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Katsillis N, Kariki O, Gavrielatos G, Dimopoulos A, Papakonstantinou N, Bousoula E, Linardakis S, Saplaouras A, Malakos J, Dragasis S, Letsas KP, Efremidis M, Patsourakos N. Ventricular arrhythmias in patients with chronic total occlusion of coronary arteries: a review focused on interventional treatments. Hellenic J Cardiol 2025:S1109-9666(25)00126-5. [PMID: 40348335 DOI: 10.1016/j.hjc.2025.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Revised: 03/08/2025] [Accepted: 04/10/2025] [Indexed: 05/14/2025] Open
Abstract
A chronic total occlusion (CTO) of a coronary artery is present in almost one-fifth of patients undergoing a scheduled coronary angiography. A CTO may be classified as infarct related when there is evidence of myocardial dysfunction in the territory of the obstructed vessel or as non-infarct related when the myocardial substrate has preserved its systolic function. The presence of a CTO has been associated with an increased risk of malignant ventricular arrhythmias (VAs), appropriate ICD shocks, and cardiac mortality, with infarct-related CTOs exhibiting a worse prognosis. During the last decade, technological advancements have improved the success rates of transcatheter revascularization, a treatment that has been proven valuable for persistently symptomatic patients. However, the role of revascularization in reducing the arrhythmic burden is unclear. On the contrary, catheter ablation of VAs has been suggested to be effective, despite the presence of a CTO. As for device therapies, an increased prevalence of appropriate ICD shocks should be expected in this population, bringing into consideration the implementation of the presence of CTO as a risk modifier in sudden cardiac death prevention algorithms. The aim of this review is to present the existing literature on the role of all kinds of interventions in the management of patients with CTOs and VAs.
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Affiliation(s)
- Nikitas Katsillis
- Interventional Cardiology Department, Tzaneio General Hospital of Piraeus, Greece.
| | - Ourania Kariki
- Arrhythmia Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Antonios Dimopoulos
- Interventional Cardiology Department, Tzaneio General Hospital of Piraeus, Greece
| | | | - Elena Bousoula
- Interventional Cardiology Department, Tzaneio General Hospital of Piraeus, Greece
| | - Sarantos Linardakis
- Interventional Cardiology Department, Tzaneio General Hospital of Piraeus, Greece
| | | | - John Malakos
- Interventional Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | - Nikolaos Patsourakos
- Interventional Cardiology Department, Tzaneio General Hospital of Piraeus, Greece
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2
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Moroni A, Mascaretti A, Dens J, Knaapen P, Nap A, Somsen YBO, Bennett J, Ungureanu C, Bataille Y, Haine S, Coussement P, Kayaert P, Avran A, Sonck J, Collet C, Carlier S, Vescovo G, Avesani G, Egred M, Spratt JC, Diletti R, Goktekin O, Boudou N, Di Mario C, Mashayekhi K, Agostoni P, Zivelonghi C. Machine Learning-Based Algorithm to Predict Procedural Success in a Large European Cohort of Hybrid Chronic Total Occlusion Percutaneous Coronary Interventions. Am J Cardiol 2025; 248:50-57. [PMID: 40204173 DOI: 10.1016/j.amjcard.2025.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Revised: 03/25/2025] [Accepted: 04/01/2025] [Indexed: 04/11/2025]
Abstract
CTOs are frequently encountered in patients undergoing invasive coronary angiography. Even though technical progress in CTO-PCI and enhanced skills of dedicated operators have led to substantial procedural improvement, the success of the intervention is still lower than in non-CTO PCI. Moreover, the scores developed to appraise lesion complexity and predict procedural outcomes have shown suboptimal discriminatory performance when applied to unselected cohorts. Accordingly, we sought to develop a machine learning (ML)-based model integrating clinical and angiographic characteristics to predict procedural success of chronic total occlusion (CTO)-percutaneous coronary intervention(PCI). Different ML-models were trained on a European multicenter cohort of 8904 patients undergoing attempted CTO-PCI according to the hybrid algorithm (randomly divided into a training set [75%] and a test set [25%]). Sixteen clinical and 16 angiographic variables routinely assessed were used to inform the models; procedural volume of each center was also considered together with 3 angiographic complexity scores (namely, J-CTO, PROGRESS-CTO and RECHARGE scores). The area under the curve (AUC) of the receiver operating characteristic curve was employed, as metric score. The performance of the model was also compared with that of 3 existing complexity scores. The best selected ML-model (Light Gradient Boosting Machine [LightGBM]) for procedural success prediction showed an AUC of 0.82 and 0.73 in the training and test set, respectively. The accuracy of the ML-based model outperformed those of the conventional scores (J-CTO AUC 0.66, PROGRESS-CTO AUC 0.62, RECHARGE AUC 0.64, p-value <0.01 for all the pairwise comparisons). In conclusion, the implementation of a ML-based model to predict procedural success in CTO-PCIs showed good prediction accuracy, thus potentially providing new elements for a tailored management. Prospective validation studies should be conducted in real-world settings, integrating ML-based model into operator decision-making processes in order to validate this new approach.
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Affiliation(s)
- Alice Moroni
- HartCentrum Bonheiden-Lier, Imelda Hospital, Bonheiden, Belgium
| | - Andrea Mascaretti
- Department of Theoretical and Scientific Data Science, Scuola Superiore Internazionale di Studi Avanzati, Trieste, Italy
| | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yvemarie B O Somsen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
| | | | - Yoann Bataille
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Steven Haine
- Department of Cardiology, Antwerp University Hospital, Edegem, and University of Antwerp, Belgium
| | | | - Peter Kayaert
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Alexander Avran
- Department of Interventional Cardiology, Valenciennes Hospital, Valenciennes, France
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Giovanni Vescovo
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice, Italy
| | - Giacomo Avesani
- Department of Imaging and Radiation Oncology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - James C Spratt
- Department of Interventional Cardiology, St. George's, University of London, London, United Kingdom
| | - Roberto Diletti
- Department of Cardiology, Thorax Center, Erasmus MC Cardiovascular Institute, Rotterdam, the Netherlands
| | | | - Nicolas Boudou
- Interventional Cardiology Department, Clinique Saint-Augustin-Elsan, Bordeaux, France
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology, II University Heart Center, Freiburg Bad Krozingen, Germany
| | | | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis aan de Stroom (ZAS) Middelheim, Antwerp, Belgium.
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Wen S, Dai C, Huang Z, Wang J, Wang F, Wu K, Ma D, Han F, Xiao J, Huang Y, Wu S, Zhang B. Retrograde percutaneous coronary intervention for chronic total occlusions in patients with reduced left ventricular ejection fraction: a single-center retrospective cohort study. Heart Vessels 2025:10.1007/s00380-025-02526-6. [PMID: 39985700 DOI: 10.1007/s00380-025-02526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 01/29/2025] [Indexed: 02/24/2025]
Abstract
BACKGROUND Data on the safety and prognostic implications of retrograde percutaneous coronary intervention (PCI) in patients with low left ventricular ejection fraction (LVEF) and chronic total occlusion (CTO) are unclear. This study aimed to assess the procedural results and long-term outcomes of retrograde CTO PCI in individuals with reduced LVEF (≤ 40%). METHODS We conducted a retrospective analysis of 836 consecutive patients who underwent elective retrograde CTO PCI at a single center between January 2011 and April 2023. Patients and lesion characteristics, procedural details and results, and long-term outcomes were compared between patients with reduced (LVEF ≤ 40%) and preserved left ventricular systolic function (LVEF > 40%) based on echocardiographic assessment. RESULTS Baseline LVEF ≤ 40% was presented in 156 (18.7%) patients. The collateral channel (CC) tracking success was high (overall 93.5%) and similar among the groups (94.2% vs. 93.4%, p = 0.835), as well as retrograde technical success (87.8% vs. 89.9%, p = 0.548) and recanalization success (87.8% vs. 91.5%, p = 0.281). Procedure complications were low and similar between the groups (all p > 0.05). Clinical follow-up was available in 767 (91.2%) patients with a medium follow-up of 1041 (531-1511) days. In patients with lower LVEF, the incidence of MACE was higher (23.2% vs. 14.9%, p = 0.021), mainly the all-cause mortality (15.4% vs. 4.1%, p < 0.001) and cardiac death (12.2% vs. 2.5%, p < 0.001). Multivariable analysis revealed that age (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.01-1.04, p = 0.008), LVEF ≤ 40% (HR: 1.21, 95%CI: 1.01-1.45, p = 0.039), and revascularization success (HR: 0.38, 95% CI: 0.22-0.66, p < 0.001) were independently associated with MACE. CONCLUSIONS Retrograde PCI may represent a safe and efficient management strategy for patients with reduced LVEF and CTO. Furthermore, our study demonstrated that successful CTO recanalization was associated with a significant survival benefit, regardless of left ventricular systolic function.
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Affiliation(s)
- Song Wen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Chang Dai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
- Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Zehan Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Jing Wang
- Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People's Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong, China
| | - Feng Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Kaize Wu
- Department of Cardiology, School of Medicine, The Sixth Affiliated Hospital, South China University of Technology, Guangzhou, 528000, Guangdong, China
| | - Dunliang Ma
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Feihuang Han
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Jiquan Xiao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Yuqing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China.
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China.
- Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China.
| | - Bin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China.
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Goyal A, Tariq MD, Shahnoor S, Saeed H, Khan AM, Sulaiman SA, Jain H, Khan R, AlJaroudi W. Short- and long-term outcomes of antegrade versus retrograde approaches in patients undergoing percutaneous coronary intervention for chronic total occlusion: A meta-analysis. Int J Cardiol 2025; 418:132590. [PMID: 39307312 DOI: 10.1016/j.ijcard.2024.132590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/01/2024] [Accepted: 09/20/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Chronic Total Occlusion (CTO) involves severe coronary artery blockage that impairs blood flow and affects 15-20 % of patients undergoing coronary angiography and over 40 % with diabetes or heart failure. Percutaneous Coronary Intervention (PCI) is used to restore blood flow in such cases. The retrograde approach, developed due to lower success with the antegrade method in complex cases, improves outcomes but increases complications. This meta-analysis compares the efficacy and safety of both approaches to guide clinical practice. METHODS A comprehensive literature search was conducted on PubMed, Embase, Google Scholar, and Scopus until June 5, 2024, to find studies comparing antegrade and retrograde approaches in CTO-PCI patients. Pooled risk ratios (RR) with 95 % confidence intervals (CI) were calculated using R software (version 4.4.1), with significance set at p < 0.05. Random-effects models were used for all analyses. RESULTS Our analysis included 22 observational studies with 49,152 CTO-PCI patients: 35,844 in the antegrade arm and 13,308 in the retrograde arm. The antegrade approach showed significantly lower risks of in-hospital outcomes, including mortality [RR: 0.45; p < 0.001], myocardial infarction [RR: 0.37; p < 0.001], major adverse cardiovascular events [RR: 0.34; p < 0.001], and cerebrovascular events [RR: 0.50; p = 0.011]. Long-term outcomes, such as all-cause mortality [RR: 0.71; p = 0.157] and myocardial infarction [RR: 0.76; p = 0.438], were comparable between both approaches. CONCLUSION The antegrade technique shows better outcomes and procedural advantages over retrograde revascularization, though long-term outcomes are similar. Further studies, especially randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India.
| | - Muhammad Daoud Tariq
- Department of Internal Medicine, Foundation University Medical College, Islamabad, Pakistan
| | - Syeda Shahnoor
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Humza Saeed
- Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan
| | - Abdul Moiz Khan
- Department of Internal Medicine, Ayub Medical College, Abbottabad, Pakistan
| | | | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences-, Jodhpur, India
| | - Rozi Khan
- Department of Internal Medicine, Medical University of South Carolina, Florence, SC, USA
| | - Wael AlJaroudi
- Department of Cardiology, WellStar MCG Health, Augusta, GA, USA.
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5
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Tannu M, Nelson AJ, Rymer JA, Jones WS. Myocardial Revascularization in Heart Failure: A State-of-the-Art Review. J Card Fail 2024; 30:1330-1342. [PMID: 39389744 DOI: 10.1016/j.cardfail.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 10/12/2024]
Abstract
Patients with heart failure (HF) and underlying coronary artery disease (CAD) have a substantially higher risk of mortality compared with those with HF from other causes. However, identifying individuals with HF for whom revascularization is likely to improve prognosis is a complex clinical decision. Revascularization is likely beneficial for patients with CAD-predominant symptoms, such as those with acute myocardial infarction or stable ischemic heart disease with refractory angina. However, for patients with HF-predominant symptoms, characterized by dyspnea without acute myocardial infarction or refractory angina, the benefits of revascularization are less clear. This state-of-the-art review summarizes the outcomes, clinical trials, and therapeutic approaches for patients with both CAD and HF, and proposes a therapeutic algorithm to guide the diagnosis and comprehensive workup of these complex patients.
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Affiliation(s)
- Manasi Tannu
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Adam J Nelson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; School of Medicine, University of Adelaide, SA, Australia
| | - Jennifer A Rymer
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - W Schuyler Jones
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
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Soriano K, Jiang GY, Balkan L, Tamez H, Yeh RW. Who Should Undergo Chronic Total Occlusions Percutaneous Coronary Intervention and When?: An Evidence-Based Approach to the Patient Referred for Percutaneous Coronary Intervention of Chronic Total Occlusion. Am J Cardiol 2024; 227:18-28. [PMID: 39032587 DOI: 10.1016/j.amjcard.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
Chronic total occlusions (CTO) of the coronary arteries are common among patients presenting to the cardiac catheterization laboratory, and data suggests a worse overall prognosis in patients with CTOs. Percutaneous coronary intervention (PCI) of CTOs has been shown to improve anginal symptoms in observational studies and in a limited number of randomized trials. However, CTO PCI has not been shown to lead to a reduction in other important end points such as myocardial infarction or death. Furthermore, despite recent advances in the field, CTO PCI still carries higher risks and a lower likelihood of success compared with non-CTO PCI. Thus, determining which patients may be appropriate for CTO PCI is challenging and must involve a comprehensive risk-benefit analysis and discussion with the patient. Therefore, we review the currently available data regarding CTO PCI, including the clinical outcomes, the role of preprocedural ischemia testing, and various procedural success and risk stratification scores. Finally, we present our approach to the patient referred for CTO PCI.
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Affiliation(s)
- Kevin Soriano
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ginger Y Jiang
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lauren Balkan
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Hector Tamez
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Robert W Yeh
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Chen W, Du Z, Qin Y, Zheng Z, Liu J, Shi Y. Efficacy of revascularization in CTO patients based on hibernating myocardium therapy. Eur J Clin Invest 2024; 54:e14237. [PMID: 38757632 DOI: 10.1111/eci.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The effectiveness of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still uncertain, especially for patients with ischemic left ventricular dysfunction. This study aimed to assess hibernating myocardium (HM), as determined by single-photon emission computed tomography (SPECT) and 18F-FDG positron emission tomography (PET), and to compare the benefits of PCI and optimal medical therapy (OMT). METHODS A retrospective study collected data from 332 patients with CTO and ischemic left ventricular dysfunction. The study compared patients who underwent PCI or OMT via propensity score matching (PSM) analysis which was performed with a 1:2 matching protocol using the nearest neighbour matching algorithm. The primary endpoint of the study was the occurrence of major adverse cardiac events (MACE), defined as a composite of cardiac death, readmission for worsening heart failure (WHF), revascularization and myocardial infarction (MI). RESULTS After PSM, there were a total of 246 individuals in the PCI and OMT groups. Following Cox regression, hibernating myocardium/total perfusion defect (HM/TPD) was identified as an independent risk factor (hazard ratio (HR): 1.03, 95% confidence interval (CI): 1.008-1.052, p = .007). The cut-off value of HM/TPD was 38%. The results of the subgroup analysis suggest that for patients with HM/TPD >38%, the OMT group had a greater risk of MACE (p = .035). A sensitivity analysis restricting patients with single-vessel CTO lesions, HM/TPD remained an independent predictor (HR 1.025, 95% CI 1.008-1.043, p = .005). CONCLUSION HM/TPD is an independent predictor of MACE, and for patients with HM/TPD > 38%, CTO-PCI had a lower risk of MACE compared with OMT. However, further validation is still needed through large-scale studies.
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Affiliation(s)
- Wenjie Chen
- Center for Coronary Artery Disease (CCAD), Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhiyong Du
- Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yanwen Qin
- Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ze Zheng
- Center for Coronary Artery Disease (CCAD), Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinghua Liu
- Center for Coronary Artery Disease (CCAD), Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuchen Shi
- Center for Coronary Artery Disease (CCAD), Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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8
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Chen W, Liu Y, Shi Y, Liu J. Prognostic Value of Estimated Glucose Disposal Rate and Systemic Immune-Inflammation Index in Non-Diabetic Patients Undergoing PCI for Chronic Total Occlusion. J Cardiovasc Dev Dis 2024; 11:261. [PMID: 39330319 PMCID: PMC11432108 DOI: 10.3390/jcdd11090261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic total occlusion (CTO) is a complex lesion of coronary artery disease (CAD) with a detection rate of approximately 25% on coronary angiography. CTO patients generally experience poor quality of life and prognosis. This study aims to evaluate the association between the estimated glucose disposal rate (eGDR), a surrogate marker for insulin resistance (IR), and the prognosis of CTO PCI patients, as well as to investigate the potential role of the systemic immune-inflammation index (SII) in this process. METHODS We retrospectively included 1482 non-diabetic patients who underwent successful CTO PCI at Anzhen Hospital between January 2018 and December 2021. The primary endpoint was major adverse cardiovascular events (MACEs). Clinical characteristics, biochemical markers, and interventional records were collected, and the eGDR and SII were calculated. Cox regression, restricted cubic splines (RCSs), receiver operating characteristic (ROC) analysis, and Kaplan-Meier curves were used to assess associations. RESULTS MACEs occurred in 158 patients (10.67%). Patients with MACEs had lower eGDR and higher SII levels. A high eGDR significantly reduced MACE risk (Q4 vs. Q1: HR 0.06, 95% CI 0.03-0.12), while a high SII increased it (Q4 vs. Q1: HR 3.32, 95% CI 1.78-6.33). The combination of low eGDRs and high SIIs predicted the highest MACE risk (HR 4.36, 95% CI 2.71-6.01). The SII partially mediated the relationship between eGDR and MACEs. CONCLUSIONS A low eGDR and high SII are significant predictors of poor prognosis in non-diabetic CTO PCI patients. Combining the eGDR and the SII provides a comprehensive assessment for better predicting cardiovascular outcomes.
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Affiliation(s)
| | | | - Yuchen Shi
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China; (W.C.); (Y.L.)
| | - Jinghua Liu
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China; (W.C.); (Y.L.)
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9
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Gold DA, Sandesara PB, Jain V, Gold ME, Vatsa N, Desai SR, Hassan ME, Yuan C, Ko YA, Ejaz K, Alvi Z, Jaber WA, Nicholson WJ, Quyyumi AA. Long-Term Outcomes in Patients With Chronic Total Occlusion. Am J Cardiol 2024; 214:59-65. [PMID: 38195045 PMCID: PMC10947430 DOI: 10.1016/j.amjcard.2023.12.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/24/2023] [Indexed: 01/11/2024]
Abstract
Although a chronic total occlusion (CTO) in the setting of an acute coronary syndrome is associated with greater risk, the prognosis of patients with a CTO and stable coronary artery disease (CAD) remains unknown. This study aimed to investigate adverse event rates in patients with stable CAD with and without a CTO. In 3,597 patients with stable CAD (>50% coronary luminal stenosis) who underwent cardiac catheterization, all-cause mortality, cardiovascular mortality, and the composite major adverse cardiac event (MACE) rates for cardiovascular death, myocardial infarction, and heart failure hospitalization were evaluated. Cox proportional hazards and Fine and Gray subdistribution hazard models were used to compare event-free survival in patient subsets after adjustment for covariates. Event rates were higher in patients with CTOs than in those without CTOs after adjusting for demographic and clinical characteristics (cardiovascular death hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.05 to 1.57, p = 0.012). Patients with CTO revascularization had lower event rates than those of patients without CTO revascularization (cardiovascular death HR 0.43, CI 0.26 to 0.70, p = 0.001). Those with nonrevascularized CTOs were at particularly great risk when compared with those without CTO (cardiovascular death HR 1.52, CI 1.25 to 1.84, p <0.001). Moreover, those with revascularized CTOs had similar event rates to those of patients with CAD without CTOs. Patients with CTO have higher rates of adverse cardiovascular events than those of patients with significant CAD without CTO. This risk is greatest in patients with nonrevascularized CTO.
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Affiliation(s)
- Daniel A Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Vardhmaan Jain
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew E Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nishant Vatsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shivang R Desai
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Malika Elhage Hassan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chenyang Yuan
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kiran Ejaz
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zain Alvi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wissam A Jaber
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - William J Nicholson
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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10
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Vadalà G, Galassi AR, Werner GS, Sianos G, Boudou N, Garbo R, Maniscalco L, Bufe A, Avran A, Gasparini GL, La Scala E, Ladwiniec A, Saghatelyan M, Goktekin O, Gorgulu S, Reifart N, Agostoni P, Rathore S, Ayoub M, Behnes M, Atmowihardjo I, Iannaccone M, Diletti R, Di Mario C, Mashayekhi K, Euro Cto Investigators OBOT. Contemporary outcomes of chronic total occlusion percutaneous coronary intervention in Europe: the ERCTO registry. EUROINTERVENTION 2024; 20:e185-e197. [PMID: 38343371 PMCID: PMC10836392 DOI: 10.4244/eij-d-23-00490] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/28/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) have reached high procedural success rates thanks to dedicated equipment, evolving techniques, and worldwide adoption of state-of-the-art crossing algorithms. AIMS We report the contemporary results of CTO PCIs performed by a large European community of experienced interventionalists. Furthermore, we investigated the impact of different risk factors for procedural major adverse cardiac and cerebrovascular events (MACCE) and trends of employment of specific devices like dual lumen microcatheters, guiding catheter extensions, intravascular ultrasound and calcium-modifying tools. METHODS We evaluated data from 8,673 CTO PCIs included in the European Registry of Chronic Total Occlusion (ERCTO) between January 2021 and October 2022. RESULTS The overall technical success rate was 89.1% and was higher in antegrade as compared with retrograde cases (92.8% vs 79.3%; p<0.001). Compared with antegrade procedures, retrograde procedures had a higher complexity of attempted lesions (Japanese CTO [J-CTO] score: 3.0±1.0 vs 1.9±1.2; p<0.001), a higher procedural and in-hospital MACCE rate (3.1% vs 1.2%; p<0.018) and a higher perforation rate with and without tamponade (1.5% vs 0.4% and 8.3% vs 2.1%, respectively; p<0.001). As compared with mid-volume operators, high-volume operators had a higher technical success rate in antegrade and retrograde procedures (93.4% vs 91.2% and 81.5% vs 69.0%, respectively; p<0.001), and had a lower MACCE rate (1.47% vs 2.41%; p<0.001) despite a higher mean complexity of the attempted lesions (J-CTO score: 2.42±1.28 vs 2.15±1.27; p<0.001). CONCLUSIONS The adoption of different recanalisation techniques, operator experience and the use of specific devices have contributed to a high procedural success rate despite the high complexity of the lesions documented in the ERCTO.
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Affiliation(s)
- Giuseppe Vadalà
- Division of Cardiology, University Hospital "P. Giaccone", Palermo, Italy
| | - Alfredo R Galassi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Gerald S Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | | | | | - Roberto Garbo
- Maria Pia Hospital, GVM Care & Research, Turin, Italy
| | - Laura Maniscalco
- Division of Cardiology, University Hospital "P. Giaccone", Palermo, Italy
| | - Alexander Bufe
- Helios Klinikum Krefeld, University Witten/Herdecke, Witten, Germany
| | | | | | | | - Andrew Ladwiniec
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Meruzhan Saghatelyan
- Erebouni Medical Center, Yerevan, Armenia and Nork-Marash Medical Center (NMMC), Yerevan, Armenia
| | | | - Sevket Gorgulu
- Department of Cardiology, Acibadem University Istanbul, Istanbul, Turkey
| | | | | | - Sudhir Rathore
- Frimley Park Hospital, NHS Foundation Trust, Camberley, United Kingdom
| | - Mohamed Ayoub
- University Heart Center NRW, Bad Oeynhausen, Germany
| | | | - Iskander Atmowihardjo
- Department of Cardiology and Angiology, DRK Kliniken Berlin Köpenick, Berlin, Germany
| | | | - Roberto Diletti
- Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
| | - Carlo Di Mario
- Department of Clinical & Experimental Medicine, Structural Interventional Cardiology Division, Careggi University Hospital, Florence, Italy
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology, University Heart Center, University Freiburg, Freiburg, Germany
- Department of Internal Medicine and Cardiology, Heart Center Lahr, Lahr, Germany
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11
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Lu Y, Wang Y, Zhou B. Predicting long-term prognosis after percutaneous coronary intervention in patients with acute coronary syndromes: a prospective nested case-control analysis for county-level health services. Front Cardiovasc Med 2023; 10:1297527. [PMID: 38111892 PMCID: PMC10725923 DOI: 10.3389/fcvm.2023.1297527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
Purpose We aimed to establish and authenticate a clinical prognostic nomogram for predicting long-term Major Adverse Cardiovascular Events (MACEs) among high-risk patients who have undergone Percutaneous Coronary Intervention (PCI) in county-level health service. Patients and methods This prospective study included Acute Coronary Syndrome (ACS) patients treated with PCI at six county-level hospitals between September 2018 and August 2019, selected from both the original training set and external validation set. Least Absolute Shrinkage and Selection Operator (LASSO) regression techniques and logistic regression were used to assess potential risk factors and construct a risk predictive nomogram. Additionally, the potential non-linear relationships between continuous variables were tested using Restricted Cubic Splines (RCS). The performance of the nomogram was evaluated based on the Receiver Operating Characteristic (ROC) curve analysis, Calibration Curve, Decision Curve Analysis (DCA), and Clinical Impact Curve (CIC). Results The original training set and external validation set comprised 520 and 1,061 patients, respectively. The final nomogram was developed using nine clinical variables: Age, Killip functional classification III-IV, Hypertension, Hyperhomocysteinemia, Heart failure, Number of stents, Multivessel disease, Low-density Lipoprotein Cholesterol, and Left Ventricular Ejection Fraction. The AUC of the nomogram was 0.79 and 0.75 in the training set and external validation set, respectively. The DCA and CIC validated the clinical value of the constructed prognostic nomogram. Conclusion We developed and validated a prognostic nomogram for predicting the probability of 3-year MACEs in ACS patients who underwent PCI at county-level hospitals. The nomogram could provide a precise risk assessment for secondary prevention in ACS patients receiving PCI.
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Affiliation(s)
| | | | - Bo Zhou
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Hospital of China Medical University, Shenyang, China
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12
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Dyrbuś M, Pyka Ł, Kurek A, Niedziela JT, Adamowicz-Czoch E, Ostręga M, Sokoła K, Pres D, Gąsior M, Tajstra M. Alert Transmissions From Remote Monitoring of Patients With Cardiac Implantable Devices. JACC Clin Electrophysiol 2023; 9:2163-2165. [PMID: 37565950 DOI: 10.1016/j.jacep.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/25/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
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13
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Cojocaru C, Nastasa A, Bogdan S, Iorgulescu C, Deaconu A, Onciul S, Vatasescu R. Non-revascularized chronic total occlusions impact on substrate and post-ablation results in drug-refractory electrical storm. Front Cardiovasc Med 2023; 10:1258373. [PMID: 37808884 PMCID: PMC10552148 DOI: 10.3389/fcvm.2023.1258373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background and aims There is limited data concerning the effect of non-revascularized chronic total occlusions (NR-CTOs) after VT ablation. This study sought to evaluate the impact of NR-CTOs after ablation for electrical storm (ES). Methods Post-hoc retrospective analysis of data regarding 64 consecutive post-myocardial infarction patients (out of which 12 patients with NR-CTOs and 52 without NR-CTOs) undergoing substrate ablation for ES with an available median follow-up of 37.53 (7.25-64.65) months. Ablation result was assessed by inducibility of sustained monomorphic VT (SMVT) during final programmed ventricular stimulation (PVS). The primary endpoints were all-cause mortality and VT/VF recurrences after ablation, respectively, stratified by the presence of NR-CTOs. The secondary endpoint was to assess the predictive effect of NR-CTOs on all-cause mortality and VT/VF recurrences in relation to other relevant prognostic factors. Results At baseline, the presence of NR-CTOs was associated with higher bipolar BZ-to-total scar ratio (72.4% ± 17.9% vs. 52% ± 37.7%, p = 0.022) and more failure to eliminate the clinical VT (25% (3) vs. 0% (0), p < 0.001). During follow-up, overall all-cause mortality and recurrences were more frequent in the NR-CTO subgroup (75% (9) vs. 19.2% (10), log rank p = 0.003 and 58.3% vs. 23.1% (12), log rank p = 0.042 respectively). After adjusting for end-procedural residual SMVT inducibility, NR-CTOs predicted death during follow-up (HR 3.380, p = 0.009) however not recurrence (HR 1.986, p = 0.154). Conclusions NR-CTO patients treated by RFCA for drug-refractory ES demonstrated a higher ratio of BZ-to-total-scar area. In this analysis, NR-CTO was associated with worse acute procedural results and may as well impact long-term outcomes which should be further assessed in larger patient populations.
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Affiliation(s)
- Cosmin Cojocaru
- Department of Cardiothoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | | | - Stefan Bogdan
- Department of Cardiothoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Elias University Hospital, Bucharest, Romania
| | - Corneliu Iorgulescu
- Department of Cardiology, Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - Alexandru Deaconu
- Department of Cardiothoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - Sebastian Onciul
- Department of Cardiothoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - Radu Vatasescu
- Department of Cardiothoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Emergency Clinical Hospital Bucharest, Bucharest, Romania
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14
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Song Y, Cui K, Yang M, Song C, Yin D, Dong Q, Gao Y, Dou K. High triglyceride-glucose index and stress hyperglycemia ratio as predictors of adverse cardiac events in patients with coronary chronic total occlusion: a large-scale prospective cohort study. Cardiovasc Diabetol 2023; 22:180. [PMID: 37454147 PMCID: PMC10350280 DOI: 10.1186/s12933-023-01883-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index and the stress hyperglycaemia ratio (SHR) are both positively associated with cardiovascular (CV) risk in patients with coronary heart disease. However, the prognostic value of these two biomarkers has not been well elucidated in patients with chronic total occlusion (CTO). Therefore, this study aims to evaluate the association of the TyG index and the SHR with long-term prognosis in patients with CTO. METHODS This prospective cohort study consecutively included 2740 angina patients with CTO from January 2017 to December 2018 at Fuwai Hospital. The outcomes are a composite of CV death and target vessel myocardial infarction (TVMI) and major CV cerebrovascular adverse events (MACCEs, including all-cause death, nonfatal MI, ischaemia-driven target vessel revascularization, and stroke). The association between biomarkers and prognosis was analysed by multivariable Cox proportional hazard models, and the predictive value was determined by a receiver-operating characteristic (ROC) curve. RESULTS During the follow-up with a median time of 3 years, 179 (6.5%) cases of MACCEs and 47 (1.7%) cases of CV death or TVMI were recorded. Patients with a high TyG index (> 9.10) and a high SHR (> 0.87) showed a significantly increased risk of CV death/TVMI (TyG index: HR 4.23, 95% CI 1.58-11.37; SHR: HR 5.14, 95% CI 1.89-13.98) and MACCEs (TyG index: HR 2.47, 95% CI 1.54-3.97; SHR: HR 2.91, 95% CI 1.84-4.60) compared with those with a low Tyg index and a low SHR (TyG < 8.56, SHR < 0.76). The area under the curve (AUC) values were 0.623 (TyG index) and 0.589 (SHR) for CV death/TVMI and 0.659 (TyG index) and 0.624 (SHR) for MACCEs. Furthermore, patients with both a high TyG index and a high SHR showed the highest risk of clinical outcomes among patients with different levels of these two biomarkers, and the AUC for the TyG-SHR combination was larger than the TyG index alone in predicting MACCE risk. CONCLUSIONS The study revealed that a high TyG index and a high SHR were significantly correlated with poor prognosis in patients with CTO and suggested that these two biomarkers are reliable in predicting long-term prognosis in CTO patients.
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Affiliation(s)
- Yanjun Song
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Kongyong Cui
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Min Yang
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chenxi Song
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Dong Yin
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Qiuting Dong
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Ying Gao
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Kefei Dou
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
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15
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Pyka L, Szkodzinski J, Piegza J, Swietlińska M, Gąsior M. Case Report: do heart transplant candidates benefit from mechanically supported revascularization? Front Cardiovasc Med 2023; 10:1169165. [PMID: 37424922 PMCID: PMC10326613 DOI: 10.3389/fcvm.2023.1169165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Recently published studies suggest that percutaneous coronary intervention (PCI) has no significant impact on outcomes in patients with heart failure and stable coronary artery disease. The use of percutaneous mechanical circulatory support is growing, but its value is still uncertain. If large areas of viable myocardium are ischemic, the benefit from revascularization should be evident. In such instances, we should strive for complete revascularization. The use of mechanical circulatory support in such cases is vital because it provides hemodynamic stability throughout the complex procedure. Case report We present a case of a 53-year-old male heart transplant candidate with type 1 diabetes mellitus, initially considered unsuitable for revascularization and qualified for heart transplantation, transferred to our center due to acute decompensated heart failure. At this time, the patient had temporary contraindications for heart transplantation. As the patient was considered no-option, we have decided to reassess the possibility of revascularization. The heart team opted for a high-risk mechanically supported PCI with the aim of complete revascularization. A complex multivessel PCI was performed with optimal effect. The patient was weaned off dobutamine on the second day post-PCI. Four months post-discharge, he remains stable, is in NYHA II class, and has no chest pain. Control echocardiography showed improved ejection fraction. The patient is not a heart transplant candidate anymore. Conclusions This case report shows that we must strive for revascularization in select heart failure cases. The outcome of this patient suggests that heart transplant candidates with potentially viable myocardium should be considered for revascularization, especially as the shortage of donors persists. In the most complex coronary anatomy and severe heart failure, mechanical support in the procedure might be essential.
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Affiliation(s)
- Lukasz Pyka
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Janusz Szkodzinski
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jacek Piegza
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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16
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Blach A, Kwiecinski J. The Role of Positron Emission Tomography in Advancing the Understanding of the Pathogenesis of Heart and Vascular Diseases. Diagnostics (Basel) 2023; 13:1791. [PMID: 37238275 PMCID: PMC10217133 DOI: 10.3390/diagnostics13101791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. For developing new therapies, a better understanding of the underlying pathology is required. Historically, such insights have been primarily derived from pathological studies. In the 21st century, thanks to the advent of cardiovascular positron emission tomography (PET), which depicts the presence and activity of pathophysiological processes, it is now feasible to assess disease activity in vivo. By targeting distinct biological pathways, PET elucidates the activity of the processes which drive disease progression, adverse outcomes or, on the contrary, those that can be considered as a healing response. Given the insights provided by PET, this non-invasive imaging technology lends itself to the development of new therapies, providing a hope for the emergence of strategies that could have a profound impact on patient outcomes. In this narrative review, we discuss recent advances in cardiovascular PET imaging which have greatly advanced our understanding of atherosclerosis, ischemia, infection, adverse myocardial remodeling and degenerative valvular heart disease.
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Affiliation(s)
- Anna Blach
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
- Nuclear Medicine Department, Voxel Diagnostic Center, 40-514 Katowice, Poland
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, 04-628 Warsaw, Poland
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17
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Albaeni A, Chatila KF, Thakker RA, Kumfa P, Alwash H, Elsherbiny A, Gilani S, Khalife WI, Jneid H, Motiwala A, Motiwala A. In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Heart failure patients. Curr Probl Cardiol 2023; 48:101458. [PMID: 36261103 DOI: 10.1016/j.cpcardiol.2022.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
In-hospital outcomes of chronic total occlusion Percutaneous Coronary Interventions (CTO PCI) in heart failure patients has not been evaluated on a national base and was the focus of this investigation. We used the Nationwide Inpatient Sample database from 2008 to 2014 to identify adults with single vessel CTO PCI for stable ischemic heart disease (SIHD). Patients were divided into 3 groups: patients without heart failure, heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Clinical characteristics and in-hospital outcomes were studied using relevant statistics. Multiple logistic regression models were performed to assess in-hospital mortality, acute renal failure, and the use of mechanical support devices. Of 112,061 inpatients with SIHD from 2008 to 2014 undergoing CTO PCI, 21,185 (19%) had HFrEF and 3309 (3%) had HFpEF. Compared to patients without heart failure, HFrEF and HFpEF patients were older (mean age 69.2 vs 66.3, 70.3 vs 66.3 respectively, P < 0.001), had more comorbidities and higher acute in-hospital complications. HFrEF patients had higher adjusted in-hospital mortality [AOR 1.73, 95% CI (1.21-2.48)], acute renal failure [AOR 2.68, 95% CI (2.34-3.06)], and need for mechanical support [AOR 2.76, 95% CI (2.17-3.51)]. Compared to patients without heart failure, HFpEF patients had similar mortality and need for mechanical support, but higher incidence of acute renal failure. Older age was significantly associated with increased in-hospital mortality. chronic total occlusion PCI in patients with heart failure is associated with higher in-hospital morbidity and mortality and warrants further investigation to optimize health care delivery.
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Affiliation(s)
- Aiham Albaeni
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX.
| | - Khaled F Chatila
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Ravi A Thakker
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Paul Kumfa
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Haider Alwash
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Ahmed Elsherbiny
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Syed Gilani
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Wissam I Khalife
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Hani Jneid
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Afaq Motiwala
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
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Sengodan P, Davies RE, Matsuno S, Chan AK, Kearney K, Salisbury A, Grantham JA, Hirai T. Chronic Total Occlusion Interventions in Patients with Reduced Ejection Fraction. Curr Cardiol Rep 2023; 25:43-50. [PMID: 36576680 DOI: 10.1007/s11886-022-01832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE OF THE REVIEW The goal of this paper is to review the current evidence surrounding CTO PCI in patients with low EF, the most high-risk population to treat. We also present pertinent case examples and offer practical tips to increase success and lower complications when performing CTO PCI in patients with low EF. RECENT FINDINGS In a prospective randomized control study, greater improvement in angina frequency and quality of life, assessed by the Seattle Angina Questionnaire, was achieved by CTO PCI compared to optimal medical therapy. Furthermore, after successful CTO PCI, improvements in health status were similar in patients with both low and normal EF. CTO PCI can not only ameliorate symptoms of angina in patients with low EF but may also potentially improve EF in carefully selected populations. However, information regarding treatment of this high-risk population is lacking and large-scale studies targeting patients with severely reduced EF remain necessary.
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Affiliation(s)
| | | | | | - Albert K Chan
- University of Missouri Columbia, One Hospital Drive, Columbia, MO, 65212, USA
| | | | - Adam Salisbury
- St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | - Taishi Hirai
- University of Missouri Columbia, One Hospital Drive, Columbia, MO, 65212, USA.
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19
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Kucheriava MV, Mankovsky GB. Reasonable Incomplete Myocardial Revascularization in Patients with Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2022. [DOI: 10.30702/ujcvs/22.30(04)/km057-2025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim. To evaluate the results of incomplete myocardial revascularization with percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy and heart failure with reduced left ventricular ejection fraction based on the residual SYNTAX Score (rSS) scale.
Materials and methods. This prospective observational one-center study was conducted at the Ukrainian Children’s Cardiac Center, Clinic for Adults and included 192 patients whounderwent coronary angiography and myocardial re-vascularization using PCI. Baseline demographic and clinical parameters, including gender, age, presence of comorbid pathology were obtained from the medical history of each patient retrospectively. The results of revascularization were evaluated over a period of 2 years (from March 2020 to March 2022). To assess the completeness of revascularization, the rSS scale was used, and coronary angiography was repeated.
Results and discussion. The most significant adverse events during 24 months of follow-up, associated with the severity of coronary artery damage according to the SYNTAX scale ≥23 points, were: death from any cause with odds ratio (OR) 6.9 (95% CI, p = 0.05); myocardial infarction (MI) with OR 5.5 (95% CI, p = 0.001); the combined endpoint was OR 2.4 (95% CI, p = 0.005). Over a 2-year follow-up period,results of myocardial revascularization according to the rSS scale were evaluated the effect of coronary artery stenting with minimal residual atherosclerotic narrowing (rSS ≤8) and significant arterial lesions (rSS ≥9) on indicators such as all-cause mortality, myocardial revascularization, re-hospitalization, recurrent acute MI and stroke were analyzed. Data analysis showed statistically significant difference in all indicators in favor of the group with a score of rSS ≤8 (р <0.05).
Conclusions. The rSS scale in patients with coronary artery disease and heart failure with reduced left ventricular ejection fraction after PCI is a statistically significant criterion for the impact on the combined endpoint. In addition, an rSS score ≥9 was associated with a significantly higher riskof all-cause mortality, recurrent acute MI, and recurrent revascularization. A stratified rSS score ≥9 in ischemic cardiomyopathy with left ventricular ejection fraction ≤40% was more often observed in patients with existing comorbid pathology, such as hypertension, diabetes mellitus, stroke, peripheral artery disease.
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20
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Zhao S, Chen Y, Zhu B, Wang J, Wei Z, Zou Y, Hu W, Chen G, Wang H, Xia C, Yu T, Han P, Yang L, Wang W, Zhai Z, Gao H, Li C, Lian K. Percutaneous coronary intervention improves quality of life of patients with chronic total occlusion and low estimated glomerular filtration rate. Front Cardiovasc Med 2022; 9:1019688. [PMID: 36620621 PMCID: PMC9812571 DOI: 10.3389/fcvm.2022.1019688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background A low estimated glomerular filtration rate (eGFR <90 mL/min/1.73 m2) is widely recognized as a risk factor for major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). However, the impact of successful CTO-PCI on quality of life (QOL) of patients with low eGFR remains unknown. Objectives The aim of this prospective study was to assess the QOL of CTO patients with low eGFR after successful PCI. Methods Consecutive patients undergoing elective CTO-PCI were prospectively enrolled and subdivided into four groups: eGFR ≥90 mL/min/1.73 m2 (n = 410), 90 > eGFR ≥ 60 mL/min/1.73 m2 (n = 482), 60 > eGFR ≥ 30 mL/min/1.73 m2 (n = 161), and eGFR <30 mL/min/1.73 m2 (n = 23). The primary outcomes included QOL, as assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire, and symptoms, as assessed with the Rose Dyspnea Scale (RDS) and Seattle Angina Questionnaire (SAQ), at 1 month and 1 year after successful PCI. Results With the decline of eGFR, CTO patients were more likely to present with comorbidities of hypertension, diabetes, hyperuricemia, and previous stroke, in addition to lower hemoglobin levels and left ventricular ejection fraction (p < 0.05). Low eGFR was associated with greater incidences of in-hospital pericardiocentesis, major bleeding, acute renal failure, and subcutaneous hematoma, but not in-hospital MACE (p < 0.05). Symptoms of dyspnea and angina were alleviated in all CTO patients with eGFR ≥30 mL/min/1.73 m2 at 1 month and 1 year after successful CTO-PCI, but only at 1 month for those with eGFR <30 mL/min/1.73 m2 (p < 0.01). Importantly, QOL was markedly improved at 1 month and 1 year after successful PCI (p < 0.01), notably at a similar degree between patients with low eGFR and those with normal eGFR (p > 0.05). Conclusion Successful PCI effectively improved symptoms and QOL of CTO patients with low eGFR.
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Affiliation(s)
- Shuai Zhao
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yan Chen
- Department of Cardiology, No. 971 Hospital of the PLA Navy, Qingdao, Shandong, China
| | - Boda Zhu
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China,Primary Flight Training Base, Air Force Aviation University, Harbin, Heilongjiang, China
| | - Jiayi Wang
- Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhihong Wei
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yiming Zou
- Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wentao Hu
- Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Genrui Chen
- Department of Cardiology, Hanyin County People's Hospital, Ankang, Shaanxi, China
| | - Huan Wang
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chenhai Xia
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tiantong Yu
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Peng Han
- Department of Cardiology, 981 Hospital of Joint Logistics Support Force, Chengde, Hebei, China
| | - Li Yang
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Wang
- Department of Pharmaceutics and Pharmacy Administration, School of Pharmacy, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhongjie Zhai
- Department of Health Statistics, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haokao Gao
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China,Haokao Gao
| | - Chengxiang Li
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China,Chengxiang Li
| | - Kun Lian
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China,*Correspondence: Kun Lian ;
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21
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Zhao S, Chen Y, Wang Q, Zhu B, Wei Z, Wang Z, Wang J, Zou Y, Hu W, Liu C, Yu T, Han P, Yang L, Wang H, Xia C, Liu Q, Wang W, Gao H, Li C, Lian K. Benefits of successful percutaneous coronary intervention in chronic total occlusion patients with diabetes. Cardiovasc Diabetol 2022; 21:271. [PMID: 36471410 PMCID: PMC9724402 DOI: 10.1186/s12933-022-01708-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetes was commonly seen in chronic total occlusion (CTO) patients but data regarding the impact of successful percutaneous coronary intervention (PCI) on clinical outcome of CTO patients with diabetes was controversial. And importantly, no studies have compared quality of life (QOL) after CTO-PCI in patients with and without diabetes. METHODS Consecutive patients undergoing elective CTO-PCI were prospectively enrolled from Apr. 2018 to May 2021. Patients were subdivided into 2 groups: Diabetes and No Diabetes. Detailed baseline characteristics, assessment of symptoms and QOL, angiographic and procedural details, in-hospital complications, and 1 month and 1 year follow-up data were collected. These data were analyzed accordingly for risk predictors of clinical outcome in patients who have diabetes and received successful CTO-PCI. RESULTS A total of 1076 patients underwent CTO-PCI attempts. Diabetes was present in 374 (34.76%) patients, who had more hypertension, previous PCI and stroke. Regarding the coronary lesions, diabetic patients suffered more LCX lesion, multivessel disease, number of lesions per patient, blunt stump, calcification and higher J-CTO score (p < 0.05). In-hospital major adverse cardiac event (MACE) (4.13% vs. 5.35%; p = 0.362) was similar in the two groups. At 1 month and 1 year follow-up after successful CTO-PCI, the incidence of MACE and all-cause mortality were also similar in the two groups (p > 0.05). Number of lesions per patient was an independent risk factor of MACE and all-cause mortality (p < 0.001) 1 year after successful CTO-PCI. Symptom and QOL were markedly improved regardless of diabetes both at 1 month and 1 year follow-up, and importantly, patients with diabetes showed similar degrees of improvement to those without diabetes (P > 0.05). CONCLUSIONS Successful CTO-PCI could represent an effective strategy improving clinical outcome, symptoms and QOL in CTO patients with diabetes.
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Affiliation(s)
- Shuai Zhao
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Yan Chen
- Department of Cardiology, No.971 Hospital of the PLA Navy, Qingdao, 266071 Shandong People’s Republic of China
| | - Qingyi Wang
- grid.233520.50000 0004 1761 4404Department of Foreign Languages, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Boda Zhu
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China ,Primary Flight Training Base, Air Force Aviation University, Harbin, 150100 Hei Longjiang People’s Republic of China
| | - Zhihong Wei
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Ziwei Wang
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Jiayi Wang
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Yiming Zou
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Wentao Hu
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Cheng Liu
- grid.233520.50000 0004 1761 4404Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Tiantong Yu
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Peng Han
- Department of Cardiology, 981 Hospital of Joint Logistics Support Force, Chengde, 067000 Hebei People’s Republic of China
| | - Li Yang
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Huan Wang
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Chenhai Xia
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Qiling Liu
- grid.449637.b0000 0004 0646 966XDepartment of Epidemiology and Medical Statistical, School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, 712046 Shaanxi People’s Republic of China
| | - Wei Wang
- grid.233520.50000 0004 1761 4404Department of Pharmaceutics and Pharmacy Administration, School of Pharmacy, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Haokao Gao
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Chengxiang Li
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Kun Lian
- grid.417295.c0000 0004 1799 374XDepartment of Cardiology, Xijing Hospital, The Fourth Military Medical University, 169 West Changle Road, Xi’an, 710032 Shaanxi People’s Republic of China
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Assessing the Clinical Influence of Chronic Total Occlusions (CTOs) Revascularization and the Impact of Vascularization Completeness on Patients with Left Ventricular (LV) Systolic Dysfunction. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:9128206. [PMID: 35990115 PMCID: PMC9385310 DOI: 10.1155/2022/9128206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022]
Abstract
Objectives This paper intends to assess the clinical influence of chronic total occlusions (CTOs), revascularization, and the impact of vascularization completeness on patients with left ventricular (LV) systolic dysfunction. Background The roles of CTO vascularization in clinical benefits remain conflicting. In addition, data concerning the different results of CTO vascularization and vascularization completeness according to LV systole function were assessed. Methods From an overall 918 consecutive patients with at least one CTO, 281 patients with ejection fraction (EF) ≤40% accepted coronary angiographic analysis between Jan 1, 2012, and Dec 31, 2020, and 29 patients were excluded. Subsequently, 261 patients were grouped into the successful CTO-PCI revascularization group (SCR, n = 135) and the optimal medical therapy group (OMT, n = 126). The prognosis influence of successfully finished CTO-PCI and complete revascularization on survival was evaluated. The primary endpoint was cardiac mortality, and the secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE). Results After a median follow-up time of 38.02 months, the cardiac mortality (p=0.037) and MACCE (p=0.001) were more remarkable in the OMT group than in the SCR group. Moreover, patients with CTO-PCI had survival benefits from complete revascularization for MACCE (p=0.025) and cardiac mortality (p=0.041). Based on multivariable Cox proportional hazards regression analysis, age ≧ 75 years (HR: 3.443, 95% CI 1.719–6.897, p < 0.001) predicted a worse probability of cardiac mortality. Additionally, previous PCI (HR: 1.592, 95% CI 1.034–2.449, p=0.035) and previous MI (HR: 1.971, 95% CI 1.258–3.088, p=0.003) predicted a worse probability of MACCE, and SCR (HR: 0.499, 95% CI 0.320–0.776, p=0.002) was a protection predictor of MACCE. Conclusion In patients with LV systole dysfunction (EF ≤ 40%), successfully finished CTO-PCI is related to long-term survival benefits. The benefits were more remarkable in patients with complete coronary revascularization (CCR).
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Yang L, Li H, Guo G, Du J, Hao Z, Kong L, Shi H, Wang X, Zhang Y. Development and Validation of a Novel Nomogram to Predict Improved Left Ventricular Ejection Fraction in Patients With Heart Failure After Successful Percutaneous Coronary Intervention for Chronic Total Occlusion. Front Cardiovasc Med 2022; 9:864366. [PMID: 35514438 PMCID: PMC9062645 DOI: 10.3389/fcvm.2022.864366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHeart failure with improved left ventricular ejection fraction (HFiEF) is linked to a good clinical outcome. The purpose of this study was to create an easy-to-use model to predict the occurrence of HFiEF in patients with heart failure (HF), 1 year after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) (CTO PCI).MethodsPatients diagnosed with HF who successfully underwent CTO PCI between January 2016 and August 2019 were included. To mitigate the effect of residual stenosis on left ventricular (LV) function, we excluded patients with severe residual stenosis, as quantitatively measured by a residual synergy between PCI with Taxus and Cardiac Surgery score (rSS) of >8. We gathered demographic data, medical history, angiographic and procedural characteristics, echocardiographic parameters, laboratory results, and medication information. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression models were used to identify predictors of HFiEF 1 year after CTO revascularization. A nomogram was established and validated according to the area under the receiver operating characteristic curve (AUC) and calibration curves. Internal validation was performed using bootstrap resampling.ResultsA total of 465 patients were finally included in this study, and 165 (35.5%) patients experienced HFiEF 1 year after successful CTO PCI. According to the LASSO regression and multivariate logistic regression analyses, four variables were selected for the final prediction model: age [odds ratio (OR): 0.969; 95% confidence interval (CI): 0.952–0.988; p = 0.001], previous myocardial infarction (OR: 0.533; 95% CI: 0.357–0.796; p = 0.002), left ventricular end-diastolic dimension (OR: 0.940; 95% CI: 0.910–0.972; p < 0.001), and sodium glucose cotransporter two inhibitors (OR: 5.634; 95% CI: 1.756–18.080; p = 0.004). A nomogram was constructed to present the results. The C-index of the model was 0.666 (95% CI, 0.613–0.719) and 0.656 after validation. The calibration curve demonstrated that the nomogram agreed with the actual observations.ConclusionsWe developed an simple and effective nomogram for predicting the occurrence of HFiEF in patients with HF, 1 year after successful CTO PCI without severe residual stenosis.
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24
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Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Karmpaliotis D, Masoumi A, Jaffer FA, Doshi D, Khatri J, Poommipanit P, Gorgulu S, Goktekin O, Krestyaninov O, Davies R, ElGuindy A, Jefferson BK, Patel TN, Patel M, Chandwaney RH, Mashayekhi K, Galassi AR, Rangan BV, Brilakis ES. Outcomes of chronic total occlusion percutaneous coronary intervention in patients with reduced left ventricular ejection fraction. Catheter Cardiovasc Interv 2022; 99:1059-1064. [DOI: 10.1002/ccd.30097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Bahadir Simsek
- Center for Coronary Artery Disease Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota USA
| | - Spyridon Kostantinis
- Center for Coronary Artery Disease Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota USA
| | - Judit Karacsonyi
- Center for Coronary Artery Disease Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota USA
| | | | - Dimitri Karmpaliotis
- Gagnon Cardiovascular Institute Morristown Medical Center Morristown New Jersey USA
| | - Amirali Masoumi
- Gagnon Cardiovascular Institute Morristown Medical Center Morristown New Jersey USA
| | - Farouc A. Jaffer
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital Harvard University Boston Massachusetts USA
| | - Darshan Doshi
- Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital Harvard University Boston Massachusetts USA
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland Ohio USA
| | - Paul Poommipanit
- Section of Cardiology, University Hospitals Case Western Reserve University Cleveland Ohio USA
| | - Sevket Gorgulu
- Department of Cardiology Acibadem Kocaeli Hospital Kocaeli Turkey
| | | | - Oleg Krestyaninov
- Department of Invasive Cardiology, Meshalkin National Medical Research Center Ministry of Health of the Russian Federation Novosibirsk Russian Federation
| | | | | | | | | | - Mitul Patel
- Division of Cardiovascular Medicine UCSD Medical Center La Jolla California USA
| | | | - Kambis Mashayekhi
- Division of Cardiology and Angiology II University Heart Center Freiburg ‐ Bad Krozingen Bad Krozingen Germany
| | - Alfredo R. Galassi
- Department of PROMISE, Cardiovascular Medicine University of Palermo Palermo Italy
| | - Bavana V. Rangan
- Center for Coronary Artery Disease Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota USA
| | - Emmanouil S. Brilakis
- Center for Coronary Artery Disease Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis Minnesota USA
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25
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Strauss BH, Knudtson ML, Cheema AN, Galbraith PD, Elbaz-Greener G, Abuzeid W, Henning KA, Qiu F, Wijeysundera HC. Canadian Multicenter Chronic Total Occlusion Registry: Ten-Year Follow-Up Results of Chronic Total Occlusion Revascularization. Circ Cardiovasc Interv 2021; 14:e010546. [PMID: 34932391 DOI: 10.1161/circinterventions.121.010546] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic total occlusions (CTO) occur in nearly 20% of coronary angiograms. CTO revascularization, either by percutaneous coronary intervention (PCI) or coronary artery bypass grafting surgery (CABG), is infrequently performed, approximately one-third of cases. Long-term outcomes are unknown. The objective of the study was to determine whether early CTO revascularization of patients, either by CABG or PCI, was associated with improved clinical outcomes. METHODS One thousand six hundred twenty-four patients from the Canadian CTO registry were followed for at least 9.75 years. Revascularization was performed according to routine clinical practice. Patients were grouped according to CTO revascularization status (PCI or CABG of CTO vessel, CTO revasc) or no CTO revasc (medical therapy only, or PCI/CABG of non-CTO vessels only), within 3 months of initial angiogram. Patients were followed for mortality, revascularization procedures (PCI and CABG), and hospitalizations for acute coronary syndromes and heart failure. RESULTS Early CTO revasc was performed in 28.2% of patients (17.5% CABG, 10.7% PCI). The CTO revasc group was younger, with more males and generally fewer comorbidities. There was a significantly lower mortality probability at 10 years in the CTO revascularization group (22.7% [95% CI, 19.0%-26.9%]) compared with the no CTO revasc group (36.6% [95% CI, 33.8%-39.5%]). At 10 years, revascularization rates (14.0% versus 22.8%) and acute coronary syndrome hospitalization rates (10.0% versus 16.6%) were significantly lower in the CTO revasc group. Baseline-adjusted analysis showed CTO revasc was associated with significantly lower all-cause mortality (hazard ratio, 0.67 [95% CI, 0.54-0.84]). In both landmark and time varying analyses, association with lower mortality was particularly robust for CTO revascularization by CABG (hazard ratio 0.56 and 0.60, respectively), with a marginally significant result for PCI in the time varying analysis (hazard ratio 0.711 [95% CI, 0.51-0.998]). CONCLUSIONS Early CTO revascularization was associated with significantly lower all-cause mortality, revascularization rates, and hospitalization for acute coronary syndrome at 10 years, and mainly driven by outcomes in patients with CABG.
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Affiliation(s)
- Bradley H Strauss
- Schulich Heart Program, Sunnybrook Health Sciences Centre (B.H.S., G.E.-G., W.A., H.C.W.).,University of Toronto, Ontario, Canada (B.H.S., A.N.C., K.A.H., F.Q., H.C.W.)
| | - Merril L Knudtson
- Libin Cardiovascular Institute of Alberta, Calgary, Canada (M.L.K., P.D.G.)
| | - Asim N Cheema
- Terrence Donnelly Heart Center, St. Michael's Hospital (A.N.C.).,University of Toronto, Ontario, Canada (B.H.S., A.N.C., K.A.H., F.Q., H.C.W.)
| | - P Diane Galbraith
- Libin Cardiovascular Institute of Alberta, Calgary, Canada (M.L.K., P.D.G.)
| | - Gabby Elbaz-Greener
- Schulich Heart Program, Sunnybrook Health Sciences Centre (B.H.S., G.E.-G., W.A., H.C.W.).,Now with Hadassah Medical Center, Hebrew University, Jerusalem, Israel (G.E.-G.)
| | - Wael Abuzeid
- Schulich Heart Program, Sunnybrook Health Sciences Centre (B.H.S., G.E.-G., W.A., H.C.W.).,Now with Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (W.A.)
| | - Kayley A Henning
- University of Toronto, Ontario, Canada (B.H.S., A.N.C., K.A.H., F.Q., H.C.W.).,ICES, Toronto, Ontario (K.A.H., F.Q., H.C.W.)
| | - Feng Qiu
- University of Toronto, Ontario, Canada (B.H.S., A.N.C., K.A.H., F.Q., H.C.W.).,ICES, Toronto, Ontario (K.A.H., F.Q., H.C.W.)
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Centre (B.H.S., G.E.-G., W.A., H.C.W.).,University of Toronto, Ontario, Canada (B.H.S., A.N.C., K.A.H., F.Q., H.C.W.).,ICES, Toronto, Ontario (K.A.H., F.Q., H.C.W.)
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26
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Dyrbuś M, Desperak P, Pawełek M, Możdżeń M, Gąsior M, Hawranek M. Serum uric acid is an independent risk factor of worse mid- and long-term outcomes in patients with non-ST-segment elevation acute coronary syndromes. Cardiol J 2021; 30:VM/OJS/J/84645. [PMID: 34897641 PMCID: PMC10713218 DOI: 10.5603/cj.a2021.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The data on the association between serum uric acid (sUA) concentration and outcomes in patients with an ACS are inconsistent and do not focus on patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). The aim of this study was to analyze an association of sUA concentration on admission and outcomes in those patients. METHODS Data from the prospective, single-center registry of patients hospitalized due to NSTE-ACS from January 2006 to December 2016 were analyzed retrospectively. The population was divided into quartiles according to the baseline sUA. The primary outcome was the incidence of all-cause death, non-fatal myocardial infarction, stroke and ACS-driven revascularization at 36 months. RESULTS Total of 2,824 patients with sUA measured on admission were included in this analysis with a median sUA of 352 µmol/L (5.92 mg/dL). Patients with higher sUA were older and more burdened with cardiovascular risk factors and history of coronary events. The prevalence of multivessel coronary artery disease and left main stenosis was significantly higher in patients with higher sUA. Elevated sUA concentration was associated with significantly worse short-, mid- and long-term outcomes. All-cause mortality was significantly higher in each analyzed period. In the multivariable analysis, sUA elevation was identified as an independent predictor of all-cause mortality at 12-month and 36-month follow-up. CONCLUSIONS Elevated baseline sUA concentration was independently associated with worse mid- and long-term outcomes in patients with NSTE-ACS. Baseline sUA concentration could identify patients with NSTE-ACS at higher risk of more dismal prognosis.
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Affiliation(s)
- Maciej Dyrbuś
- Student Scientific Society, 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Desperak
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marta Pawełek
- Student Scientific Society, 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mateusz Możdżeń
- Student Scientific Society, 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Michał Hawranek
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
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Yang X, Tian J, Zhang L, Dong W, Mi H, Li J, Li J, Han Y, Zuo H, An J, He Y, Song X. Myocardial Viability, Functional Status, and Collaterals of Patients With Chronically Occluded Coronary Arteries. Front Cardiovasc Med 2021; 8:754826. [PMID: 34869665 PMCID: PMC8632801 DOI: 10.3389/fcvm.2021.754826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/11/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: Viability and functional assessments are recommended for indication and intervention for chronic coronary total occlusion (CTO). We aimed to evaluate myocardial viability and left ventricular (LV) functional status by using cardiovascular magnetic resonance (CMR) and to investigate the relationship between them and collaterals in patients with CTO. Materials and Methods: We enrolled 194 patients with one CTO artery as detected by coronary angiography. Patients were scheduled for CMR within 1 week after coronary angiography. Results: A total of 128 CTO territories (66%) showed scar based on late gadolinium enhancement (LGE) imaging. There were 1,112 segments in CTO territory, while only 198 segments (18%) subtended by the CTO artery showed transmural scar (i.e., >50% extent on LGE). Patients with viable myocardium had higher LV ejection fraction (LVEF) (56.7 ± 13.5% vs. 48.3 ± 15.4%, p < 0.001) than those with transmural scar. Angiographically, well-developed collaterals were found in 164 patients (85%). There was no significant correlation between collaterals and the presence of myocardial scar (p = 0.680) or between collaterals and LVEF (p = 0.191). Nevertheless, more segments with transmural scar were observed in patients with poorly-developed collaterals than in those with well-developed collaterals (25 vs. 17%, p = 0.010). Conclusion: Myocardial infarction detected by CMR is widespread among patients with CTO, yet only a bit of transmural myocardial scar was observed within CTO territory. Limited number of segments with transmural scar is associated with preserved LV function. Well-developed collaterals are not related to the prevalence of myocardial scar or systolic functioning, but could be related to reduce number of non-viable segments subtended by the CTO artery.
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Affiliation(s)
- Xueyao Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinfan Tian
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lijun Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Dong
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongzhi Mi
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiahui Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Han
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huijuan Zuo
- Department of Community Health Research, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Yang L, Guo L, Lv H, Liu X, Zhong L, Ding H, Zhou X, Zhu H, Huang R. Predictors of Adverse Events Among Chronic Total Occlusion Patients Undergoing Successful Percutaneous Coronary Intervention and Medical Therapy. Clin Interv Aging 2021; 16:1847-1855. [PMID: 34703218 PMCID: PMC8523319 DOI: 10.2147/cia.s337069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Limited data are available on the predictors of major adverse cardiac events (MACE) after a successful coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and medical therapy. This study aimed to identify predictors of MACE in CTO patients undergoing successful recanalization and medical therapy. Methods A total of 2015 patients with CTOs were enrolled. About 718 patients underwent successful CTO recanalization, and 1297 patients received medical therapy. The primary outcome was the frequency of MACE, defined as a composite of cardiac death, myocardial infarction, and target-vessel revascularization. Multivariate models were used to determine predictors of MACE. Results In successful CTO recanalization group, MACE occurred in 123 (17.1%) patients. In multivariate analysis, heart failure (hazard ratio [HR] 1.77, 95% confidence interval [CI]: 1.04–3.04, p = 0.036) was identified as independent predictors for MACE in successful CTO recanalization. Additionally, in medical therapy group, the significant predictors of MACE were male gender (HR 1.53, 95% CI: 1.13–2.05, p = 0.005), diabetes mellitus (HR 1.39, 95% CI: 1.11–1.74, p = 0.003), heart failure (HR 1.44, 95% CI: 1.10–1.87, p = 0.007), J-CTO score (HR 1.17, 95% CI: 1.07–1.28, p = 0.001) and multivessel disease (HR 2.20, 95% CI: 1.42–3.39, p < 0.001). Conclusion Heart failure was predictor for composite cardiovascular events in patients with CTO after successful recanalization. Male gender, diabetes mellitus, heart failure, J-CTO score and multivessel disease were predictors of MACE in CTO patients with medical therapy.
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Affiliation(s)
- Le Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China.,Department of Cardiology, Dalian Third People's Hospital, Dalian City, People's Republic of China
| | - Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Haichen Lv
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Xiaodong Liu
- Department of Radiology, Dalian Friendship Hospital, Dalian City, People's Republic of China
| | - Lei Zhong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Huaiyu Ding
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Xuchen Zhou
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Hao Zhu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China
| | - Rongchong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China.,Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Guo L, Meng S, Lv H, Zhong L, Wu J, Ding H, Xu J, Zhang X, Huang R. Long-Term Outcomes of Successful Recanalization Compared With Optimal Medical Therapy for Coronary Chronic Total Occlusions in Patients With and Without Left Ventricular Systolic Dysfunction. Front Cardiovasc Med 2021; 8:654730. [PMID: 33959643 PMCID: PMC8093409 DOI: 10.3389/fcvm.2021.654730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The number of coronary chronic total occlusion (CTO) patients with left ventricular (LV) systolic dysfunction is significant, but the clinical outcomes of these patients are rarely reported. The present retrospective cohort study aimed to investigate the long-term outcomes of successful recanalization vs. optimal medical therapy (MT) for CTOs in patients with preserved and impaired LV systolic function. Methods: A total of 1,895 patients with CTOs were stratified according to LV function. Of these, 1,420 patients (74.9%) with LV ejection fraction (LVEF) >45% and 475 patients (25.1%) with LVEF ≤45% were treated with optimal MT or successful CTO percutaneous coronary intervention (PCI). A 1:1 propensity score matching (PSM) was conducted to reduce the impact of potential confounding on the outcomes. The primary outcome was the frequency of major adverse cardiac events (MACEs). Results: Throughout a 2.6-year follow-up and after adjusting for confounders, among patients with preserved LV function, successful CTO PCI was associated with reduced incidence of MACE (14.2 vs. 23.9%, adjusted HR 0.63, 95% CI 0.48–0.83, p = 0.001) compared to MT. There was no significant difference in MACE occurrence (29.6 vs. 28.9%, adjusted HR 1.05, 95% CI: 0.71–1.56, p = 0.792) between successful recanalization and MT in patients with LV systolic dysfunction. The primary outcome among patients with impaired and preserved LV systolic function after PSM was similar to that from earlier findings before PSM was conducted. A significant interaction between LV function and therapeutic strategy for MACE was observed (interaction p = 0.038). Conclusions: Compared to MT alone for management of patients with CTOs, successful CTO PCI may reduce the risk of MACE in patients with preserved LV systolic function, but not in patients with LV dysfunction.
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Affiliation(s)
- Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shaoke Meng
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haichen Lv
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lei Zhong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jian Wu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Huaiyu Ding
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jiaying Xu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoyan Zhang
- Department of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang, China
| | - Rongchong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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30
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Shokry KAA, Farag ESM, Salem AM, Ibrahim IM, Abel-Aziz M, El Zayat A. Original Article--Value of Pathological Q Waves and Angiographic Collateral Grade in Patients Undergoing Coronary Chronic Total Occlusion Recanalization: Cardiac Magnetic Resonance Study. J Saudi Heart Assoc 2021; 33:41-50. [PMID: 33880327 PMCID: PMC8051329 DOI: 10.37616/2212-5043.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background/aim Successful coronary chronic total occlusion (CTO) revascularization was found by many studies to be associated with improved left ventricular (LV) systolic function and survival if evidence of viability is present. Little is known about the association of CTO revascularization in patients with electrocardiographic Q waves and improvement in angina burden as a measurement of health-related quality of life (HRQOL) afterwards. Methods In this study, 100 patients with single vessel CTO were included. Myocardial viability was tested by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and 50 patients showed evidence of viability. Seattle Angina Questionnaire (SAQ) scores were used as a measure of HRQOL. Results Pathological Q waves were present in 48 patients (including 19 patients with viable CTO territory) out of 100 patients. Patients with Q waves tended to have worse Seattle Angina Questionnaire (SAQ) scores compared to those with no Q waves (31.2 ± 11.7 vs 45.3 ± 13.9 respectively, p = 0.002), worse LV systolic function and wall motion score index (WMSI) on CMR. They also had significantly less prevalence of viability (p < 0.001). Patients with Q waves and positive viability had lower SAQ scores (37.2 ± 10.1 vs 52.7 ± 13.2 respectively, p = 0.02), higher LVEF and lower WMSI. They also had well developed collateral grade (2.1 ± 1.03 vs 0.7 ± 0.82 respectively, p < 0.001). After successful percutaneous coronary intervention (PCI), in the viable LV group, presence of Q waves was not associated with better LV functional recovery, while those with higher collateral grades were more likely to have better LV functional recovery post CTO-PCI. Patients with Q waves and viable CTO territory showed significantly better SAQ scores compared to pre-PCI (87.3 ± 12.2 vs 37.2 ± 10.1 respectively, p < 0.001). For angina frequency, post–PCI score was 80.2 ± 7.9 compared to 39.2 ± 7.1 before PCI, p < 0.001). Multivariate regression analysis showed that pathological Q waves, Rentrop's collateral grade and the Canadian Cardiovascular Society (CCS) angina class before PCI were the most significant independent predictors of improved HRQOL as reflected by SAQ (OR for Q waves 7.83, 95% CI 1.62–18.91,p 0.003), (OR for Rentrop's collateral grade 8.31,95% CI 2.21–26.33, p < 0.001), (OR for CCS class 8.39, 95% CI 1.21–20.8, p 0.01). Conclusion Well-developed collateral circulation could independently predict LV functional recovery after CTO-PCI. Patients with Q waves and viable CTO territory tend to have higher CCS class before revascularization and get significant improvement of HRQOL after PCI. Other predictors of improved HRQOL are Rentrop's collateral grade and worse CCS class before PCI.
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Affiliation(s)
| | | | - Ahmed Mohamed Salem
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Ahmed El Zayat
- Department of Cardiology, Zagazig University, Zagazig, Egypt
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31
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El Awady WS, Samy M, Al-Daydamony MM, Abd El Samei MM, Shokry KAEA. Periprocedural and clinical outcomes of percutaneous coronary intervention of chronic total occlusions in patients with low- and mid-range ejection fractions. Egypt Heart J 2020; 72:28. [PMID: 32449095 PMCID: PMC7246267 DOI: 10.1186/s43044-020-00065-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The benefit and safety of percutaneous coronary intervention (PCI) to chronic total occlusions (CTO) in patients with low and mid-range left ventricular ejection fraction (LVEF) continue to be evidence limited. The aim of our study was to investigate the impact of LVEF in patients undergoing CTO PCI and to evaluate the mid-term clinical outcome of those with low and mid-range LVEF. We assessed the periprocedural and mid-term outcomes of 75 patients undergoing CTO PCIs according to pre-procedural LVEF: group (N), ≥ 50% (normal, nom.= 25); group (M), 40-49% (mid-range, nom.= 25); and group (L), < 40% (low, nom.= 25); within 6 months of follow-up. RESULTS The prevalence of DM and chronic kidney disease (CKD) was significantly higher in low LVEF group (60%, p = 0.04 and 48%, p = 0.01 respectively). Apart from significantly lower contrast volume in patients with low LVEF (p = 0.04), there was no significant difference between the three groups regarding the procedural time, SYNTAX score and J-CTO score. We noticed similar procedural success in the three groups (88% vs. 84% vs. 76%, p = 0.521). LVEF category failed to predict procedural success (OR = 0.652, p = 0.268). There was a highly significant improvement in angina 6 months following intervention in normal LVEF group (p value < 0.001). Grade of dyspnea significantly improved 6 months following intervention in mid-range LVEF and low LVEF groups (p value = 0.04 and 0.031 respectively). There was no significant difference between the three groups regarding the reported MACCEs (12% vs. 16% vs. 28%, p = 0.268). CONCLUSION CTO PCI represents an efficient and safe strategy in patients with low and mid-range LVEFs. Mid-term outcomes in these patients were significantly improved following successful CTO PCI, without higher risk of MACCE at 6 months follow-up.
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Affiliation(s)
- Waleed Salem El Awady
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Ash Sharkia Egypt
| | - Mohamed Samy
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Ash Sharkia Egypt
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Tian J, Zuo H, Zhang L, Zhang M, Zhang D, Zhang M, Zhou Y, He Y, Mi H, Yang X, Huang R, Song X. The success of opening concurrent chronic total occlusion lesion to improve cardiac function trial in patients with multi-vessel disease (SOS-moral): Study protocol of a prospective multicenter study. Medicine (Baltimore) 2020; 99:e20349. [PMID: 32481325 PMCID: PMC7249893 DOI: 10.1097/md.0000000000020349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS The purpose of the present trial is to determine whether opening co-existing chronic total occlusions (CTOs) using percutaneous coronary interventions (PCIs) improves cardiac function in patients with multi-vessel disease (MVD). Patients with MVD are defined as having at least one additional major vessel exhibiting no less than 75% stenosis combined with the presence of a CTO artery. METHODS AND RESULTS Patients will be prospectively recruited who meet the following criteria:Patients presenting with no necrosis of myocardial tissue in the territory of the CTO will be excluded. Recruited patients will be randomized into 2 groups: those undergoing PCI of only the non-CTO artery (non-CTO PCI group), and those undergoing PCI of the non-CTO artery concurrently with the CTO artery (CTO-PCI group). The primary outcome will be the change in cardiac function evaluated via CMR at a 12-month of follow-up appointment, which will be compared to a baseline measurement. Secondary outcomes include occurrence of major cardiac events, CMR-assessed myocardial viability in the CTO-supplied territory, and quality of life assessed by Seattle angina questionnaire, Patient Health Questionnaire 9 and Generalized Anxiety Disorder Scale-7 after 12-month follow-up. CONCLUSION The SOS-moral trial will provide data necessary to determine whether to open concurrent CTOs among MVD patients with CMR-detected necrotic myocardial tissue.
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Affiliation(s)
| | | | - Lijun Zhang
- Department of Radiology, Beijing Anzhen Hospital
| | | | | | | | | | - Yi He
- Department of Radiology, Beijing Friendship Hospital
| | - Hongzhi Mi
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing
| | | | - Rongchong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian
- The Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Agrawal H, Lange RA, Montanez R, Wali S, Mohammad KO, Kar S, Teleb M, Mukherjee D. The Role of Percutaneous Coronary Intervention in the Treatment of Chronic Total Occlusions: Rationale and Review of the Literature. Curr Vasc Pharmacol 2020; 17:278-290. [PMID: 29345588 DOI: 10.2174/1570161116666180117100635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) of a coronary artery is defined as an occluded segment with no antegrade flow and a known or estimated duration of at least 12 weeks. OBJECTIVE We considered the current literature describing the indications and clinical outcomes for denovo CTO- percutaneous coronary intervention (PCI), and discuss the role of CTO-PCI and future directions for this procedure. METHODS Databases (PubMed, the Cochrane Library, Embase, EBSCO, Web of Science, and CINAHL were searched and relevant studies of CTO-PCI were selected for review. RESULTS The prevalence of coronary artery CTO's has been reported to be ~ 20% among patients undergoing diagnostic coronary angiography for suspected coronary artery disease. Revascularization of any CTO can be technically challenging and a time-consuming procedure with relatively low success rates and may be associated with a higher incidence of complications, particularly at non-specialized centers. However, with an increase in experience and technological advances, several centers are now reporting success rates above 80% for these lesions. There is marked variability among studies in reporting outcomes for CTO-PCI with some reporting potential mortality benefit, better quality of life and improved cardiac function parameters. Anecdotally, properly selected patients who undergo a successful CTO-PCI most often have profound relief of ischemic symptoms. Intuitively, it makes sense to revascularize an occluded coronary artery with the goal of improving cardiovascular function and patient quality of life. CONCLUSION CTO-PCI is a rapidly expanding specialized procedure in interventional cardiology and is reasonable or indicated if the occluded vessel is responsible for symptoms or in selected patients with silent ischemia in whom there is a large amount of myocardium at risk and PCI is likely to be successful.
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Affiliation(s)
- Harsh Agrawal
- Division of Interventional Cardiology, Department of Internal Medicine, St. Elizabeth's Medical Center, Tufts School of Medicine, Boston, MA 02135, United States
| | - Richard A Lange
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
| | - Ruben Montanez
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
| | - Soma Wali
- Department of Internal Medicine, University of California at Los Angeles, Olive View Medical Centre, David Geffen School of Medicine, Los Angeles, CA 90024, United States
| | - Khan Omar Mohammad
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
| | - Subrata Kar
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
| | - Mohamed Teleb
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
| | - Debabrata Mukherjee
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, United States
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Neupane S, Gupta A, Basir M, Alaswad K. Chronic total occlusion percutaneous coronary interventions: identifying patients at risk of complications. Expert Rev Cardiovasc Ther 2020; 18:269-275. [DOI: 10.1080/14779072.2020.1760091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Saroj Neupane
- Department of Internal Medicine, WakeMed Hospital, Raleigh, NC, USA
| | - Ankur Gupta
- Division of Cardiology, Henry Ford Hospital/Wayne State University, Detroit, MI, USA
| | - Mir Basir
- Division of Cardiology, Henry Ford Hospital/Wayne State University, Detroit, MI, USA
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital/Wayne State University, Detroit, MI, USA
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35
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Clinical impact of successful recanalization for chronic total occlusion: insights from stress myocardial perfusion imaging. Heart Vessels 2020; 35:894-900. [DOI: 10.1007/s00380-020-01559-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
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Samy M, El Awady WS, Al-Daydamony MM, Abd El Samei MM, Shokry KAEA. Echocardiographic assessment of left ventricular function recovery post percutaneous coronary intervention of chronic total occlusions in patients with low and mid-range left ventricular ejection fractions. Echocardiography 2020; 37:239-246. [PMID: 31913538 DOI: 10.1111/echo.14582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/30/2019] [Accepted: 12/15/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Coronary chronic total occlusion (CTO) is a frequent condition encountered in cardiac catheterization laboratory with a prevalence of about 20%. Through literature, data are scarcely reported regarding the left ventricular (LV) function recovery post CTO percutaneous coronary intervention (PCI) in patients with low (<40%) and mid-range (40%-49%) LV ejection fraction (LVEF). The aim of this study was to assess the echocardiographic outcomes of CTO patients with low and mid-range LVEF successfully revascularized at 6-month follow-up. METHODS This prospective study included 75 patients with at least one CTO of an epicardial coronary artery proved by previous diagnostic coronary angiography with PCI attempt indication, and successfully revascularized. They were equally divided according to LVEF into three groups, and echocardiographic remodeling indices were assessed at baseline and 6 months post PCI. RESULTS Our study showed significant improvement of LVEF, S-wave velocity by tissue doppler imaging (TDI), LV wall-motion score (LVWMS), and LV systolic sphericity index (LVSIS) 6 months post CTO PCI in low LVEF group, and a significant improvement in LVEF, S-wave velocity, and LVWMS in mid-range LVEF group (P < .05). The delta change in LVEF was significantly more in low LVEF group, compared to the other two groups (F = 4.739, P < .05). CONCLUSION Successful CTO PCI in patients with low and mid-range LVEF is associated with significant improvement of LVEF and other indices of myocardial remodeling after 6 months of follow-up.
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Affiliation(s)
- Mohamed Samy
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Khariton Y, Airhart S, Salisbury AC, Spertus JA, Gosch KL, Grantham JA, Karmpaliotis D, Moses JW, Nicholson WJ, Cohen DJ, Lombardi W, Sapontis J, McCabe JM. Health Status Benefits of Successful Chronic Total Occlusion Revascularization Across the Spectrum of Left Ventricular Function: Insights From the OPEN-CTO Registry. JACC Cardiovasc Interv 2019; 11:2276-2283. [PMID: 30466826 DOI: 10.1016/j.jcin.2018.07.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/02/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to describe the association between chronic total occlusion (CTO) revascularization (CTO percutaneous coronary intervention [PCI]) and health status in patients with and without cardiomyopathy. BACKGROUND Prior PCI trials for cardiomyopathy have excluded CTO patients. Whether patients with reduced left ventricular ejection fraction (LVEF) receive similar health status benefit from CTO-PCI compared with patients with normal LVEF is unclear. METHODS We assessed health status change, using the Seattle Angina Questionnaire (SAQ) Summary, SAQ Angina Frequency, and Rose Dyspnea Scale scores, among patients undergoing successful CTO PCI in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion) Registry. Participants were classified by LVEF (normal, ≥50%; mild-moderate, 30% to 49%; and severe, <30%), with higher SAQ and lower Rose Dyspnea Scale scores indicating better health status. Differences in 1-year outcomes were compared using hierarchical multivariable regression. RESULTS Of 762 patients, 506 (66.4%), 193 (25.3%), and 63 (8.3%) had normal, mild-moderate, and severely reduced LVEF. SAQ Summary score improvements were observed in each group (27.1 ± 20.4, 26.7 ± 21.2, and 20.3 ± 18.1, respectively). Compared with patients with LVEF ≥50%, those with LVEF <30% had less improvement in SAQ Summary Score (-5.2 points; 95% confidence interval: -9.0 to -1.5; p = 0.01) and Rose Dyspnea Scale (+0.5 points; 95% confidence interval: 0.1 to 0.8; p = 0.01), with no difference in odds of angina (odds ratio: 1.3; 95% confidence interval: 0.6 to 3.0; p = 0.48). Health status improvement was similar between patients with LVEF ≥50% and LVEF 30% to 49%. CONCLUSIONS Although health status improvement was less in patients with severely reduced LVEF compared with those with normal LVEF, each group experienced large health status improvements after CTO-PCI.
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Affiliation(s)
- Yevgeniy Khariton
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Jeffrey W Moses
- Columbia University Medical Center, New York Presbyterian Hospital, New York, New York
| | | | - David J Cohen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | | | - James Sapontis
- The Avenue Hospital and Monash Medical Center, Windsor, Victoria, Australia
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Konstantinidis NV, Werner GS, Deftereos S, Di Mario C, Galassi AR, Buettner JH, Avran A, Reifart N, Goktekin O, Garbo R, Bufe A, Mashayekhi K, Boudou N, Meyer-Geßner M, Lauer B, Elhadad S, Christiansen EH, Escaned J, Hildick-Smith D, Carlino M, Louvard Y, Lefèvre T, Angelis L, Giannopoulos G, Sianos G. Temporal Trends in Chronic Total Occlusion Interventions in Europe. Circ Cardiovasc Interv 2019; 11:e006229. [PMID: 30354635 DOI: 10.1161/circinterventions.117.006229] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The study focuses on the evolution of practice, procedural outcomes, and in-hospital complications of chronic total occlusion percutaneous coronary intervention in Europe. METHODS AND RESULTS Data from 17 626 procedures enrolled in European Registry of Chronic Total Occlusion between January 2008 and June 2015 were assessed. The mean patient age was 63.9±10.9 years; 85% were men. Procedural success increased from 79.7% to 89.3% through the study period. Patients enrolled during the years had increasing comorbidities and lesion complexity (J-CTO score [Multicenter CTO Registry of Japan] increased from 1.76±1.03 in 2008 to 2.17±0.91 in 2015; P for trend, <0.001). Retrograde approach utilization steadily increased from 10.1% in 2008 to 29.9% in 2015 ( P for trend, <0.001). Antegrade dissection reentry adoption was low, not exceeding 5.5%. In-hospital mortality decreased during the study period from 0.4% to 0.1% ( P for trend, <0.001), whereas in-hospital complication rates remained essentially unchanged, in the range 4.4% to 5.2% ( P for trend, 0.390). CONCLUSIONS Chronic total occlusion percutaneous coronary intervention has shown a steady increase in procedural success rate over time, with unchanged complication rates, despite the increasing complexity of the lesions attempted. The J-CTO score predictive value for procedural success was low for the entire registry and had no predictive ability for the retrograde approach.
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Affiliation(s)
| | - Gerald S Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Germany (G.S.W.)
| | - Spyridon Deftereos
- Second Department of Cardiology, Attikon University Hospital, Athens, Greece (S.D., G.G.)
| | - Carlo Di Mario
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.)
| | - Alfredo R Galassi
- Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Italy (A.R.G.)
| | - Joachim H Buettner
- Interventional Cardiology Department, University Heart Center Freiburg, Bad-Krozingen, Germany (J.H.B.)
| | - Alexandre Avran
- Interventional Cardiology Department, Arnaud Tzanck Institut, Saint Laurent du Var, France (A.A.)
| | - Nicolaus Reifart
- Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany (N.R.)
| | - Omer Goktekin
- Department of Cardiology, Istanbul Memorial Hospital, Turkey (O.G.)
| | - Roberto Garbo
- Interventional Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy (R.G.)
| | - Alexander Bufe
- Medizinische Klinik I, HELIOS Klinikum, Wuppertal, Germany (A.B.)
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart center Freiburg, Bad-Krozingen, Germany (K.M.)
| | - Nicolas Boudou
- Department of Cardiology, Rangueil University Hospital, Toulouse, France (N.B.)
| | | | - Bernward Lauer
- Division of Cardiology, Zentralklinik Bad Berka, Germany (B.L.)
| | - Simon Elhadad
- Department of Cardiology, CH-de-Lagny, Lagny-sur-Marne, France (S.E.)
| | | | - Javier Escaned
- Interventional Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain (J.E.)
| | - David Hildick-Smith
- Department of Cardiology, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S.)
| | - Mauro Carlino
- Invasive Cardiology Unit, San Raffaele Hospital, Milan, Italy (M.C.)
| | - Yves Louvard
- Institut Hospitalier Jacques Cartier, Massy, France (Y.L., T.L.)
| | - Thierry Lefèvre
- Institut Hospitalier Jacques Cartier, Massy, France (Y.L., T.L.)
| | - Lefteris Angelis
- School of Informatics, Aristotle University of Thessaloniki, Greece (L.A.)
| | - Georgios Giannopoulos
- Second Department of Cardiology, Attikon University Hospital, Athens, Greece (S.D., G.G.)
| | - Georgios Sianos
- First Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (N.V.K., G.S.)
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Vutthikraivit W, Rattanawong P, Kewcharoen J, Kanitsoraphan C, Pachariyanon P, Suchartlikitwong S, Klomjit S, Tantrachoti P. Impact of chronic total occlusion on ventricular arrhythmia and mortality in ischaemic cardiomyopathy patient with implantable cardiac defibrillator: a meta-analysis. Acta Cardiol 2019; 74:395-402. [PMID: 30328769 DOI: 10.1080/00015385.2018.1516268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Recent studies suggested that chronic total occlusion of the coronary artery increased risk of ventricular arrhythmia (VA) and all-cause mortality in ischaemic cardiomyopathy (ICM) patient who underwent implantable cardiac defibrillator (ICD) implantation. We aim to demonstrate an association between a presence of CTO and poor cardiovascular outcome in ICD implanted ICM patients. Objective: To examine the association between the presence of CTO and all-cause mortality in ICM with ICD implantation Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to February 2018. The studies that reported appropriated shock and all-cause mortality in ICD implanted ICM patients, compared between patients with and without CTO of the coronary artery, were included for meta-analysis. Results: Five studies from 2015 to 2018 were included in this meta-analysis involving 1,095 subjects (505 CTO and 590 non-CTO). The presence of CTO was associated with increased incidence of VA (pooled risk ratio = 1.75, 95% confidence interval: 1.10-2.77, p = 0.01) and all-cause mortality (pooled risk ratio = 1.63, 95% confidence interval: 1.10-2.41, p = 0.001) in ICD implanted ICM patients. Conclusions: Presence of CTO of the coronary artery increased risk of VA and all-cause mortality in ICD implanted ICM patients up to 75% and 63%, respectively. Our study suggested that CTO is an independent predictor of unfavourable outcome and revascularised option should be considered in ICM patients with ICD.
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Affiliation(s)
- Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Pavida Pachariyanon
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Saranapoom Klomjit
- Department of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Pakpoom Tantrachoti
- Department of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Gadula-Gacek E, Tajstra M, Gąsior M. Electrical storm - still an extremely poor prognosis. Do these acute states of life-threatening arrhythmias require a multidirectional approach from the start? ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:1-12. [PMID: 31043979 PMCID: PMC6488832 DOI: 10.5114/aic.2019.83769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/13/2018] [Indexed: 11/23/2022] Open
Abstract
Electrical storm (ES) is a state of electrical instability of the heart manifesting as multiple and potentially lethal recurring ventricular arrhythmias such as ventricular tachycardia or ventricular fibrillation. This definition is not related to the condition of each patient, who can present from asymptomatic to unconscious and in deep cardiogenic shock. Most patients affected by ES have heart failure (HF) of ischaemic origin. Ischaemia, exacerbation of HF, low ejection fraction, previous ventricular arrhythmias, infection or electrolyte disturbances together with other factors, or a few factors combined, may result in ES. The prognosis of ES survivors is very poor, with 1-year mortality exceeding 40%, which should draw attention to this group of patients as one of extremely high risk. The number of patients with cardioverter-defibrillators is increasing and so is the number of patients suffering from ES. Therefore, each patient should be supported with tailored therapy, and not only restricted to pharmacotherapy or ablation procedures. This paper was written to analyse the most frequent causes of ES and prompt the most appropriate clinical pathways and possibilities, underlining the need for a comprehensive invasive approach to diagnosis, treatment and circulatory stabilization in addition to adequate pharmacotherapy. This approach might help to reduce the mortality rate in this group of patients and improve the prognosis.
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Affiliation(s)
- Elżbieta Gadula-Gacek
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Disease in Zabrze, Poland
| | - Mateusz Tajstra
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Disease in Zabrze, Poland
| | - Mariusz Gąsior
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Disease in Zabrze, Poland
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41
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Iannaccone M, D'ascenzo F, Piazza F, De Benedictis M, Doronzo B, Behnes M, Garbo R, Mashayekhi K. Optimal medical therapy vs. coronary revascularization for patients presenting with chronic total occlusion: A meta-analysis of randomized controlled trials and propensity score adjusted studies. Catheter Cardiovasc Interv 2018; 93:E320-E325. [PMID: 30549199 DOI: 10.1002/ccd.28037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/21/2018] [Accepted: 12/02/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The optimal management of patients with coronary chronic total occlusions (CTO) remains controversial. This meta-analysis aims to compare percutaneous coronary intervention of CTO (CTO-PCI) versus optimal medical therapy (OMT) in CTO patients. METHODS A literature search with highly specific terms was conducted using MEDLINE, EMBASE, and Web of Science to identify most relevant randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) evaluating differences in between CTO-PCI versus OMT. The primary endpoint was the incidence of major adverse cardiac events (MACEs, composite of cardiovascular death, acute coronary syndrome, and repeat PCI, re-PCI) while its single components were defined as secondary endpoints. RESULTS A total of eight studies was included, four RCTs and four PSMs. 3,971 patients were included in the analysis (2,050 CTO-PCI versus 1,921 OMT) with a mean follow-up of 3 years. No significant differences were found regarding overall MACE, re-PCI and AMI. Regarding CV-death, CTO-PCI was associated with a better outcome compared with OMT driven by PSMs (OR 0.52, 0.0.81, P < 0.01). CONCLUSIONS As compared to OMT, CTO-PCI was associated with similar MACE rate; however, CTO-PCI may be associated with reduced CV death, mainly due to PSMs effect.
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Affiliation(s)
| | - Fabrizio D'ascenzo
- Department of Cardiology, Città della Scienza e dalla Salute Hospital, University of Turin, Turin, Italy
| | - Fabio Piazza
- SS. Annunziata Hospital, ASL CN 1, Savigliano, Italy
| | | | | | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research) Partner Site, Mannheim, Germany
| | | | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
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Abouzaki NA, Exaire JE, Guzmán LA. Role of Percutaneous Chronic Total Occlusion Interventions in Patients with Ischemic Cardiomyopathy and Reduced Left Ventricular Ejection Fraction. Curr Cardiol Rep 2018; 20:124. [PMID: 30276495 DOI: 10.1007/s11886-018-1066-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine current evidence on the benefit of chronic total occlusion (CTO) revascularization in patients with ischemic cardiomyopathy and propose a systematic approach on how and when to accomplish revascularization in these patients. RECENT FINDINGS Coronary revascularization in patients with reduced ejection fraction (EF) is advocated for to improve left ventricular function and consequently clinical outcomes. Approximately 16-31% of angiograms in patients with advanced CAD are noted to have a concomitant coronary CTO. Its presence is a main predictor of worse outcomes. Over the past 15 years, advancements in interventional technologies and techniques have made it possible to treat CTO lesions percutaneously with success rates exceeding 90%. Different revascularization techniques have been organized into widely used algorithms for systematic CTO lesion crossing and treatment. Patients with reduced EF can be revascularized percutaneously with goal of complete functional revascularization. However, randomized prospective data is needed to justify the increased patient risks and healthcare costs associated with these procedures.
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Affiliation(s)
- Nayef A Abouzaki
- Division of Cardiology, Medical College of Virginia/VCU School of Medicine, Virginia Commonwealth University, 1200 East Broad St, 5th Floor-West wing, Room #526, Richmond, VA, 23298, USA.,Hunter Holmes McGuire Richmond VA Medical Center, Richmond, VA, 23249, USA
| | - Jose E Exaire
- Division of Cardiology, Medical College of Virginia/VCU School of Medicine, Virginia Commonwealth University, 1200 East Broad St, 5th Floor-West wing, Room #526, Richmond, VA, 23298, USA.,Hunter Holmes McGuire Richmond VA Medical Center, Richmond, VA, 23249, USA
| | - Luis A Guzmán
- Division of Cardiology, Medical College of Virginia/VCU School of Medicine, Virginia Commonwealth University, 1200 East Broad St, 5th Floor-West wing, Room #526, Richmond, VA, 23298, USA.
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Opolski MP, Gransar H, Lu Y, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJ, Cury RC, DeLago A, Feuchtner GM, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei EC, Marques H, Pontone G, Raff G, Rubinshtein R, Shaw LJ, Villines TC, Gomez M, Jones EC, Peña JM, Min JK, Lin FY. Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography. Heart 2018; 105:196-203. [PMID: 30061160 DOI: 10.1136/heartjnl-2017-312907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Data describing clinical relevance of chronic total occlusion (CTO) identified by coronary CT angiography (CCTA) have not been reported to date. We investigated the prognosis of CTO on CCTA. METHODS We identified 22 828 patients without prior known coronary artery disease (CAD), who were followed for a median of 26 months. Based on CCTA, coronary lesions were graded as normal (no atherosclerosis), non-obstructive (1%-49%), moderate-to-severe (50%-99%) or totally occluded (100%). All-cause mortality, and major adverse cardiac events defined as mortality, non-fatal myocardial infarction and late coronary revascularisation (≥90 days after CCTA) were assessed. RESULTS The distribution of patients with normal coronaries, non-obstructive CAD, moderate-to-severe CAD and CTO was 10 034 (44%), 7965 (34.9%), 4598 (20.1%) and 231 (1%), respectively. The mortality rate per 1000 person-years of CTO patients was non-significantly different from patients with moderate-to-severe CAD (22.95; 95% CI 12.71 to 41.45 vs 14.46; 95% CI 12.34 to 16.94; p=0.163), and significantly higher than of those with normal coronaries and non-obstructive CAD (p<0.001 for both). Among 14 382 individuals with follow-up for the composite end point, patients with CTO had a higher rate of events than those with moderate-to-severe CAD (106.56; 95% CI 76.51 to 148.42 vs 65.45; 95% CI 58.01 to 73.84, p=0.009). This difference was primarily driven by an increase in late revascularisations in CTO patients (27 of 35 events). After multivariable adjustment, compared with individuals with normal coronaries, the presence of CTO conferred the highest risk for adverse cardiac events (14.54; 95% CI 9.11 to 23.20, p<0.001). CONCLUSIONS The detection of CTO on non-invasive CCTA is associated with increased rate of late revascularisation but similar 2-year mortality as compared with moderate-to-severe CAD. TRIAL REGISTRATION NUMBER NCT01443637.
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Affiliation(s)
- Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yao Lu
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | | | - Mouaz H Al-Mallah
- King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Riyadh, Saudi Arabia
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, HARTZ, Leiden, The Netherlands
| | - Daniel S Berman
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California, USA
| | - Filippo Cademartiri
- Department of Radiology, SDN IRCCS Cardiovascular Imaging Center, Naples, Italy
| | - Tracy Q Callister
- Tennessee Heart and Vascular Institute, Hendersonville, Tennessee, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan, USA
| | - Benjamin Jw Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, Florida, USA
| | | | - Gudrun M Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erica C Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Gilbert Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oaks, Michigan, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Todd C Villines
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Millie Gomez
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Erica C Jones
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Jessica M Peña
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - James K Min
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovacular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, USA
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van Dongen IM, Yilmaz D, Elias J, Claessen BEPM, Delewi R, Knops RE, Wilde AAM, van Erven L, Schalij MJ, Henriques JPS. Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long-Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter-Defibrillator (the eCTOpy-in-ICD Study). J Am Heart Assoc 2018; 7:JAHA.118.008609. [PMID: 29720502 PMCID: PMC6015331 DOI: 10.1161/jaha.118.008609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Previous studies report conflicting results about a higher incidence of ventricular arrhythmias in patients with a chronic total coronary occlusion (CTO). We aimed to investigate this association in a large cohort of implantable cardioverter defibrillator patients with long‐term follow‐up. Methods and Results All consecutive patients from 1992 onwards who underwent implantable cardioverter defibrillator implantation for ischemic cardiomyopathy at the Leiden University Medical Center were evaluated. Coronary angiograms were reviewed for the presence of a CTO. The occurrence of ventricular arrhythmias and survival status at follow‐up were compared between patients with and patients without a CTO. A total of 722 patients constitute the study cohort (age 66±11 years; 84% males; 74% primary prevention, median left ventricular ejection fraction 30% [first–third quartile: 25–37], 44% received a cardiac resynchronization therapy defibrillator). At baseline, 240 patients (33%) had a CTO, and the CTOs were present for at least 44 (2–127) months. The median follow‐up duration was 4 (2–6) years. On long‐term follow‐up, CTO patients had a higher crude appropriate device therapy rate (37% versus 27%, P=0.010) and a lower crude survival rate (51% versus 67%, P<0.001) compared with patients without a CTO. Corrected for baseline characteristics including left ventricular ejection fraction, the presence of a CTO was an independent predictor for appropriate device therapy. Conclusions The presence of a CTO in implantable cardioverter defibrillator patients was associated with more appropriate device therapy and worse prognosis at long‐term follow‐up. Further investigation is warranted regarding a potential beneficial effect of CTO revascularization on the incidence of ventricular arrhythmias.
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Affiliation(s)
- Ivo M van Dongen
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Dilek Yilmaz
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joëlle Elias
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Bimmer E P M Claessen
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - José P S Henriques
- Department of Cardiology, Heart Center, Academic Medical Center - University of Amsterdam, The Netherlands
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Kranjec I, Zavrl Džananovič D, Mrak M, Bunc M. Robustness of Percutaneously Completed Coronary Revascularization in Stable Coronary Artery Disease: Obstructive Versus Occlusive Lesions. Angiology 2018; 70:78-86. [PMID: 29631418 DOI: 10.1177/0003319718767737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study sought to assess long-term outcomes of percutaneously completed coronary revascularization (CCR) in patients with obstructive coronary artery disease (CAD) comprising chronic total occlusions (CTOs). Between 2010 and 2014, percutaneous coronary interventions (PCIs) of the CTOs were attempted in 213 patients: the CCR was achieved in 125 patients (group 1), while the PCI failed in 88 patients (group 2). They were matched against 252 patients (group 3) with the CCR obtained by the non-CTO PCIs. In the 5-year follow-up, more adverse cardiovascular (CV) events occurred in group 2 (29.5% vs 4.8% in group 1 vs 3.5% in group 3, P = .0001), mainly due to recurrent severe symptoms and additional revascularization of the CTOs; CV mortality did not seem to be significantly affected. Survival curves for the successful CTO and non-CTO PCIs appeared indistinguishable. Stent thromboses were infrequent in the CCR groups. In conclusion, long-term outcomes of the patients with the obstructive CAD containing the CTOs showed a favorable outcome if the CCR had been achieved percutaneously.
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Affiliation(s)
- Igor Kranjec
- 1 Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | | | - Miha Mrak
- 1 Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Matjaz Bunc
- 1 Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
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Galassi AR, Boukhris M, Toma A, Elhadj ZI, Laroussi L, Gaemperli O, Behnes M, Akin I, Lüscher TF, Neumann FJ, Mashayekhi K. Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients With Low Left Ventricular Ejection Fraction. JACC Cardiovasc Interv 2017; 10:2158-2170. [PMID: 29055762 DOI: 10.1016/j.jcin.2017.06.058] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The study sought to assess the outcome of percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) in patients with low left ventricular ejection fraction (LVEF) (≤35%). BACKGROUND Data regarding the outcome of PCI in patients with low LVEF affected by CTO are scarcely reported. METHODS The authors performed a prospective longitudinal multicenter study including consecutive patients undergoing elective PCI of CTOs. Patients were subdivided into 3 groups: group 1 (LVEF ≥50%), group 2 (LVEF 35% to 50%), and group 3 (LVEF ≤35%). RESULTS A total of 839 patients (mean 64.6 ± 10.5 years of age, 87.7% men) underwent CTO PCI attempts. Baseline LVEF ≤35% was present in 72 (8.6%) patients. The angiographic success was high (overall 93.6%) and similar among the 3 groups (93.5% vs. 94.4% vs. 91.7%, respectively; all p = NS). In group 3, no periprocedural complications of CTO PCI were observed. Mean clinical follow-up of 16.3 ± 8.2 months duration was available in 781 (93.1%) patients including those with LVEF ≤35%. At 2 years, major cardiac and cerebrovascular events (MACCE) free survival was similar in the 3 groups (86% vs. 82.8% vs. 75.2%; all p = NS). In patients with LVEF ≤35%, LVEF improved significantly in the presence of a successful CTO PCI from 29.1 ± 3.4% to 41.6 ± 7.9% (p < 0.001). CONCLUSIONS In CTO patients with low LVEF, PCI could represent a safe and effective revascularization strategy achieving good midterm outcome and LVEF improvement.
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Affiliation(s)
- Alfredo R Galassi
- Department of Experimental and Clinical Medicine, University of Catania, Catania, Italy; University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
| | - Marouane Boukhris
- Department of Experimental and Clinical Medicine, University of Catania, Catania, Italy; Cardiology Department, Abderrhamen Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Aurel Toma
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Zied Ibn Elhadj
- Cardiology Department, Abderrhamen Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Lobna Laroussi
- Cardiology Department, Abderrhamen Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Oliver Gaemperli
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas F Lüscher
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Franz J Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
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Nombela-Franco L, Iannaccone M, Anguera I, Amat-Santos IJ, Sanchez-Garcia M, Bautista D, Calvelo MN, Di Marco A, Moretti C, Pozzi R, Scaglione M, Cañadas V, Sandin-Fuentes M, Arenal A, Bagur R, Perez-Castellano N, Fernandez-Perez C, Gaita F, Macaya C, Escaned J, Fernández-Lozano I. Impact of Chronic Total Coronary Occlusion on Recurrence of Ventricular Arrhythmias in Ischemic Secondary Prevention Implantable Cardioverter-Defibrillator Recipients (VACTO Secondary Study). JACC Cardiovasc Interv 2017; 10:879-888. [DOI: 10.1016/j.jcin.2017.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/30/2017] [Accepted: 02/09/2017] [Indexed: 01/14/2023]
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48
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Pyka Ł, Hawranek M, Gąsior M. Revascularization in ischemic heart failure with reduced left ventricular ejection fraction. The impact of complete revascularization. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2017; 14:37-42. [PMID: 28515747 PMCID: PMC5404126 DOI: 10.5114/kitp.2017.66928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022]
Abstract
Heart failure is a growing problem worldwide, with coronary artery disease being the underlying cause of over two-thirds of cases. Revascularization in this group of patients may potentially inhibit the progressive damage to the myocardium and lead to improved outcomes, but data in this area are scarce. This article emphasizes the role of qualification for revascularization and selection of method (percutaneous coronary intervention vs. coronary artery bypass grafting) and subsequently focuses on the issue of completeness of revascularization in this group of patients.
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Affiliation(s)
- Łukasz Pyka
- 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Michał Hawranek
- 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Mariusz Gąsior
- 3 Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
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49
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Di Mario C, Sorini Dini C. Conquering CTO revascularisation: the summit is near with 90% of the ascent behind us. EUROINTERVENTION 2016; 12:e1319-e1321. [PMID: 27934607 DOI: 10.4244/eijv12i11a218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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50
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Nombela-Franco L, Ryan N. Ischemic Cardiomyopathy and Chronic Total Occlusions. JACC Cardiovasc Interv 2016; 9:1798-800. [DOI: 10.1016/j.jcin.2016.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/30/2016] [Indexed: 12/12/2022]
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