month by 19%. On a scale of 0-10, the median comfort levels in treating coronary artery perforation were: covered stents 8.8 (7.0-10), coil embolization 5.0 (2.1-8.5), and fat embolization 3.7 (0.6-7.3). Most (51%) participants had a complication cart/kit and 25% conducted regular complication drills with catheterization laboratory staff. CONCLUSION Contemporary CTO PCI practices vary widely. Further research on barriers to following the guiding principles of CTO PCI may improve patient outcomes.
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Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Deniz Mutlu
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Louisiana, USA
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Lorenzo Azzalini
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Ahmed ElGuindy
- Adult Cardiology Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University, Istanbul, Turkey
| | - Wissam Jaber
- Department of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Kathleen E Kearney
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - William L Lombardi
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Kambis Mashayekhi
- Department for Internal Medicine and Cardiology, Heartcenter Lahr, Lahr, Germany
| | - Margaret McEntegart
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | | | - Stephane Rinfret
- Department of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Allana SS, Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Alaswad K, Krestyaninov O, Khelimskii D, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Patel MP, Mahmud E, Koutouzis M, Tsiafoutis I, Gorgulu S, Elbarouni B, Nicholson W, Jaber W, Rinfret S, Abi Rafeh N, Goktekin O, ElGuindy AM, Sandoval Y, Burke MN, Rangan BV, Brilakis ES. Lesion complexity and procedural outcomes associated with ostial chronic total occlusions: Insights from the PROGRESS-CTO Registry. J Invasive Cardiol 2023; 35. [PMID: 38108870 DOI: 10.25270/jic/23.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Ostial CTOs can be challenging to revascularize. We aim to describe the outcomes of ostial chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We examined the clinical and angiographic characteristics and procedural outcomes of 8788 CTO PCIs performed at 35 US and non-US centers between 2012 and 2022. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target-vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. RESULTS Ostial CTOs constituted 12% of all CTOs. Patients with ostial CTOs had higher J-CTO score (2.9 ± 1.2 vs 2.3 ± 1.3; P less than .01). Ostial CTO PCI had lower technical (82% vs. 86%; P less than .01) and procedural (81% vs. 85%; P less than .01) success rates compared with non-ostial CTO PCI. Ostial location was not independently associated with technical success (OR 1.03, CI 95% 0.83-1.29 P =.73). Ostial CTO PCI had a trend towards higher incidence of MACE (2.6% vs. 1.8%; P =.06), driven by higher incidence of in-hospital death (0.9% vs 0.3% P less than.01) and stroke (0.5% vs 0.1% P less than .01). Ostial lesions required more often use of the retrograde approach (30% vs 9%; P less than .01). Ostial CTO PCI required longer procedure time (149 [103,204] vs 110 [72,160] min; P less than .01) and higher air kerma radiation dose (2.3 [1.3, 3.6] vs 2.0 [1.1, 3.5] Gray; P less than .01). CONCLUSIONS Ostial CTOs are associated with higher lesion complexity and lower technical and procedural success rates. CTO PCI of ostial lesions is associated with frequent need for retrograde crossing, higher incidence of death and stroke, longer procedure time and higher radiation dose.
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Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | | | | | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | | | | | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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Simsek B, Rempakos A, Kostantinis S, Alexandrou M, Gorgulu S, Alaswad K, Frizzell JD, Yildirim U, Poommipanit P, Aygul N, Abi Rafeh N, Bagur R, Davies R, Goktekin O, Choi JW, Reddy N, Dattilo P, Kerrigan J, Haddad EV, Mastrodemos OC, Rangan BV, Karacsonyi J, Allana SS, Kearney KE, Sandoval Y, Burke MN, Brilakis ES, Azzalini L. Activated clotting time and outcomes of chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO Registry. J Invasive Cardiol 2023; 35. [PMID: 38108868 DOI: 10.25270/jic/23.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND The optimal range of activated clotting time (ACT) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS We examined the association between ACT and in-hospital ischemic and bleeding outcomes in patients who underwent CTO PCI in the Prospective Global Registry for the Study of CTO Intervention. RESULTS ACT values were available for 4377 patients who underwent CTO PCI between 2012 and 2023 at 29 centers. The mean ACT distribution was less than 250 seconds (19%), 250 to 349 seconds (50%), and greater than or equal to 350 seconds (31%). The incidence of ischemic events, bleeding events, and net adverse cardiovascular events (NACE) was 0.8%, 3.0%, and 3.8%, respectively. In multiple logistic regression analysis, increasing nadir ACT was associated with decreasing ischemic events (adjusted odds ratio [aOR] per 50-second increments: 0.69 [95% confidence interval (CI), 0.50-0.94; P=.017]; and increasing peak ACT was associated with increasing bleeding events (aOR per 50-second increments: 1.17 [95% CI ,1.01-1.36; P=.032]). A U-shaped association was seen between mean ACT and NACE, where restricted cubic spline analysis demonstrated that patients with a low ( less than 200 seconds) or high ( greater than 400 seconds) ACT had increasing NACE risk compared with an ACT of 200 to 400 seconds (aOR 2.06, 95% CI 1.18-3.62; P=.012). CONCLUSIONS Among patients who underwent CTO PCI, mean ACT had a U-shaped relationship with NACE, where patients with a low ( less than 200 seconds) ACT (driven by ischemic events) or high ( greater than 400 seconds) ACT (driven by bleeding) had higher NACE compared with an ACT of 200 to 400 seconds.
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Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University, Istanbul, Turkey
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jarrod D Frizzell
- Department of Cardiology, The Christ Hospital, Cincinnati, Ohio, USA
| | - Ufuk Yildirim
- Department of Cardiology, Ondokuz Mayis University, Samsun, Turkey
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nazif Aygul
- Department of Cardiology, Selcuk University, Konya, Turkey
| | | | - Rodrigo Bagur
- Department of Cardiology, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Rhian Davies
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | | | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Niranjan Reddy
- Department of Cardiology, Kettering Health Medical Group, Dayton, Ohio, USA
| | - Philip Dattilo
- UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | - Jimmy Kerrigan
- Ascension Saint Thomas Heart Hospital, Nashville, Tennessee, USA
| | - Elias V Haddad
- Ascension Saint Thomas Heart Hospital, Nashville, Tennessee, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA 98195, USA.
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Kostantinis S, Bagur R, Rempakos A, Simsek B, Karacsonyi J, Allana SS, Alexandrou M, Rangan BV, Brilakis ES, Ybarra LF. Calcium Modification Strategies in Dissection and Re-Entry vs True-to-True Wiring in Chronic Total Occlusion Interventions. JACC Cardiovasc Interv 2023; 16:2797-2799. [PMID: 38030368 DOI: 10.1016/j.jcin.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023]
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Allana SS, Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Alexandrou M, Choi JW, Alaswad K, Krestyaninov O, Khelimskii D, Gorgulu S, Davies R, Benton S, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Azzalini L, Kearney K, Chandwaney R, Nicholson W, Jaber W, Rinfret S, Frizzell J, Patel T, Jefferson B, Aygul N, Rangan BV, Brilakis ES. The Retrograde Approach to Chronic Total Occlusion Percutaneous Coronary Interventions: Technical Analysis and Procedural Outcomes. JACC Cardiovasc Interv 2023; 16:2748-2762. [PMID: 38030360 DOI: 10.1016/j.jcin.2023.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with lower success and higher complication rates when compared with the antegrade approach. OBJECTIVES This study sought to assess contemporary techniques and outcomes of retrograde CTO PCI. METHODS We examined the baseline characteristics, procedural techniques and outcomes of 4,058 retrograde CTO PCIs performed at 44 centers between 2012 and 2023. Major adverse cardiac events (MACE) included any of the following in-hospital events: death, myocardial infarction, repeat target vessel revascularization, pericardiocentesis, cardiac surgery, and stroke. RESULTS The average J-CTO (Multicenter CTO Registry in Japan) score was 3.1 ± 1.1. Retrograde crossing was successful in 60.5% and lesion crossing in 81.6% of cases. The collaterals pathways successfully used were septals in 62.0%, saphenous vein grafts in 17.4%, and epicardials in 19.1%. The technical and procedural success rates were 78.7% and 76.6%, respectively. When retrograde crossing failed, technical success was achieved in 50.3% of cases using the antegrade approach. In-hospital MACE was 3.5%. The clinical coronary perforation rate was 5.8%. The incidence of in-hospital MACE with retrograde true lumen crossing, just marker antegrade crossing, conventional reverse controlled antegrade and retrograde tracking (CART), contemporary reverse CART, extended reverse CART, guide-extension reverse CART, and CART was 2.1%, 0.8%, 5.5%, 3.0%, 2.1%, 3.2%, and 4.1%, respectively; P = 0.01). CONCLUSIONS Retrograde CTO PCI is utilized in highly complex cases and yields moderate success rates with 5.8% perforation and 3.5% periprocedural MACE rates. Among retrograde crossing strategies, retrograde true lumen puncture was the safest. There is need for improvement of the efficacy and safety of retrograde CTO PCI.
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Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | | | | | - Dmitrii Khelimskii
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | | | | | | | | | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathleen Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | - Taral Patel
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | - Brian Jefferson
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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12
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Rempakos A, Alexandrou M, Simsek B, Kostantinis S, Karacsonyi J, Mutlu D, Ybarra LF, Bagur R, Choi JW, Poommipanit P, Khatri JJ, Davies R, Benton S, Gorgulu S, Jaffer FA, Chandwaney R, Jaber W, Rinfret S, Nicholson W, Azzalini L, Kearney KE, Kerrigan JL, Haddad EV, Alaswad K, Basir MB, Krestyaninov O, Khelimskii D, Abi-Rafeh N, ElGuindy A, Goktekin O, Rangan BV, Mastrodemos OC, Al-Ogaili A, Allana SS, Sandoval Y, Burke MN, Brilakis ES. Trends and Outcomes of Antegrade Dissection and Re-Entry in Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:2736-2747. [PMID: 37877912 DOI: 10.1016/j.jcin.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The contemporary frequency and outcomes of antegrade dissection and re-entry (ADR) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study. OBJECTIVES The aim of this study was to determine the frequency and outcomes of ADR use in a large multicenter CTO PCI registry. METHODS The characteristics and outcomes of ADR were examined among 12,568 patients who underwent 12,841 CTO PCIs at 46 U.S. and non-U.S. centers between 2012 and 2023. RESULTS ADR was used in 2,385 of the procedures (18.6%). ADR use declined from 37.9% in 2012 to 14.5% in 2022 (P < 0.001). Patients in whom ADR was used had a high prevalence of comorbidities. Compared with cases that did not use ADR, ADR cases had more complex angiographic characteristics, higher mean J-CTO (Multicenter CTO Registry in Japan) score (2.94 ± 1.11 vs 2.23 ± 1.26; P < 0.001), lower technical success (77.0% vs 89.3%; P < 0.001), and higher in-hospital major adverse cardiac events (3.7% vs 1.6%; P < 0.001). The use of the CrossBoss declined from 71% in 2012 to 1.4% in 2022 and was associated with higher technical success (87%) compared with wire-based techniques (73%). The Stingray device displayed higher technical success (86%) compared with subintimal tracking and re-entry (STAR) (74%) and limited antegrade subintimal tracking (78%); however, its use has been decreasing, with STAR becoming the most used re-entry technique in 2022 (44% STAR vs 38% Stingray). CONCLUSIONS The use of ADR has been decreasing. ADR was used in more complex lesions and was associated with lower technical success and higher major adverse cardiac events compared with non-ADR cases. There has been a decrease in Stingray use and an increase in the use of STAR for re-entry.
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Affiliation(s)
- Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Deniz Mutlu
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Luiz F Ybarra
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jimmy L Kerrigan
- Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee, USA
| | - Elias V Haddad
- Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee, USA
| | | | - Mir B Basir
- Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | | | | | | | - Ahmed ElGuindy
- Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ahmed Al-Ogaili
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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13
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Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Allana SS, Alexandrou M, Gorgulu S, Alaswad K, Basir MB, Davies RE, Benton SM, Krestyaninov O, Khelimskii D, Frizzell J, Ybarra LF, Bagur R, Reddy N, Kerrigan JL, Haddad EV, Love M, Elbarouni B, Soylu K, Yildirim U, Dattilo P, Azzalini L, Kearney K, Sadek Y, ElGuindy AM, Abi Rafeh N, Goktekin O, Mastrodemos OC, Rangan BV, Sandoval Y, Burke MN, Brilakis ES. Impact of calcium on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention. Int J Cardiol 2023; 390:131254. [PMID: 37562751 DOI: 10.1016/j.ijcard.2023.131254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Coronary calcification is common and increases the difficulty of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We examined the impact of calcium on procedural outcomes of 13,079 CTO PCIs performed in 12,799 patients at 46 US and non-US centers between 2012 and 2023. RESULTS Moderate or severe calcification was present in 46.6% of CTO lesions. Patients whose lesions were calcified were older and more likely to have had prior coronary artery bypass graft surgery. Calcified lesions were more complex with higher J-CTO score (3.0 ± 1.1 vs. 1.9 ± 1.2; p < 0.001) and lower technical (83.0% vs. 89.9%; p < 0.001) and procedural (81.0% vs. 89.1%; p < 0.001) success rates compared with mildly calcified or non-calcified CTO lesions. The retrograde approach was more commonly used among cases with moderate/severe calcification (40.3% vs. 23.5%; p < 0.001). Balloon angioplasty (76.6%) was the most common lesion preparation technique for calcified lesions, followed by rotational atherectomy (7.3%), laser atherectomy (3.4%) and, intravascular lithotripsy (3.4%). The incidence of major adverse cardiovascular events (MACE) was higher in cases with moderate or severe calcification (3.0% vs. 1.2%; p < 0.001), as was the incidence of perforation (6.5% vs. 3.4%; p < 0.001). On multivariable analysis, the presence of moderate/severe calcification was independently associated with lower technical success (odds ratio, OR = 0.73, 95% CI: 0.63-0.84) and higher MACE (OR = 2.33, 95% CI: 1.66-3.27). CONCLUSIONS Moderate/severe calcification was present in nearly half of CTO lesions, and was associated with higher utilization of the retrograde approach, lower technical and procedural success rates, and higher incidence of in-hospital MACE.
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Affiliation(s)
- Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | | | | | | | | | | | | | - Jarrod Frizzell
- The Christ Hospital, Ohio Heart and Vascular, Cincinnati, OH, USA
| | - Luiz F Ybarra
- London Health Sciences Center, Western University, London, ON, Canada
| | - Rodrigo Bagur
- London Health Sciences Center, Western University, London, ON, Canada
| | | | | | | | - Michael Love
- St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | | | - Korhan Soylu
- Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Ufuk Yildirim
- Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Philip Dattilo
- UC Health Medical Center of the Rockies, Loveland, CO, USA
| | | | | | | | | | | | | | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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14
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Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Alexandrou M, Choi JW, Poommipanit P, Khatri JJ, Young L, Davies R, Benton S, Jaffer FA, Chandwaney R, Azzalini L, Alaswad K, Jefferson B, Frizzell J, Abi-Rafeh N, Elguindy A, Goktekin O, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke NM, Brilakis ES, Gorgulu S. Impact of preprocedural anemia on in-hospital and follow-up outcomes of chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv 2023; 102:857-863. [PMID: 37681964 DOI: 10.1002/ccd.30810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/17/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The impact of preprocedural anemia on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS We examined the clinical and angiographic characteristics and procedural outcomes of 8633 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023. Anemia was defined as a hemoglobin level of <13 g/dL in men and <12 g/dL in women. RESULTS Anemia was present in 1652 (19%) patients undergoing CTO PCI. Anemic patients had a higher incidence of comorbidities, such as diabetes mellitus, hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease. CTOs in anemic patients were more likely to have complex angiographic characteristics, including smaller diameter, longer length, moderate to severe calcification, and moderate to severe proximal tortuosity. Anemic patients required longer procedure (119 vs. 107 min; p < 0.001) and fluoroscopy (45 vs. 40 min; p < 0.001) times but received similar contrast volumes. Technical success was similar between the two groups. In-hospital major adverse cardiac events (MACE) rates were higher in patients with anemia; however, this association was no longer significant after adjusting for confounding factors. Baseline anemia was independently associated with follow-up MACE (adjusted hazard ratio [HR]: 1.63; 95% confidence interval [CI]: 1.07-2.49; p = 0.023) and all-cause mortality (adjusted HR: 3.03; 95% CI: 1.41-6.49; p = 0.004). CONCLUSIONS Preprocedural anemia is associated with more comorbidities, higher lesion complexity, longer procedure times, and higher follow-up MACE and mortality after CTO PCI.
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Affiliation(s)
- Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | - Lorenzo Azzalini
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | | | - Brian Jefferson
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | | | | | - Ahmed Elguindy
- Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Nicholas M Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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15
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Gorgulu S, Kostantinis S, ElGuindy AM, Abi Rafeh N, Simsek B, Rempakos A, Karacsonyi J, Kalay N, Samir A, Jaoudeh FA, Maalouf A, Soylu K, Yildirim U, Tigen MK, Cincin A, Kalyanasundaram A, Aygul N, Altunkeser BB, El Sayed A, Sadek Y, Shelton C, Jbara K, Vemmou E, Nikolakopoulos I, Mastrodemos OC, Rangan BV, Allana SS, Sandoval Y, Burke MN, Brilakis ES, Goktekin O. Contemporary In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the MENATA (Middle East, North Africa, Turkey, and Asia) Chapter of the PROGRESS-CTO Registry. Am J Cardiol 2023; 206:221-229. [PMID: 37717475 DOI: 10.1016/j.amjcard.2023.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been rapidly evolving in different parts of the world. We examined the clinical and angiographic characteristics and procedural outcomes of 1,079 consecutive CTO PCIs performed in 1,063 patients at 10 centers in the Middle East, North Africa, Turkey, and Asia regions between 2018 and 2022. The mean age was 61 ± 10 years and 82% of the patients were men. The prevalence of diabetes (49%) and previous PCI (50%) was high. The most common target vessel was the right coronary artery (51%), followed by the left anterior descending artery (33%) and the circumflex artery (15%). The mean Japanese CTO score was 2.1 ± 1.2 and mean PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) score was 1.2 ± 1.0. The technical and procedural success rates were high (91% and 90%, respectively) with a low incidence (1.6%) of in-hospital major adverse cardiac events. The incidence of perforation was 4.6% (n = 50): guidewire exit was the most common mechanism of perforation (48%) and 14 patients required pericardiocentesis (28%). Antegrade wire escalation was the most common crossing strategy used (91%), followed by retrograde approach (24%) and antegrade dissection and re-entry (12%). Median contrast volume, air kerma radiation dose, and fluoroscopy time were 300 (200 to 400) ml, 3.7 (2.0 to 6.3) Gy, and 40 (25 to 65) minutes, respectively. In conclusion, high success and acceptable complication rates are currently achieved at experienced centers in the Middle East, North Africa, Turkey, and Asia regions using a combination of crossing strategies.
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Affiliation(s)
- Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey.
| | - Spyridon Kostantinis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Louisiana
| | - Bahadir Simsek
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Judit Karacsonyi
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Nihat Kalay
- Department of Cardiology, Acibadem Kocaeli Hospital, Izmit, Turkey
| | - Ahmad Samir
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt; Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Fadi Abou Jaoudeh
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Assaad Maalouf
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Korhan Soylu
- Department of Cardiology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Ufuk Yildirim
- Department of Cardiology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | | | - Altug Cincin
- Department of Cardiology, Marmara University Medical Faculty, Istanbul, Turkey
| | | | - Nazif Aygul
- Department of Cardiology, Selcuk University Medical Faculty, Konya, Turkey
| | | | - Ali El Sayed
- Department of Cardiology, Al Zahraa University Hospital, Beirut, Lebanon
| | - Yasser Sadek
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Charlie Shelton
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | - Kassem Jbara
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Evangelia Vemmou
- Department of Cardiology, Yale New Haven Hospital, New Haven, Connecticut
| | | | - Olga C Mastrodemos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bavana V Rangan
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Salman S Allana
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - M Nicholas Burke
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
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Alexandrou M, Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Choi JW, Poommipanit P, Alaswad K, Basir MB, Megaly M, Davies R, Benton S, Jaffer FA, Karmpaliotis D, Azzalini L, Kearney KE, ElGuindy AM, Rafeh NA, Goktekin O, Gorgulu S, Khatri JJ, Aygul N, Jaber W, Nicholson W, Rinfret S, Krestyaninov O, Khelimskii D, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke MN, Brilakis ES. Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Previous Coronary Artery Bypass Graft Surgery. Am J Cardiol 2023; 205:40-49. [PMID: 37586120 DOI: 10.1016/j.amjcard.2023.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/21/2023] [Accepted: 07/21/2023] [Indexed: 08/18/2023]
Abstract
The outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) in patients with previous coronary artery bypass graft (CABG) surgery have received limited study. We examined the baseline characteristics and outcomes of CTO PCIs performed at 47 United States and non-United States centers between 2012 and 2023. Of the 12,164 patients who underwent CTO PCI during the study period, 3,475 (29%) had previous CABG. Previous CABG patients were older, more likely to be men, and had more comorbidities and lower left ventricular ejection fraction and estimated glomerular filtration rate. Their CTOs were more likely to have moderate/severe calcification and proximal tortuosity, proximal cap ambiguity, longer lesion length, and higher Japanese CTO scores. The first and final successful crossing strategy was more likely to be retrograde. Previous CABG patients had lower technical (82.1% vs 88.2%, p <0.001) and procedural (80.8% vs 86.8%, p <0.001) success, higher in-hospital mortality (0.8% vs 0.3%, p <0.001), acute myocardial infarction (0.9% vs 0.5%, p = 0.007) and perforation (7.0% vs 4.2%, p <0.001) but lower incidence of pericardial tamponade and pericardiocentesis (0.1% vs 1.3%, p <0.001). At 2-year follow-up, the incidence of major adverse cardiac events, repeat PCI and acute coronary syndrome was significantly higher in previous CABG patients, whereas all-cause mortality was similar. In conclusion, patients with previous CABG who underwent CTO PCI had more complex clinical and angiographic characteristics and lower success rate, higher perioperative mortality, and myocardial infarction but lower tamponade, and higher incidence of major adverse cardiac events with similar all-cause mortality during follow-up.
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Affiliation(s)
- Michaella Alexandrou
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Paul Poommipanit
- Section of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Mir Bahar Basir
- Division of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Michael Megaly
- Division of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Rhian Davies
- Department of Cardiology, WellSpan York Hospital, York, Pennsylvania
| | - Stewart Benton
- Department of Cardiology, WellSpan York Hospital, York, Pennsylvania
| | - Farouc A Jaffer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | | | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | | | - Nazif Aygul
- Department of Cardiology, Selcuk University, Konya, Turkey
| | - Wissam Jaber
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - William Nicholson
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Stephane Rinfret
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Dmitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Salman S Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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17
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Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Allana SS, Alexandrou M, Davies RE, Rangan BV, Sandoval Y, Brilakis ES. Temporal Trends of Calcium Modification Therapies in Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:2475-2477. [PMID: 37821191 DOI: 10.1016/j.jcin.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 10/13/2023]
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18
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Yanar K, Atayik MC, Horozoğlu C, Demirkol Ş, Simsek B, Verim A, Küçükhüseyin Ö, Aydın S, Yaylım İ, Çakatay U. Significance of Intercellular adhesion molecule-1 Lys496Glu gene polimorphism on plasma redox status regulation in laryngeal carcinoma. J Cancer Res Ther 2023; 19:1781-1787. [PMID: 38376278 DOI: 10.4103/jcrt.jcrt_1081_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/24/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intercellular adhesion molecule-1 (ICAM-1) is a surface glycoprotein important for tumor invasion and angiogenesis. The present research is conducted to investigate whether specific gene polymorphism of ICAM-1 K469E (rs5498) and plasma redox status could be associated with laryngeal cancer (LC) development. Since there is no clear evidence which investigates the relationship between ICAM-1 polymorphism and ROS-mediated plasma protein oxidation in LC, our study is the first significant contribution for investigating the relationship. METHODS The study covered patients with primary LC and their age-matched healthy control subjects. Evaluation of ICAM-1 K469E (rs5498) gene polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism. Plasma redox status was assessed with spectrophotometric methods. RESULTS In the current paper, we found that LC patients with GG genotype had a decreasing trend for the plasma oxidative damage biomarker levels when compared with all allele genotypes (AA and AG). CONCLUSION We concluded that G allele of the ICAM-1 K469E gene plays a significant role in the optimal regulation of plasma redox homeostasis in patients with LC.
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Affiliation(s)
- Karolin Yanar
- Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mehmet Can Atayik
- Medical Program, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cem Horozoğlu
- Department of Medical Services and Techniques, Istanbul Gelişim University, Istanbul, Turkey
| | - Şeyda Demirkol
- Vocational School of Health Services, Biruni University, Istanbul, Turkey
| | - Bahadir Simsek
- Center for Coronary Artery Disease Minneapolis Heart Institute Foundation Minneapolis United States
| | - Aysegul Verim
- Department of Otorhinolaryngology/Head and Neck Surgery, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Özlem Küçükhüseyin
- Department of Molecular Medicine, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey
| | - Seval Aydın
- Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - İlhan Yaylım
- Department of Molecular Medicine, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey
| | - Ufuk Çakatay
- Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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19
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Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Allana SS, Alaswad K, Basir MB, Krestyaninov O, Khelimskii D, Gorgulu S, Davies RE, Benton SM, Khatri JJ, Poommipanit P, Choi JW, Jaber WA, Rinfret S, Nicholson W, Al-Azizi KM, Potluri S, Aygul N, Altunkeser BB, Koutouzis M, Tsiafoutis I, Milkas A, ElGuindy AM, Abi Rafeh N, Goktekin O, Mastrodemos OC, Rangan BV, Sandoval Y, Burke MN, Brilakis ES. Incidence, mechanisms, treatment, and outcomes of donor vessel injury during percutaneous coronary interventions for chronic total occlusion. Catheter Cardiovasc Interv 2023; 102:585-593. [PMID: 37560823 DOI: 10.1002/ccd.30798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/22/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Donor vessel injury is a potentially life-threatening complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). AIMS Our goal was to examine the incidence, mechanisms, treatment, and outcomes of patients with donor vessel injury in a large multicenter CTO PCI registry. METHODS We analyzed the baseline clinical and angiographic characteristics, and procedural outcomes of 12,349 CTO PCIs performed between 2012 and 2022 at 44 centers. RESULTS The incidence of donor vessel injury was 0.35% (n = 43). The baseline clinical characteristics of patients with and without donor vessel injury were similar. Cases complicated by donor vessel injury were more complex with higher Japanese CTO score (2.9 ± 1.1 vs. 2.4 ± 1.3; p = 0.004) and lower procedural success rate (69.8% vs. 85.2%; p = 0.004). The retrograde approach was used more commonly in donor vessel injury cases (68.9% vs. 30.9%; p < 0.001). Most (53.5%) donor vessel injuries were guide catheter-induced, whereas 20.9% were due to donor vessel thrombosis. Of the 43 patients with donor vessel injury, 36 (83.7%) were treated with stenting and seven (16.3%) received a left ventricular assist device. The incidence of major adverse cardiovascular events (MACEs) was significantly higher in cases with donor vessel injury (23.3% vs. 2.0%; p < 0.001). Of the 43 patients with donor vessel injury, five patients (11.6%) experienced acute myocardial infarction and four patients (9.3%) died. CONCLUSIONS Donor vessel injury, occurred in 0.35% of CTO PCIs performed by experienced operators, was mainly due to guide catheter-induced dissection or thrombosis and was associated with lower procedural success and higher MACE.
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Affiliation(s)
- Spyridon Kostantinis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | - Mir B Basir
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | - Oleg Krestyaninov
- Department of Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Dmitrii Khelimskii
- Department of Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | - Rhian E Davies
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | - Stewart M Benton
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | | | - Paul Poommipanit
- Department of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Wissam A Jaber
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Stephane Rinfret
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - William Nicholson
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Karim M Al-Azizi
- Department of Cardiology, The Heart Hospital - Plano, Plano, Texas, USA
| | - Srinivasa Potluri
- Department of Cardiology, The Heart Hospital - Plano, Plano, Texas, USA
| | - Nazif Aygul
- Department of Cardiology, Selcuk University Medical Faculty, Konya, Turkey
| | | | - Michael Koutouzis
- Department of Cardiology, Red Cross Hospital of Athens, Athens, Greece
| | | | - Anastasios Milkas
- Department of Cardiology, Athens Naval and Veterans Hospital, Athens, Greece
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Los Angeles, USA
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Olga C Mastrodemos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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20
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Karacsonyi J, Stanberry L, Simsek B, Kostantinis S, Allana SS, Rempakos A, Okeson B, Alaswad K, Basir MB, Jaffer F, Poommipanit P, Khatri J, Patel M, Mahmud E, Sheikh A, Wollmuth JR, Yeh RW, Chandwaney RH, ElGuindy AM, Abi Rafeh N, Schimmel DR, Benzuly K, Burke MN, Rangan BV, Mastrodemos OC, Sandoval Y, Ungi I, Brilakis ES. Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2023; 202:111-118. [PMID: 37429059 DOI: 10.1016/j.amjcard.2023.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/12/2023]
Abstract
Estimating the likelihood of urgent mechanical circulatory support (MCS) can facilitate procedural planning and clinical decision-making in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,784 CTO PCIs performed between 2012 and 2021 at 12 centers. The variable importance was estimated by a bootstrap applying a random forest algorithm to a propensity-matched sample (a ratio of 1:5 matching cases with controls on center). The identified variables were used to predict the risk of urgent MCS. The performance of the risk model was assessed in-sample and on 2,411 out-of-sample procedures that did not require urgent MCS. Urgent MCS was used in 62 (2.2%) of cases. Patients who required urgent MCS were older (70 [63 to 77] vs 66 [58 to 73] years, p = 0.003) compared with those who did not require urgent MCS. Technical (68% vs 87%, p <0.001) and procedural success (40% vs 85%, p <0.001) was lower in the urgent MCS group compared with cases that did not require urgent MCS. The risk model for urgent MCS use included retrograde crossing strategy, left ventricular ejection fraction, and lesion length. The resulting model demonstrated good calibration and discriminatory capacity with the area under the curve (95% confidence interval) of 0.79 (0.73 to 0.86) and specificity and sensitivity of 86% and 52%, respectively. In the out-of-sample set, the specificity of the model was 87%. The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention CTO MCS score can help estimate the risk of urgent MCS use during CTO PCI.
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Affiliation(s)
- Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Larissa Stanberry
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Salman S Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Brynn Okeson
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Mir B Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Farouc Jaffer
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul Poommipanit
- Department of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mitul Patel
- Cardiovascular Institute, VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - Ehtisham Mahmud
- Cardiovascular Institute, VA San Diego Healthcare System and University of California San Diego, La Jolla, California
| | - Abdul Sheikh
- Interventional Cardiology Department, WellStar Health System, Marietta, Georgia
| | - Jason R Wollmuth
- Interventional Cardiology, Providence Heart Institute, Portland, Oregon
| | - Robert W Yeh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Raj H Chandwaney
- Interventional Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Louisiana
| | - Daniel R Schimmel
- Cardiovascular Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Keith Benzuly
- Cardiovascular Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Imre Ungi
- Division of Invasive Cardiology, Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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21
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Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Allana SS, Alaswad K, Basir MB, Davies RE, Benton SM, Krestyaninov O, Khelimskii D, Jaber WA, Rinfret S, Nicholson W, Frizzell J, Jaffer FA, Khatri JJ, Poommipanit P, Choi JW, Chandwaney R, Jefferson BK, Patel TN, Al-Azizi KM, Potluri S, Aygul N, ElGuindy AM, Abi Rafeh N, Goktekin O, Alexandrou M, Mastrodemos OC, Rangan BV, Sandoval Y, Burke MN, Brilakis ES, Gorgulu S. Impact of target vessel on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention. J Invasive Cardiol 2023; 35. [PMID: 37983108 DOI: 10.25270/jic/23.00139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND There is limited information on the impact of the target vessel on the procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 11,580 CTO PCIs performed between 2012 and 2022 at 44 centers. RESULTS The most common CTO target vessel was the right coronary artery (RCA) (53.1%) followed by the left anterior descending artery (LAD) (26.0%) and the left circumflex artery (LCX) (19.8%). RCA CTOs were longer and more complex, with a higher Japanese CTO score compared with LAD or LCX CTOs. Technical success was higher among LAD (88.8%) lesions when compared with RCA (85.7%) or LCX (85.8%) lesions (P less than .001). The incidence of major adverse cardiovascular events (MACE) was overall 1.9% (n = 220) and was similar among target vessels (P=.916). There was a tendency toward more frequent utilization of the retrograde approach for more proximal occlusions in all 3 target vessels. When compared with all other RCA lesions combined, distal RCA lesions had higher technical success (87.7% vs 85.3%; P=.048). Technical success was similar between various locations of LAD CTOs (P=.704). First/second/third obtuse marginal branch had lower technical success when compared with all other LCX lesion locations (82.7% vs 86.8%; P=.014). There was no association between MACE and CTO location in all 3 target vessels. CONCLUSIONS LAD CTO PCIs had higher technical and procedural success rates among target vessels. The incidence of MACE was similar among target vessels and among various locations within the target vessel.
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Affiliation(s)
- Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | | | | | | | | | | | | | | | | | - Jarrod Frizzell
- The Christ Hospital, Ohio Heart and Vascular, Cincinnati, OH, USA
| | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, TX, USA
| | | | | | - Taral N Patel
- Tristar Centennial Medical Center, Nashville, TN, USA
| | | | | | - Nazif Aygul
- Selcuk University Medical Faculty, Konya, Turkey
| | | | | | | | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Sevket Gorgulu
- Biruni University Medical School, Istanbul, Turkey. E-mail:
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Rempakos A, Simsek B, Kostantinis S, Alexandrou M, Karacsonyi J, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke MN, Brilakis ES. Adverse events with intravascular lithotripsy after coronary use: A report from the FDA MAUDE database. J Invasive Cardiol 2023; 35. [PMID: 37983110 DOI: 10.25270/jic/23.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Percutaneous coronary intervention (PCI) on heavily calcified lesions has been associated with more complications.1 Intravascular lithotripsy (IVL) was recently approved for treating de novo calcified coronary lesions based on excellent safety and efficacy on several studies, but there are limited "real world" outcomes. We conducted a comprehensive search of the MAUDE database between February 12, 2021, and February 28, 2023 using the manufacturer and brand name tabs with the keywords "Shockwave Medical" and "Shockwave," respectively. Given that a single IVL catheter can fail or cause multiple adverse events through different mechanisms, we considered all possible outcomes. The MAUDE database is freely accessible and de-identified, obviating the need for institutional review board approval.
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Affiliation(s)
- Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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23
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Alexandrou M, Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Choi JW, Poommipanit P, Khatri JJ, Young L, Davies R, Benton S, Jaffer FA, Chandwaney R, Azzalini L, ElGuindy AM, Rafeh NA, Koutouzis M, Tsiafoutis I, Goktekin O, Gorgulu S, Rangan BV, Mastrodemos OC, Allana SS, Sandoval Y, Burke MN, Brilakis ES. Atrial fibrillation and chronic total occlusion percutaneous coronary intervention outcomes: insights from the Progress-CTO registry. J Invasive Cardiol 2023; 35. [PMID: 37983099 DOI: 10.25270/jic/23.00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND We examined the effect of atrial fibrillation on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We examined the baseline characteristics and procedural outcomes of 9,166 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023. RESULTS Atrial fibrillation was present in 1122 (12%) patients. These patients were older and had a higher incidence of comorbidities, such as hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease, lower left ventricular ejection fraction, and lower eGFR. Their CTOs were more likely to have moderate to severe calcification and longer lesion length. They also had higher mean J-CTO and PROGRESS-CTO complications (Acute MI, MACE, Mortality, Perforation, and Pericardiocentesis) scores. Patients with atrial fibrillation had higher prevalence of uncrossable and undilatable CTO lesions and required longer procedure (107 vs 119 min; P less than .001) and fluoroscopy (40 vs 43 min; P=.005) time. Technical success and MACE, including procedural/in-hospital bleeding, were similar in patients with and without atrial fibrillation. Although the crude incidence of MACE on follow-up (median 61 days) was significantly higher in patients with atrial fibrillation, the latter was not independently associated with adverse events on Cox proportional hazards analysis. CONCLUSIONS Patients with atrial fibrillation undergoing CTO PCI are older, have more comorbidities, higher lesion complexity, and longer procedure time, but similar technical success and in-hospital MACE. They have higher MACE and mortality during follow-up, but the difference is not significant after adjusting for potential confounding variables.
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Affiliation(s)
- Michaella Alexandrou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, TX, USA
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | | | | | | | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | | | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, Minnesota 55407.
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Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Rinfret S, Jaber W, Nicholson W, Gorgulu S, Alaswad K, Khatri J, Poommipanit P, Aygul N, Krestyanino O, Khelimskii D, Uretsky B, Goktekin O, Dattilo P, Potluri S, Al-Azizi K, Mastrodemos OC, Rangan BV, Allana SS, Sandoval Y, Burke MN, Brilakis ES. Frequency and outcomes of ad hoc chronic total occlusion percutaneous coronary intervention: insights from the progress-cto registry. J Invasive Cardiol 2023; 35:E329-E340. [PMID: 37769619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Although discouraged, ad hoc chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is occasionally performed. METHODS We examined the clinical, angiographic characteristics, and procedural outcomes of patients who underwent ad hoc CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436). RESULTS Of the 10,998 patients included in the registry, 899 (8.2%) underwent ad hoc CTO PCI. The incidence of ad hoc CTO PCI decreased from 18% in 2016 to 3% in 2022. Ad hoc CTO PCI patients had a lower prevalence of comorbidities and less complex angiographic characteristics demonstrated by lower J-CTO score (1.9±1.2 vs 2.4±1.3, P < .001). In these patients, PROGRESS-CTO major adverse cardiovascular events (MACE) (1.9±1.4 vs 2.5±1.7), mortality (1.2±1.0 vs 1.6±1.1), and perforation (1.5±1.2±2.2 vs 1.5) scores were lower (P < .001). Technical success was similar between the groups (86%). MACE were lower in the ad hoc CTO PCI group (.8% vs 2.0%, P=.009). Ad hoc CTO PCI was not associated with MACE after adjusting for potential confounders, odds ratio: .69 (95% confidence interval, .30-1.57). In patients with higher J-CTO scores, planned CTO PCI was associated with higher technical success (P < .001). CONCLUSION Approximately 8% of CTO PCI procedures are performed ad hoc, usually in less complex lesions and patients with lower complication risk. While ad hoc CTO PCI might be appropriate for carefully selected cases, a staged approach is recommended for most CTO PCI.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emmanouil S Brilakis
- Center for Complex Coronary Interventions, Minneapolis Heart Institute, Center for Coronary Artery Disease at the Minneapolis Heart Institute Foundation, 920 E 28th Street #300, Minneapolis, Minnesota, 55407.
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Page E, Kostantinis S, Karacsonyi J, Allana SS, Walser-Kuntz E, Rangan BV, Simsek B, Rynders B, Mastrodemos OC, Stanberry L, Avula V, Rempakos A, Burke N, Sandoval Y, Mooney M, Sorajja P, Traverse JH, Poulose A, Chavez I, Wang Y, Gössl M, Brilakis ES. Incidence, treatment and outcomes of coronary artery dissection during percutaneous coronary intervention. J Invasive Cardiol 2023; 35:E341-E354. [PMID: 37769612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Coronary artery dissection is a feared and potentially life-threatening complication of percutaneous coronary intervention (PCI). METHODS We examined the clinical, angiographic, and procedural characteristics, and outcomes of coronary dissection at a tertiary care institution. RESULTS Between 2014 and 2019, unplanned coronary dissection occurred in 141 of 10,278 PCIs (1.4%). Median patient age was 68 (60, 78) years, 68% were men, and 83% had hypertension. The prevalence of diabetes (29%), and prior PCI (37%) was high. Most target vessels were significantly diseased: 48% had moderate/severe tortuosity and 62% had moderate/severe calcification. The most common cause of dissection was guidewire advancement (30%), followed by stenting (22%), balloon angioplasty (20%), and guide-catheter engagement (18%). TIMI flow was 0 in 33% and 1-2 in 41% of cases. Intravascular imaging was used in 17% of the cases. Stenting was used to treat the dissection in 73% of patients. There was no consequence of dissection in 43% of patients. Technical and procedural success was 65% and 55%, respectively. In-hospital major adverse cardiovascular events occurred in 23% of patients: 13 (9%) had an acute myocardial infarction (MI), 3 (2%) had emergency coronary artery bypass graft surgery, and 10 (7%) died. During a mean follow up of 1612 days, 28 (20%) patients died, and the rate of target lesion revascularization was 11.3% (n=16). CONCLUSION Coronary artery dissection is an infrequent complication of PCI, but is associated with adverse clinical outcomes, such as death and acute MI.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emmanouil S Brilakis
- Director of the Center for Complex Coronary Interventions, Minneapolis Heart Institute, Chairman of the Center for Coronary Artery Disease at the Minneapolis Heart Institute Foundation, 920 E 28th Street #300, Minneapolis, Minnesota 55407.
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Allana SS, Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Alaswad K, Krestyaninov O, Khelimskiid D, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Patel MP, Mahmud E, Koutouzis M, Tsiafoutis I, Gorgulu S, Elbarouni B, Nicholson W, Jaber W, Rinfret S, Rafeh NA, Goktekin O, ElGuindy AM, Sandoval Y, Burke MN, Rangan BV, Brilakis ES. Distal Target Vessel Quality and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:1490-1500. [PMID: 37380231 DOI: 10.1016/j.jcin.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/01/2023] [Accepted: 03/07/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Distal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm. OBJECTIVES The study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention. METHODS We examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as <2 mm diameter or with significant diffuse atherosclerotic disease. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. RESULTS A total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01). CONCLUSIONS A poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose.
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Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasois Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | - Dmitrii Khelimskiid
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | | | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | | | | | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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27
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Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Rangan BV, Mastrodemos OC, Kirtane AJ, Bortnick AE, Jneid H, Azzalini L, Milkas A, Alaswad K, Linzer M, Egred M, Allana SS, Rao SV, Sandoval Y, Brilakis ES. International Psychological Well-Being Survey of Interventional Cardiologists. JACC Cardiovasc Interv 2023; 16:1401-1407. [PMID: 37316149 DOI: 10.1016/j.jcin.2023.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Anna E Bortnick
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hani Jneid
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mark Linzer
- Institute for Professional Worklife, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Sunil V Rao
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
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28
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Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Gorgulu S, Alaswad K, Choi JW, Jaffer FA, Doshi D, Poommipanit P, Aygul N, Krestyaninov O, Khelimskii D, Uretsky B, Davies R, Goktekin O, ElGuindy A, Jefferson BK, Patel TN, Patel M, Sheikh A, Karmpaliotis D, Potluri S, Al-Azizi K, Mastrodemos OC, Rangan BV, Allana SS, Sandoval Y, Burke MN, Brilakis ES. Periprocedural Mortality in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry. Circ Cardiovasc Interv 2023:e012977. [PMID: 37259859 DOI: 10.1161/circinterventions.123.012977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Death is a rare but devastating complication of chronic total occlusion (CTO) percutaneous coronary intervention. METHODS We examined the clinical characteristics and procedural outcomes of patients who died periprocedurally in the Prospective Global Registry for the Study of CTO Interventions (PROGRESS-CTO). RESULTS Of the 12 928 patients who underwent CTO percutaneous coronary intervention between 2012 and 2022, 52 (0.4%) died during the index hospitalization. Patients who died were more likely to have a history of heart failure (43% versus 28%; P=0.023). The J-CTO ([Multicenter CTO Registry of Japan]; 2.8±1.1 versus 2.4±1.3; P=0.019), PROGRESS-CTO mortality (2.6±0.9 versus 1.6±1.1; P<0.001), and PROGRESS-CTO pericardiocentesis (2.9±1.1 versus 1.9±1.3; P<0.001) scores were higher in patients who died. In these patients, the use of left ventricular assist devices was also higher (41% versus 3.5%; P<0.001), and retrograde crossing was more often the first crossing strategy (33% versus 13%; P<0.001). The cause of death was cardiac in 43 patients (83%) and noncardiac in 9 patients (17%). Complications leading to cardiac death were: tamponade in 30 patients (58%), acute myocardial infarction in 9 (17.3%), and cardiac arrest/shock in 4 (7.7%). Noncardiac causes of death were: stroke in 3 (5.8%), renal failure in 2 (3.8%), respiratory distress in 2 (3.8%), and hemorrhagic shock in 2 (3.8%). CONCLUSIONS Approximately 0.4% of patients who underwent CTO percutaneous coronary intervention died during the index hospitalization. The main cause of death was tamponade in 58%. PROGRESS-CTO complication scores might help in risk stratification and procedural planning in patients undergoing CTO percutaneous coronary intervention. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique Identifier: NCT02061436.
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Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.)
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.)
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.)
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.)
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University School of Medicine, Istanbul, Turkey (S.G.)
| | | | - James W Choi
- Division of Cardiology, Texas Health Presbyterian Hospital, Dallas (J.W.C.)
| | - Farouc A Jaffer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (F.A.J., D.D.)
| | - Darshan Doshi
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (F.A.J., D.D.)
| | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, OH (P.P.)
| | - Nazif Aygul
- Department of Cardiology, Selcuk University, Konya, Turkey (N.A.)
| | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation (O.K., D.K.)
| | - Dmitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation (O.K., D.K.)
| | - Barry Uretsky
- Department of Cardiology, Central Arkansas Veterans Health System, and University of Arkansas for Medical Sciences, Little Rock (B.U.)
| | - Rhian Davies
- Department of Cardiology, Wellspan York Hospital, PA (R.D.)
| | - Omer Goktekin
- Memorial Bahcelievler Hospital, Istanbul, Turkey (O.G.)
| | - Ahmed ElGuindy
- Department of Cardiology, Aswan Heart Centre, Egypt (A.E.)
| | - Brian K Jefferson
- Division of Cardiology, Tristar Centennial Medical Center, Nashville, TN (B.K.J, T.N.P.)
| | - Taral N Patel
- Division of Cardiology, Tristar Centennial Medical Center, Nashville, TN (B.K.J, T.N.P.)
| | - Mitul Patel
- Division of Cardiovascular Medicine, UCSD Medical Center, La Jolla, CA (M.P.)
| | | | - Dimitri Karmpaliotis
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (D.K.)
| | - Srinivasa Potluri
- Department of Medicine, Heart Hospital Baylor Plano, TX (S.P., K.A.-A.)
| | - Karim Al-Azizi
- Department of Medicine, Heart Hospital Baylor Plano, TX (S.P., K.A.-A.)
| | - Olga C Mastrodemos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.)
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.)
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.)
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.)
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.)
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.)
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29
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Rempakos A, Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Mastrodemos OC, Allana S, Sandoval Y, Kalyanasundaram A, Brilakis ES. Assessment of the ERCTO Score for Predicting Success in Retrograde Chronic Total Occlusion Percutaneous Coronary Interventions in the PROGRESS-CTO Registry. J Invasive Cardiol 2023; 35:E294-E296. [PMID: 37410746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND The retrograde strategy is a common approach used in complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The ERCTO Retrograde score is a tool that aims to predict the likelihood of technical success for retrograde CTO PCI procedures by evaluating 5 parameters: calcification, distal opacification, proximal tortuosity, collateral connection classification, and operator volume. METHODS We evaluated the performance of the ERCTO Retrograde score using data from 2341 patients enrolled in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) at 35 centers between 2013 and 2023. RESULTS Retrograde CTO PCI was the primary crossing strategy in 871 cases (37.2%) and a secondary crossing strategy in 1467 cases (62.8%). Technical success was achieved in 1,810 cases (77.3%). The technical success rate was higher for primary retrograde cases compared with secondary retrograde cases (79.8% vs 75.9%; P=.031). The ERCTO Retrograde score was positively associated with the likelihood of procedural success. The c-statistic of the ERCTO retrograde score was 0.636 (95% confidence intervals [CI]: .610-.662) for all cases and 0.651 (95% CI: .607-.695) for primary retrograde cases. CONCLUSIONS The ERCTO Retrograde score has modest predictive capacity for technical success in retrograde CTO PCI.
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Simsek B, Brilakis ES. Reply: Lack of Exposure to Catheterization in Adults With CHD During IC Fellowship: Gap in IC Fellowship Curriculum? JACC Cardiovasc Interv 2023; 16:1309. [PMID: 37225305 DOI: 10.1016/j.jcin.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023]
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Page E, Kostantinis S, Karacsonyi J, Allana SS, Walser-Kuntz E, Rangan BV, Simsek B, Rynders B, Mastrodemos OC, Stanberry L, Avula V, Rempakos A, Burke MN, Sandoval Y, Mooney M, Sorajja P, Traverse JH, Poulose A, Chavez I, Wang Y, Gössl M, Brilakis ES. Incidence, Treatment and Outcomes of Coronary Artery Dissection During Percutaneous Coronary Intervention. J Invasive Cardiol 2023:JIC20230516-1. [PMID: 37220639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Coronary artery dissection is a feared and potentially life-threatening complication of percutaneous coronary intervention (PCI). METHODS We examined the clinical, angiographic, and procedural characteristics, and outcomes of coronary dissection at a tertiary care institution. RESULTS Between 2014 and 2019, unplanned coronary dissection occurred in 141 of 10,278 PCIs (1.4%). Median patient age was 68 (60, 78) years, 68% were men, and 83% had hypertension. The prevalence of diabetes (29%), and prior PCI (37%) was high. Most target vessels were significantly diseased: 48% had moderate/severe tortuosity and 62% had moderate/severe calcification. The most common cause of dissection was guidewire advancement (30%), followed by stenting (22%), balloon angioplasty (20%), and guide-catheter engagement (18%). TIMI flow was 0 in 33% and 1-2 in 41% of cases. Intravascular imaging was used in 17% of the cases. Stenting was used to treat the dissection in 73% of patients. There was no consequence of dissection in 43% of patients. Technical and procedural success was 65% and 55%, respectively. In-hospital major adverse cardiovascular events occurred in 23% of patients: 13 (9%) had an acute myocardial infarction (MI), 3 (2%) had emergency coronary artery bypass graft surgery, and 10 (7%) died. During a mean follow up of 1,612 days, 28 (20%) patients died, and the rate of target lesion revascularization was 11.3% (n=16). CONCLUSION Coronary artery dissection is an infrequent complication of PCI, but is associated with adverse clinical outcomes, such as death and acute MI.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Chairman of the Center for Coronary Artery Disease at the Minneapolis Heart Institute Foundation, 920 E 28th Street #300, Minneapolis, Minnesota 55407 USA.
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Kostantinis S, Rempakos A, Simsek B, Karacsonyi J, Allana SS, Alaswad K, Basir MB, Krestyaninov O, Khelimskii D, Gorgulu S, Davies RE, Benton SM, Khatri JJ, Poommipanit P, Choi JW, Jaber WA, Rinfret S, Nicholson W, Aygul N, Altunkeser BB, ElGuindy AM, Abi Rafeh N, Goktekin O, Mastrodemos OC, Rangan BV, Sandoval Y, Burke MN, Brilakis ES. Aortocoronary dissection during percutaneous coronary interventions for chronic total occlusion: Insights from the PROGRESS-CTO registry. Catheter Cardiovasc Interv 2023. [PMID: 37172209 DOI: 10.1002/ccd.30680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/27/2023] [Accepted: 04/30/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND Aortocoronary dissection is a potentially serious complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS We examined the incidence, mechanisms, treatment, and outcomes of aortocoronary dissection among 12,117 CTO PCIs performed between 2012 and 2022 in a large multicenter CTO PCI registry. RESULTS The incidence of aortocoronary dissection was 0.2% (n = 27). Most aortocoronary dissections occurred in the right coronary artery (96.3%, n = 26). The baseline clinical characteristics of patients with and without aortocoronary dissection were similar, except for dyslipidemia, which was less common in patients with aortocoronary dissection (70.4% vs. 86.0%; p = 0.019). The retrograde approach was used more commonly among cases complicated by aortocoronary dissection (59.3% vs. 31.0%; p = 0.002). Technical (74.1% vs. 86.6%; p = 0.049) and procedural (70.4% vs. 85.2%; p = 0.031) success rates were lower among aortocoronary dissection cases, with a similar incidence of in-hospital major adverse cardiovascular events (3.7% vs. 2.0%; p = 0.541). Of the 27 patients with aortocoronary dissection, 19 (70.4%) were treated with ostial stenting and 8 (29.6%) were treated conservatively without subsequent adverse clinical outcomes. No patients required emergency surgery. Follow-up was available for 22 patients (81.5%): during a mean follow up of 767 (±562) days, the incidence of in-stent restenosis was 11.1% (n = 3). CONCLUSIONS Aortocoronary dissection occurred in 0.2% of CTO PCIs performed by experienced operators, was associated with lower technical and procedural success, and was treated most commonly with ostial stenting. None of the patients required emergency cardiac surgery.
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Affiliation(s)
- Spyridon Kostantinis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | - Mir Babar Basir
- Department of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan, USA
| | - Oleg Krestyaninov
- Department of Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Dmitrii Khelimskii
- Department of Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | - Rhian E Davies
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | - Stewart M Benton
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | | | - Paul Poommipanit
- Department of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Wissam A Jaber
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Stephane Rinfret
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - William Nicholson
- Department of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Nazif Aygul
- Department of Cardiology, Selcuk University Medical Faculty, Konya, Turkey
| | | | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Louisiana, USA
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Olga C Mastrodemos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Allana SS, Karacsonyi J, Kostantinis S, Simsek B, Rempakos A, Brilakis ES. Fenestration of a PK Papyrus Stent From an Extraplaque Space Into the True Lumen. JACC Cardiovasc Interv 2023; 16:1109-1112. [PMID: 37164612 DOI: 10.1016/j.jcin.2023.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
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Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Choi JW, Poommipanit P, Khatri JJ, Jaber W, Rinfret S, Nicholson W, Gorgulu S, Jaffer FA, Chandwaney R, Ybarra LF, Bagur R, Alaswad K, Krestyaninov O, Khelimskii D, Karmpaliotis D, Uretsky BF, Soylu K, Yildirim U, Potluri S, Al-Azizi KM, Rangan BV, Mastrodemos OC, Allana S, Sandoval Y, Burke MN, Brilakis ES. Procedural Time and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2023; 197:55-64. [PMID: 37156067 DOI: 10.1016/j.amjcard.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 05/10/2023]
Abstract
Chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) can be lengthy procedures. We sought to investigate the effect of procedural time on CTO PCI outcomes. We examined the procedural time required for the various steps of CTO PCI in 6,442 CTO PCIs at 40 US and non-US centers between 2012 and 2022. The mean and median procedure times were 129 ± 76 and 112 minutes, respectively, with no significant change over time. The median times from access to wire insertion, guidewire manipulation time, and post crossing were 20, 32, and 53 minutes, respectively. Lesions crossed in <30 minutes were less complex, as reflected by lower Japanese CTO score (1.89 ± 1.19, p <0.001) than lesions that were not successfully crossed (2.88 ± 1.22) and lesions that were crossed in ≥30 minutes (2.85 ± 1.13). The likelihood of successful crossing if crossing was not achieved after 30, 90, and 180 minutes were a 76.7%, 60.7%, and 42.7%, respectively. The parameters independently associated with ≥30 minutes guidewire manipulation time in patients with a primary antegrade approach included left anterior descending target vessel, proximal cap ambiguity, blunt/no stump, occlusion length, previous failed attempt, medium/severe calcification, and medium/severe tortuosity. The mean duration of CTO PCI is approximately 2 hours (∼20% of time for access to wire insertion, ∼30% wire manipulation time, and ∼50% postwiring time). Guidewire crossing time was shorter in less complex lesions and in cases without complications.
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Affiliation(s)
- Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Paul Poommipanit
- Section of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | | | - Wissam Jaber
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Stephane Rinfret
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - William Nicholson
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | - Farouc A Jaffer
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Raj Chandwaney
- Department of Invasive Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma
| | - Luiz F Ybarra
- Department of Cardiology, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Department of Cardiology, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Cardiovascular Division, Detroit, Michigan
| | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Dmitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | | | - Barry F Uretsky
- Department of Cardiology, Central Arkansas Veterans Healthcare System, Little Rock, Arizona
| | - Korhan Soylu
- Department of Cardiology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Ufuk Yildirim
- Department of Cardiology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Srinivasa Potluri
- Department of Cardiac Catheterization, The Heart Hospital Baylor Plano, Plano, Texas
| | - Karim M Al-Azizi
- Department of Cardiac Catheterization, The Heart Hospital Baylor Plano, Plano, Texas
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Salman Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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Karacsonyi J, Kostantinis S, Simsek B, Basir M, Megaly M, Ali Z, Kirtane A, McEntegart M, Brilakis ES, Alaswad K. Intravascular Imaging Use in Percutaneous Coronary Interventions of Chronic Total Occlusions. J Invasive Cardiol 2023; 35:E265-E268. [PMID: 37169391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) can assist percutaneous coronary intervention (PCI) of chronic total occlusions (CTO). METHODS We analyzed 8,983 CTO PCIs performed in 8,771 patients between 2012 and 2022 at 39 centers. RESULTS Overall, IVUS was used in 44.5% of the cases, for crossing in 11.5% and for stent optimization in 33.1%. IVUS for stent optimization was used more often for complex lesions with higher prevalence of calcification (51.2% vs 34.3%; P<.001); was associated with lower air kerma radiation dose (1.78 [1.00, 3.09] vs 2.30 (1.35, 3.91) min, P<.001) and contrast volume (190 [138, 258] vs 220 [160, 300] ml, P<.001). Among cases with successful guidewire crossing, those that used IVUS for stent optimization had higher technical (99.3% vs 96.3%; P<.001) and procedural (96.1% vs 94.6%, P=.002) success rates and similar major adverse complication event rates (2.04% vs 1.62%; P=.176). The use of IVUS for stent optimization significantly increased over time. CONCLUSION In a contemporary, multicenter registry, IVUS was used in 44.5% and its use for stent optimization significantly increased over time. Cases where IVUS was used for stent optimization had higher technical and procedural success and similar risk of complications compared with cases where IVUS was not used for stent optimization.
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Allana SS, Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Brilakis ES. Tunnel in Landslide Technique to "Block and Deliver": A Novel Method to Deliver Covered Stent for Coronary Perforation. JACC Cardiovasc Interv 2023; 16:730-733. [PMID: 36990565 DOI: 10.1016/j.jcin.2023.01.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
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Simsek B, Khatri J, Young L, Kostantinis S, Karacsonyi J, Rempakos A, Alaswad K, Jaffer FA, Doshi D, Gorgulu S, Goktekin O, Kerrigan J, Haddad EV, Rinfret S, Jaber WA, Nicholson W, Krestyaninov O, Khelimskii D, Choi JW, Patel TN, Jefferson BK, Bradley SM, Rao SV, Rangan BV, Allana SS, Sandoval Y, Burke MN, Brilakis ES, Poommipanit PB. Same day discharge versus overnight observation following chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry. Catheter Cardiovasc Interv 2023; 101:1028-1035. [PMID: 36960766 DOI: 10.1002/ccd.30644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/31/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Same day discharge (SDD) following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS We evaluated the clinical, angiographic, and procedural characteristics of patients discharged the same day versus those kept for overnight observation in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO, NCT02061436). RESULTS Of the 7181 patients who underwent CTO PCI, 943 (13%) had SDD. The SDD rate increased from 3% in 2015 to 21% in 2022. Patients with SDD were less likely to have a history of heart failure (21% vs. 26%, p = 0.005), chronic lung disease (10% vs. 15%, p = 0.001), or anemia (12% vs. 19%, p < 0.001). Technical success (87% vs. 88%, p = 0.289) was similar, but in-hospital major adverse cardiovascular events (0.0% vs. 0.4%, p = 0.041) were lower in SDD. In multivariable logistic regression analysis, prior myocardial infarction odds ratio (OR): 0.71 (95% confidence interval [CI]: 0.59-0.87, p = 0.001), chronic lung disease OR: 0.64 (95% CI: 0.47-0.88, p = 0.006), and increasing procedure time OR: 0.93 (95% CI: 0.91-0.95, p < 0.001, per 10-min increase) were associated with overnight observation, while radial-only access OR: 2.45 (95% CI: 2.03-2.96, p < 0.001) had the strongest association with SDD. In the SDD, 2 (0.4%) of 514 patients were readmitted, due to retroperitoneal bleeding (n = 1) and ischemic stroke (n = 1). CONCLUSION The overall frequency of SDD after CTO PCI was 13% and has been increasing over time. SDD is feasible in select patients following CTO PCI, and radial-only access had the strongest association with SDD.
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Affiliation(s)
- Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Jaikirshan Khatri
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Laura Young
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Farouc A Jaffer
- Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Darshan Doshi
- Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University School of Medicine, Istanbul, Turkey
| | - Omer Goktekin
- Division of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Jimmy Kerrigan
- Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee, USA
| | - Elias V Haddad
- Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee, USA
| | | | - Wissam A Jaber
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | | | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Dimitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - James W Choi
- Texas Health Heart & Vascular Specialists, Dallas, Texas, USA
| | - Taral N Patel
- Department of Cardiology, Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | - Brian K Jefferson
- Department of Cardiology, Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | - Steven M Bradley
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Sunil V Rao
- Division of Cardiology, NYU Langone Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul B Poommipanit
- Department of Cardiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Karacsonyi J, Kostantinis S, Simsek B, Rempakos A, Allana SS, Alaswad K, Krestyaninov O, Khatri J, Poommipanit P, Jaffer FA, Choi J, Patel M, Gorgulu S, Koutouzis M, Tsiafoutis I, Sheikh AM, ElGuindy A, Elbarouni B, Patel T, Jefferson B, Wollmuth JR, Yeh R, Karmpaliotis D, Kirtane AJ, McEntegart MB, Masoumi A, Davies R, Rangan BV, Mastrodemos OC, Doshi D, Sandoval Y, Basir MB, Megaly MS, Ungi I, Abi Rafeh N, Goktekin O, Brilakis ES. Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention. J Pers Med 2023; 13:515. [PMID: 36983697 PMCID: PMC10051461 DOI: 10.3390/jpm13030515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions.
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Affiliation(s)
- Judit Karacsonyi
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Athanasios Rempakos
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Salman S. Allana
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Oleg Krestyaninov
- Meshalkin Novosibirsk Research Institute, Novosibirsk 630055, Russia
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Paul Poommipanit
- Cardiology, Case Western Reserve University, University Hospitals, Cleveland, OH 44610, USA
| | - Farouc A. Jaffer
- Department of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James Choi
- Department of Cardiology, Baylor Heart and Vascular Hospital, Dallas, TX 75226, USA
| | - Mitul Patel
- Cardiovascular Institute, University of California San Diego, VA San Diego Healthcare System, La Jolla, CA 92037, USA
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University School of Medicine, Istanbul 34295, Turkey
| | - Michalis Koutouzis
- First Cardiology Department Athens, Red Cross Hospital of Athens, Athens 11526, Greece
| | - Ioannis Tsiafoutis
- First Cardiology Department Athens, Red Cross Hospital of Athens, Athens 11526, Greece
| | - Abdul M. Sheikh
- Interventional Cardiology Department, Wellstar Health System, Marietta, GA 30141, USA
| | - Ahmed ElGuindy
- Aswan Heart Centre, Department of Cardiology, Magdi Yacoub Foundation, Aswan 4271185, Egypt
| | - Basem Elbarouni
- Department of Internal Medicine, St. Boniface General Hospital, Winnipeg, MB R2H 2A6, Canada
| | - Taral Patel
- Interventional Cardiology, Tristar Centennial Medical Center, Nashville, TN 37203, USA
| | - Brian Jefferson
- Interventional Cardiology, Tristar Centennial Medical Center, Nashville, TN 37203, USA
| | - Jason R. Wollmuth
- Interventional Cardiology, Providence Heart institute, Portland, OR 97213, USA
| | - Robert Yeh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Dimitrios Karmpaliotis
- Interventional Cardiology, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ 07960, USA
| | - Ajay J. Kirtane
- Division of Cardiology, Columbia University, New York, NY 10032, USA
| | | | - Amirali Masoumi
- Interventional Cardiology, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ 07960, USA
| | - Rhian Davies
- Interventional Cardiology, WellSpan York Hospital, York, PA 17403, USA
| | - Bavana V. Rangan
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Olga C. Mastrodemos
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Darshan Doshi
- Department of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Yader Sandoval
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
| | - Mir B. Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Michael S. Megaly
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Imre Ungi
- Division of Invasive Cardiology, Department of Internal Medicine and Cardiology Center, University of Szeged, 6725 Szeged, Hungary
| | - Nidal Abi Rafeh
- Cardiology, North Oaks Health System, Hammond, LA 70403, USA
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul 34676, Turkey
| | - Emmanouil S. Brilakis
- Center for Coronary Artery Disease, Abbott Northwestern Hospital, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA
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Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Rangan BV, Mastrodemos OC, Patel UA, Allana S, Azzalini L, Kearney KE, Hirai T, Sandoval Y, Burke MN, Brilakis ES. A Systematic Review of Periprocedural Risk Prediction Scores in Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2023; 193:118-125. [PMID: 36905687 DOI: 10.1016/j.amjcard.2023.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 03/11/2023]
Abstract
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with high incidence of complications. We queried PubMed and the Cochrane Library (last search: October 26, 2022) for CTO PCI-specific periprocedural complication risk scores. We identified 8 CTO PCI-specific risk scores: (1) Angiographic coronary artery perforation (OPEN-CLEAN [Outcomes, Patient Health Status, and Efficiency iN (OPEN) Chronic Total Occlusion (CTO) Hybrid Procedures - CABG, Length (occlusion), EF <50%, Age, CalcificatioN] perforation, c-statistic 0.75): previous coronary artery bypass graft surgery, occlusion length 20 to 60 mm or ≥60 mm, left ventricular ejection fraction (LVEF) <50%, age 50 to 70 years or ≥70 years, heavy calcification. (2) Major adverse cardiovascular events (MACE) (PROGRESS-CTO complication, c-statistic 0.76): age >65 years, lesion length ≥23 mm, retrograde strategy, and (3) MACE (PROGRESS-CTO MACE, c-statistic 0.74): age ≥65 years, female gender, moderate/severe calcification, blunt/no stump, anterograde dissection and re-entry (ADR) or retrograde strategy. (4) All-cause mortality (PROGRESS-CTO mortality, c-statistic 0.80): age ≥65, moderate/severe calcification, LVEF ≤45%, ADR or retrograde strategy. (5) Perforation requiring pericardiocentesis (PROGRESS-CTO pericardiocentesis, c-statistic 0.78): age ≥65 years, moderate/severe calcification, female gender, ADR or retrograde strategy. (6) Acute myocardial infarction (PROGRESS-CTO acute myocardial infarction, c-statistic 0.72): previous coronary artery bypass graft surgery, atrial fibrillation, blunt/no stump. (7) Perforation requiring any treatment (PROGRESS-CTO perforation, c-statistic 0.74): age ≥65 years, moderate/severe calcification, blunt/no stump, ADR, or retrograde strategy. (8) Contrast-induced acute kidney injury (c-statistic 0.84): age ≥75, LVEF <40%, serum creatinine >1.5 mg/100 ml, serum albumin ≤30, 30<albumin≤40 or >40 g/L. There are 8 CTO PCI periprocedural risk scores that may facilitate risk assessment and procedural planning in patients who underwent CTO PCI.
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Affiliation(s)
- Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Urvi A Patel
- School of Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Salman Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Lorenzo Azzalini
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Kathleen E Kearney
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Taishi Hirai
- Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
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Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Choi JW, Poommipanit P, Khatri JJ, Jaber W, Rinfret S, Nicholson W, Gorgulu S, Jaffer FA, Chandwaney R, Ybarra LF, Bagur R, Alaswad K, Krestyaninov O, Khelimskii D, Karmpaliotis D, Uretsky BF, Soylu K, Yildirim U, Potluri S, Rangan BV, Mastrodemos OC, Allana S, Sandoval Y, Burke NM, Brilakis ES. Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention After a Previous Failed Attempt. Am J Cardiol 2023; 193:61-69. [PMID: 36871531 DOI: 10.1016/j.amjcard.2023.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/06/2023] [Accepted: 01/22/2023] [Indexed: 03/06/2023]
Abstract
The impact of a previous failure on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We examined the clinical and angiographic characteristics and procedural outcomes of 9,393 patients who underwent 9,560 CTO PCIs at 42 United States and non-United States centers between 2012 and 2022. A total of 1,904 CTO lesions (20%) had a previous failed PCI attempt. Patients who underwent reattempt CTO PCI were more likely to have a family history of coronary artery disease (37% vs 31%, p <0.001) and dyslipidemia (87.9% vs 84.3%, p <0.001) but were less likely to have heart failure (25.1% vs 29.5%; p <0.001) and cerebrovascular disease (8.7% vs 10.4%, p = 0.04). Patients with previous failure had a higher Japanese CTO (3.33 ± 1.16 vs 2.12 ± 1.19, p <0.001) score and required longer procedure (120 vs 111 minutes, p <0.001) and fluoroscopy (46.9 vs 40.4 minutes, p <0.001) times and higher air kerma radiation dose (2.3 vs 2.1 gray, p = 0.013). Technical success rates (84.3% vs 86.5%, p = 0.011) were lower in patients with a previous failure compared with patients who underwent first-attempt CTO PCI with no significant difference in in-hospital major adverse cardiac events. After adjusting for potential confounders, a previous failure was not associated with technical failure. Operators performing >30 CTO PCIs annually were more likely to achieve technical success in patients with previous failure. In conclusion, a previous failed CTO PCI attempt was associated with higher lesion complexity, longer procedure time, and lower technical success; however, the association with lower technical success did not remain significant in multivariable analysis.
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Affiliation(s)
- Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, Texas
| | - Paul Poommipanit
- Section of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | | | - Wissam Jaber
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Stephane Rinfret
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - William Nicholson
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | - Farouc A Jaffer
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Raj Chandwaney
- Department of Invasive Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma
| | - Luiz F Ybarra
- Department of Cardiology, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Department of Cardiology, London Health Sciences Center, Western University, London, Ontario, Canada
| | | | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | - Dmitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russian Federation
| | | | - Barry F Uretsky
- Department of Cardiology, Central Arkansas Veterans Healthcare System, Little Rock, Arizona
| | - Korhan Soylu
- Department of Cardiology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Ufuk Yildirim
- Department of Cardiology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Srinivasa Potluri
- Department of Cardiac Catheterization, The Heart Hospital Baylor Plano, Plano, Texas
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Salman Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Nicholas M Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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41
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Karacsonyi J, Kostantinis S, Simsek B, Allana SS, Rempakos A, Khatri JJ, Krestianinov O, Jaffer FA, Alaswad K, ElGuindy AM, Jefferson BK, Gorgulu S, Poommipanit P, Karmpaliotis D, Kirtane AJ, McEntegart M, Choi JW, Rafeh NA, Goktekin O, Sandoval Y, Burke MN, Mastrodemos O, Rangan BV, Ungi I, Brilakis ES. EFFECT OF OCCLUSION LESION AGE ON OUTCOMES OF CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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42
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Rempakos A, Simsek B, Kostantinis S, Karacsonyi J, Choi JW, Poommipanit P, Khatri JJ, Jaber W, Rinfret S, Nicholson W, Gorgulu S, Jaffer FA, Chandwaney R, Koutouzis M, Tsiafoutis I, Alaswad K, Krestyaninov O, Khelimskii D, Karmpaliotis D, Uretsky BF, Patel MP, Mahmud E, Potluri S, Rangan BV, Mastrodemos OC, Allana S, Sandoval Y, Burke NM, Brilakis ES. Impact of lesion length on the outcomes of chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry. Catheter Cardiovasc Interv 2023; 101:747-755. [PMID: 36740236 DOI: 10.1002/ccd.30581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 01/22/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND The impact of occlusion length on the procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. METHODS We examined the clinical and angiographic characteristics and procedural outcomes of 10,335 CTO PCIs at 42 US and non-US centers between 2012 and 2022. The cohort was divided into two groups based on lesion length (≥20 mm vs. <20 mm). RESULTS Long lesions were present in 7208 (70%) patients. Comorbidities were more common in patients with long CTOs. Compared with short lesions, long lesions had higher J-CTO score (2.8 ± 1.1 vs. 1.3 ± 1; p < 0.001) and retrograde wiring was more often the initial (15.5% vs. 4.0%; p < 0.001) and successful (22.8% vs. 8.2%; p < 0.001) crossing strategy. Long lesions were more likely to require longer procedure (123 vs. 91 min; p < 0.001) and fluoroscopy (47.1 vs. 32.2 min; p < 0.001) time, larger contrast volume (218 vs. 200 mL; p < 0.001) and higher air kerma radiation dose (2.4 vs. 1.7 Gy; p < 0.001). After adjusting for potential confounders, long lesions were associated with lower technical success (odds ratio [OR]: 0.91 per 10 mm increase; 95% confidence interval [CI]: 0.88, 0.94) and higher major adverse cardiovascular events (MACE) (OR: 1.08 per 10 mm increase; 95% CI: 1.02, 1.15). CONCLUSIONS CTO PCI of long occlusions is independently associated with lower rates of technical success and higher rates of in-hospital MACE.
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Affiliation(s)
- Athanasios Rempakos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - James W Choi
- Department of Cardiology, Texas Health Presbyterian Hospital, Dallas, TX, USA
| | - Paul Poommipanit
- Section of Cardiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jaikirshan J Khatri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wissam Jaber
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Stephane Rinfret
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - William Nicholson
- Division of Cardiology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey
| | - Farouc A Jaffer
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raj Chandwaney
- Department of Invasive Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma, USA
| | - Michael Koutouzis
- Department of Cardiology, Red Cross Hospital of Athens, Athens, Greece
| | | | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | - Dmitrii Khelimskii
- Department of Invasive Cardiology, Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia
| | | | - Barry F Uretsky
- Department of Cardiology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Mitul P Patel
- Division of Cardiovascular Medicine, UCSD Medical Center, La Jolla, California, USA
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, UCSD Medical Center, La Jolla, California, USA
| | - Srinivasa Potluri
- Department of Cardiac Catheterization, The Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Bavana V Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Olga C Mastrodemos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Salman Allana
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Nicholas M Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Simsek B, Tajti P, Carlino M, Rinfret S, Vemmou E, Kostantinis S, Nikolakopoulos I, Karacsonyi J, Agostoni P, Alaswad K, Megaly M, Avran A, Choi JW, Khatri JJ, Knaapen P, La Manna A, Spratt JC, Rangan BV, Goktekin O, Kearney KE, Lombardi WL, Grantham JA, Mashayekhi K, Brilakis ES, Azzalini L. EXTERNAL VALIDATION OF THE PROGRESS-CTO COMPLICATION RISK SCORES: INDIVIDUAL PATIENT DATA POOLED ANALYSIS OF 3 REGISTRIES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Allana SS, Kostantinis S, Simsek B, Karacsonyi J, Alaswad K, Poommipanit P, Khatri JJ, Choi JW, Rempakos A, Krestianinov O, Khelimskii D, Karmpaliotis DI, Jaffer FA, Davies RE, Bagur R, Gorgulu S, Potluri SP, Sandoval Y, Mahmud E, Patel MP, Jefferson BK, Chandwaney RH, Burke MN, Rangan BV, Brilakis ES. LESION COMPLEXITY AND PROCEDURAL OUTCOMES ASSOCIATED WITH OSTIAL CHRONIC TOTAL OCCLUSIONS: INSIGHTS FROM THE PROGRESS-CTO REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01220-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Simsek B, Carlino M, Pan M, Vemmou E, Nikolakopoulos I, Kostantinis S, Karacsonyi J, Agostoni P, Alexandre A, Knaapen P, La Manna A, Spratt JC, Tanabe M, Walsh SJ, Goktekin O, Allana SS, Rangan BV, Rempakos A, Choi JW, Kearney KE, Lombardi WL, Grantham JA, Hirai T, Brilakis ES, Azzalini L. VALIDATION OF THE OPEN-CLEAN CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION PERFORATION SCORE IN A MULTICENTER REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01218-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Allana SS, Kostantinis S, Simsek B, Karacsonyi J, Alaswad K, Rempakos A, Khelimskii D, Karmpaliotis DI, Jaffer FA, Khatri JJ, Poommipanit P, Choi JW, Patel MP, Koutouzis M, Mahmud E, Elbarouni B, Jaber WA, Rinfret S, Potluri SP, Nicholson WJ, Jefferson BK, Gorgulu S, Chandwaney RH, Rangan BV, Brilakis ES. CONTEMPORARY OUTCOMES OF CHRONIC TOTAL OCCLUSION INTERVENTIONS: UPDATE FROM THE PROGRESS-CTO (PROSPECTIVE GLOBAL REGISTRY FOR THE STUDY OF CHRONIC TOTAL OCCLUSION INTERVENTION) INTERNATIONAL REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Davies RE, Jaffer FA, Doshi D, Azzalini L, Khatri J, Brilakis ES. Body Mass Index and Chronic Total Occlusion Percutaneous Coronary Intervention Outcomes: Is Overweight the New Normal? J Invasive Cardiol 2023; 35:E126-E127. [PMID: 36645332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Although high body mass index (BMI) is a known risk factor for the development of cardiovascular diseases, people who are overweight or obese often have better outcomes after cardiac procedures. Whether this "obesity paradox" is observed in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is unknown. Therefore, we examined the association of BMI with the outcomes of CTO-PCI in patients from the large, multicenter PROGRESS-CTO registry after stratifying patients into 3 BMI groups.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Chairman of the Center for Coronary Artery Disease at the Minneapolis Heart Institute Foundation, 920 East 28th Street #300, Minneapolis, MN 55407 USA.
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Karacsonyi J, Stanberry L, Simsek B, Kostantinis S, Allana SS, Alaswad K, Jaffer FA, Poommipanit P, Khatri JJ, Patel MP, Sheikh A, Wollmuth JR, Uretsky BF, Yeh RW, Chandwaney RH, Rempakos A, ElGuindy AM, Rafeh NA, Sandoval Y, Burke MN, Mastrodemos O, Okeson B, Rangan BV, Ungi I, Brilakis ES. URGENT MECHANICAL CIRCULATORY SUPPORT SCORE IN CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01219-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Alaswad K, Megaly M, Krestyaninov O, Khelimskii D, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Patel MP, Mahmud E, Koutouzis M, Tsiafoutis I, Gorgulu S, Elbarouni B, Nicholson W, Jaber W, Rinfret S, Abi Rafeh N, Goktekin O, ElGuindy AM, Allana SS, Rangan BV, Sandoval Y, Burke MN, Brilakis ES. Impact of proximal cap ambiguity on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO Registry. Catheter Cardiovasc Interv 2023; 101:737-746. [PMID: 36740235 DOI: 10.1002/ccd.30580] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proximal cap ambiguity is a key parameter in the global chronic total occlusion (CTO) percutaneous coronary intervention (PCI) crossing algorithm. METHODS We examined the baseline characteristics and procedural outcomes of 9718 CTO PCIs performed in 9498 patients at 41 US and non-US centers between 2012 and 2022. RESULTS Proximal cap ambiguity was present in 35% of CTO lesions. Patients whose lesions had proximal cap ambiguity were more likely to have had prior coronary artery bypass graft surgery (37% vs. 24%; p < 0.001). Lesions with proximal cap ambiguity were more complex with higher J-CTO score (3.1 ± 1.0 vs. 2.0 ± 1.2; p < 0.001) and lower technical (79% vs. 90%; p < 0.001) and procedural (77% vs. 89%; p < 0.001) success rates compared with nonambiguous CTO lesions. The incidence of major adverse cardiovascular events (MACE) was higher in cases with proximal cap ambiguity (2.5% vs. 1.7%; p < 0.001). The retrograde approach was more commonly used among cases with ambiguous proximal cap (50% vs. 21%; p < 0.001) and was more likely to be the final successful crossing strategy (29% vs. 13%; p < 0.001). The antegrade dissection and re-entry (ADR) "move-the-cap" techniques were also more common among cases with proximal cap ambiguity. CONCLUSIONS Proximal cap ambiguity in CTO lesions is associated with higher utilization of the retrograde approach and ADR, lower technical and procedural success rates, and higher incidence of in-hospital MACE.
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Affiliation(s)
- Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Athanasios Rempakos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Michael Megaly
- Henry Ford Cardiovascular Division, Detroit, Minnesota, USA
| | | | | | | | | | | | - Paul Poommipanit
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | | | | | | | | | - Salman S Allana
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bavana V Rangan
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Kostantinis S, Simsek B, Karacsonyi J, Alaswad K, Jaffer FA, Khatri JJ, Poommipanit P, Davies RE, Rinfret S, Jaber WA, Choi JW, Patel MP, Jefferson BK, Kerrigan JL, Elbarouni B, Rafeh NA, Goktekin O, ElGuindy AM, Allana SS, Mastrodemos O, Rempakos A, Rangan BV, Sandoval Y, Burke MN, Brilakis ES. EQUIPMENT UTILIZATION IN CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTIONS: INSIGHTS FROM THE PROGRESS-CTO REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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