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Elzoghby MM, Salama MMA, Elsetiha MA, El Ahwal HM, Romeih SA, Shaaban MN, Elmozy WE. Territorial Post-Revascularization Remodeling of Chronic Coronary Syndromes: Cardiac Magnetic Resonance Feature Tracking Study. J Magn Reson Imaging 2024; 59:2265-2274. [PMID: 37772452 DOI: 10.1002/jmri.29026] [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: 02/17/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND MRI feature-tracking (MRI-FT) can accurately assess ventricular myocardial deformation and regional function and may be a better predictor of mortality than ejection fraction and infarct extension. However, role of MRI-FT in assessing coronary revascularization is unclear. PURPOSE To assess coronary revascularization effect on territorial left ventricle (LV) function of chronic coronary syndrome (CCS) patients by MRI-FT. STUDY TYPE Prospective. SUBJECTS 50 CCS patients (age: 62.22 ± 8.70 years) scheduled for elective percutaneous coronary intervention (PCI), and 30 healthy controls (age: 35.33 ± 11.57 years). FIELD STRENGTH/SEQUENCE 1.5T with balanced steady-state free precession cine sequence. ASSESSMENT Global and segmental peak systolic longitudinal, circumferential, and radial myocardial strains were quantified in both patient and healthy control groups by an experienced operator using dedicated software. Patients were studied both pre-PCI and 6-month post-PCI and LV territorial myocardial strain values were calculated by averaging the segmental values of each revascularized territory. STATISTICAL TESTS Student's t-test, paired t-test, Mann Whitney test, and Wilcoxon signed ranks test. Significance was judged at the 5% level. RESULTS Territorial longitudinal strain showed significant 6-month post-PCI improvement in the left anterior descending (LAD) and right coronary artery (RCA) territories, but there was not in the left circumflex (LCX) territory (LAD: mean - 11.41% ± 3.45% pre, -13.01% ± 3.53% post; RCA: mean - 11.11% ± 2.65% pre, -13.25% ± 2.81% post; and LCX: mean - 15.43% ± 3.97% pre, -16.17% ± 4.38% post, P = 0.215). Territorial circumferential strain showed significant post-PCI improvement in all revascularized territories (LAD: mean - 13.73% ± 6.56% pre, -16.98% ± 6.01% post; LCX: mean - 13.23% ± 4.23% pre, -16.34% ± 3.45% post; and RCA: mean - 11.24% ± 3.36% pre, -13.80% ± 3.51% post). Territorial radial strain showed no significant post-PCI improvement (LAD: mean 22.73% ± 12.38% pre, 21.79% ± 11.55% post, P = 0.541; LCX: mean 27.73% ± 7.95% pre, 29.0% ± 7.25% post, P = 0.264; and RCA: mean 36.68% ± 11.10% pre, 31.75% ± 10.95% post, P = 0.208). DATA CONCLUSION Territorial LV systolic function was significantly improved by coronary revascularization in CCS patients. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Mohamed M Elzoghby
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
| | - Mai M A Salama
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed A Elsetiha
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hanan M El Ahwal
- Radiodiagnosis Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Soha A Romeih
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
| | - Mahmoud N Shaaban
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
| | - Wesam E Elmozy
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
- Radiodiagnosis Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Gold DA, Sandesara PB, Jain V, Gold ME, Vatsa N, Desai SR, Hassan ME, Yuan C, Ko Y, Alkhoder A, Ejaz K, Alvi Z, Rahbar A, Murtagh G, Jaber WA, Nicholson WJ, Quyyumi AA. High Sensitivity Troponin Level and Benefits of Chronic Total Occlusion Revascularization. J Am Heart Assoc 2023; 12:e031431. [PMID: 37929763 PMCID: PMC10727412 DOI: 10.1161/jaha.123.031431] [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: 06/16/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
Background The survival benefit of revascularization of chronic total occlusion (CTO) of the coronary arteries remains a subject of controversy. We measured high sensitivity troponin-I (hsTn-I) levels as an estimate of myocardial ischemia in patients with stable coronary artery disease, with the hypothesis that (1) patients with CTO have higher levels of hsTn-I than patients without CTO, (2) hsTn-I levels will predict adverse cardiovascular events in patients with CTO, and (3) patients with elevated hsTn-I levels will have a survival benefit from CTO revascularization. Methods and Results In 428 patients with stable coronary artery disease and CTO undergoing coronary angiography, adverse event rates were investigated. Cox proportional hazards models and Fine and Gray subdistribution hazard models were performed to determine the association between hsTn-I level and incident event rates in patients with CTO. HsTn-I levels were higher in patients with compared with those without CTO (median 6.7 versus 5.6 ng/L, P=0.002). An elevated hsTn-I level was associated with higher adverse event rates (adjusted all-cause mortality hazard ratio, 1.19 [95% CI, 1.08-1.32]; P=0.030) for every doubling of hsTn-I level. CTO revascularization was performed in 28.3% of patients. In patients with a high (>median) hsTn-I level, CTO revascularization was associated with substantially lower all-cause mortality (adjusted hazard ratio, 0.26 [95% CI, 0.08-0.88]; P=0.030) compared with those who did not undergo revascularization. In patients with a low (
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Affiliation(s)
- Daniel A. Gold
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Pratik B. Sandesara
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Vardhmaan Jain
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Matthew E. Gold
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Nishant Vatsa
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Shivang R. Desai
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Malika Elhage Hassan
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Chenyang Yuan
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Yi‐An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Ayman Alkhoder
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Kiran Ejaz
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Zain Alvi
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Alireza Rahbar
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | | | - Wissam A. Jaber
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - William J. Nicholson
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
| | - Arshed A. Quyyumi
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGA
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Melotti E, Belmonte M, Gigante C, Mallia V, Mushtaq S, Conte E, Neglia D, Pontone G, Collet C, Sonck J, Grancini L, Bartorelli AL, Andreini D. The Role of Multimodality Imaging for Percutaneous Coronary Intervention in Patients With Chronic Total Occlusions. Front Cardiovasc Med 2022; 9:823091. [PMID: 35586657 PMCID: PMC9108201 DOI: 10.3389/fcvm.2022.823091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPercutaneous coronary intervention (PCI) of Chronic total occlusions (CTOs) has been traditionally considered a challenging procedure, with a lower success rate and a higher incidence of complications compared to non-CTO-PCI. An accurate and comprehensive evaluation of potential candidates for CTO-PCI is of great importance. Indeed, assessment of myocardial viability, left ventricular function, individual risk profile and coronary lesion complexity as well as detection of inducible ischemia are key information that should be integrated for a shared treatment decision and interventional strategy planning. In this regard, multimodality imaging can provide combined data that can be very useful for the decision-making algorithm and for planning percutaneous CTO recanalization.AimsThe purpose of this article is to appraise the value and limitations of several non-invasive imaging tools to provide relevant information about the anatomical characteristics and functional impact of CTOs that may be useful for the pre-procedural assessment and follow-up of candidates for CTO-PCI. They include echocardiography, coronary computed tomography angiography (CCTA), nuclear imaging, and cardiac magnetic resonance (CMR). As an example, CCTA can accurately delineate CTO location and length, distal coronary bed, vessel tortuosity and calcifications that can predict PCI success, whereas stress CMR, nuclear imaging and stress-CT can provide functional evaluation in terms of myocardial ischemia and viability and perfusion defect extension.
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Affiliation(s)
- Eleonora Melotti
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Marta Belmonte
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Carlo Gigante
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Vincenzo Mallia
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio, Pisa, Italy
- Istituto di Scienze della Vita Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Luca Grancini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Antonio L. Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
- *Correspondence: Daniele Andreini
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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: 0.5] [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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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: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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Allahwala UK, Brilakis ES, Kiat H, Ayesa S, Nour D, Ward M, Lo S, Weaver JC, Bhindi R. The indications and utility of adjunctive imaging modalities for chronic total occlusion (CTO) intervention. J Nucl Cardiol 2021; 28:2597-2608. [PMID: 33025478 DOI: 10.1007/s12350-020-02381-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 08/12/2020] [Indexed: 01/09/2023]
Abstract
Coronary chronic total occlusions (CTO) are common in patients undergoing coronary angiography, yet the optimal management strategy remains uncertain, with conflicting results from randomized trials. Appropriate patient selection and careful periprocedural planning are imperative for successful patient management. We review the role of adjunctive imaging modalities including myocardial perfusion imaging (MPI), cardiac magnetic resonance imaging (CMR), echocardiography and computed tomography coronary angiography (CTCA) in myocardial ischemic quantification, myocardial viability assessment, as well as procedural planning for CTO revascularization. An appreciation of the value, indications and limitations of these modalities prior to planned intervention are essential for optimal management.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia.
- Faculty of Health & Medicine, The University of Sydney, Sydney, Australia.
| | | | - Hosen Kiat
- Faculty of Medicine and Health Sciences, Macquarie University, Marsfield, Australia
- Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Sally Ayesa
- Faculty of Health & Medicine, The University of Sydney, Sydney, Australia
- Department of Nuclear Medicine, Prince of Wales Hospital, Sydney, Australia
| | - Daniel Nour
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia
| | - Michael Ward
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia
- Faculty of Health & Medicine, The University of Sydney, Sydney, Australia
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | - James C Weaver
- Faculty of Health & Medicine, The University of Sydney, Sydney, Australia
- Cardiology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia
- Faculty of Health & Medicine, The University of Sydney, Sydney, Australia
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Everaars H, Schumacher SP, Stuijfzand WJ, van Basten Batenburg M, Huynh J, van Diemen PA, Bom MJ, de Winter RW, van de Ven PM, van Loon RB, van Rossum AC, Opolski MP, Nap A, Knaapen P. Functional recovery after percutaneous revascularization of coronary chronic total occlusions: insights from cardiac magnetic resonance tissue tracking. Int J Cardiovasc Imaging 2021; 37:3057-3068. [PMID: 34338945 PMCID: PMC8494704 DOI: 10.1007/s10554-021-02355-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/07/2021] [Indexed: 12/02/2022]
Abstract
To evaluate the effect of percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs) on left ventricular (LV) strain assessed using cardiac magnetic resonance (CMR) tissue tracking. In 150 patients with a CTO, longitudinal (LS), radial (RS) and circumferential shortening (CS) were determined using CMR tissue tracking before and 3 months after successful PCI. In patients with impaired LV strain at baseline, global LS (10.9 ± 2.4% vs 11.6 ± 2.8%; P = 0.006), CS (11.3 ± 2.9% vs 12.0 ± 3.5%; P = 0.002) and RS (15.8 ± 4.9% vs 17.4 ± 6.6%; P = 0.001) improved after revascularization of the CTO, albeit to a small, clinically irrelevant, extent. Strain improvement was inversely related to the extent of scar, even after correcting for baseline strain (B = − 0.05; P = 0.008 for GLS, B = − 0.06; P = 0.016 for GCS, B = − 0.13; P = 0.017 for GRS). In the vascular territory of the CTO, dysfunctional segments showed minor improvement in both CS (10.8 [6.9 to 13.3] % vs 11.9 [8.1 to 15.0] %; P < 0.001) and RS (14.2 [8.4 to 18.7] % vs 16.0 [9.9 to 21.8] %; P < 0.001) after PCI. Percutaneous revascularization of CTOs does not lead to a clinically relevant improvement of LV function, even in the subgroup of patients and segments most likely to benefit from revascularization (i.e. LV dysfunction at baseline and no or limited myocardial scar).
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Affiliation(s)
- Henk Everaars
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Wijnand J Stuijfzand
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Martijn van Basten Batenburg
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jennifer Huynh
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ramon B van Loon
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit, ZH 5F003, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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8
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Yang T, Fu X, Fu P, Chen J, Xu C, Liu X, Niu T. The value of fragmented QRS in predicting the prognosis of chronic total occlusion patients with myocardial infarction history undergoing percutaneous coronary intervention: A 24-months follow-up study. Clin Cardiol 2021; 44:537-546. [PMID: 33590897 PMCID: PMC8027581 DOI: 10.1002/clc.23573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fragmented QRS (fQRS) is a marker of local myocardial scar. This study aimed to analyze the relationship between fQRS and coronary collateral circulation (CCC) and evaluate the predictive value of fQRS for long-term clinical outcomes among patients with chronic total occlusion (CTO) and prior myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI). METHODS A total of 862 patients with a definite history of MI who had one CTO coronary artery and underwent PCI between 2013 and 2018 were continuously analyzed. Patients were divided into group A (no Q wave and fQRS, n = 206), group B (fQRS, n = 265), group C (Q wave, n = 391). All patients were followed up for 2 years. RESULTS The incidence rate of major adverse cardiovascular events (MACE) in group B was significantly lower than in group C (group B vs. C: 7.2% vs. 11.3%, P = 0.043). The percentage of good CCC was 94.2%, 88.3%, and 82.9% in group A, B, and C (p < .001), respectively. The improvement of cardiac function in group B and A were more significant than in group C. Multivariate Cox regression analysis showed fQRS was an independent protective factor of MACE after PCI within 2 years in CTO patients with prior MI (RR = 0.668, 95% CI [0.422-0.917], p = .001). CONCLUSION fQRS is an independent protective factor of prognosis in patients with prior MI and one CTO vessel who underwent PCI, presenting with a higher rate of good CCC, less occurrence of MACE, and better heart function than in Q wave patients.
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Affiliation(s)
- Tiangui Yang
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Xi Fu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Peng Fu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Jie Chen
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Changlu Xu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Xiaoxia Liu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Tiesheng Niu
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
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Kwon O, Lee PH, Lee SW, Kweon J, Lee JY, Lee K, Kang DY, Ahn JM, Park DW, Kang SJ, Kim YH, Lee CW, Park SW, Park SJ. Fate of lumen size in distal coronary segment following successful chronic total occlusion recanalization. J Cardiol 2020; 77:65-71. [PMID: 33121797 DOI: 10.1016/j.jjcc.2020.07.011] [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: 03/17/2020] [Revised: 06/19/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Restoration of anterograde blood flow leads to alterations in vascular wall stress that may influence lumen size distal to chronic total occlusion (CTO) lesions. We sought to assess changes in lumen diameter of segments distal to the stent segment of successfully recanalized CTO. METHODS We analyzed 507 consecutive CTO cases with stent implantation that underwent follow-up angiography at a single high-volume center (mean follow-up of 13.5 months). Segments ≤40 mm distal to the stent edge were analyzed using quantitative coronary angiography. RESULTS At follow-up, lumen diameters significantly increased; diameter changes of 0.26 ± 0.47 (percent diameter change of 18.2%) at 5 mm distal, mean lumen diameter changes of 0.23 ± 0.35 (14.3%) and minimal lumen diameter changes of 0.22 ± 0.80 (24.7%) (all p < 0.001). Lumen enlargement was similar between visually shrunken and stenosed vessels (degree of stenosis ≥20% with luminal irregularities) distal to stents; 5 mm distal (0.32 ± 0.48 vs. 0.30 ± 0.48, p = 0.76), mean lumen diameter changes (0.26 ± 0.37mm vs. 0.26±0.33 mm, p = 0.94), minimal lumen diameter changes (0.28 ± 0.43 mm vs. 0.22 ± 1.30 mm, p = 0.48). There was no association between degree of in-stent narrowing and changes in distal lumen diameter (Spearman r = -0.02, p = 0.59). Multivariate logistic regression for the predictors of greater lumen enlargement indicated that patients with left ventricle dysfunction (ejection fraction ≤45%) had greater enlargement [odds ratio (OR): 2.53, 95% confidence interval (CI): 1.23-5.23, p = 0.01]. Conversely, a low hematocrit (male <40%, and female <35%) was associated with attenuated lumen enlargement (OR: 0.68 95% CI: 0.47-0.98; p = 0.04). CONCLUSIONS Lumen diameter distal to CTO lesions significantly increased following successful revascularization, regardless of diseased status of the distal bed or degree of in-stent narrowing. These findings implicate appropriate determination of stent size, stent coverage length, as well as management strategies of distal vessels.
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Affiliation(s)
- Osung Kwon
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
| | - Pil Hyung Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jihoon Kweon
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyusup Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Jin Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Hak Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Wook Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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10
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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: 0.3] [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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11
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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: 0.3] [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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12
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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: 1.0] [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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13
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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: 1.4] [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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14
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Bhatnagar UB, Shrestha A, Petrasko M, Stys TP, Stys AT. Current Evidence and Rationale of Percutaneous Therapy for Chronic Total Coronary Occlusions. Curr Probl Cardiol 2019; 44:100412. [PMID: 30975448 DOI: 10.1016/j.cpcardiol.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/03/2019] [Indexed: 11/28/2022]
Abstract
The prevalence of chronic total occlusion (CTO) lesions in coronary arteries is notably high in patients with significant coronary artery disease. However, only a relatively small fraction of observed CTOs classically go for revascularization. Recent advances in techniques and equipment has greatly improved the success rates of CTO revascularization while reducing complications. There has also been an increasing body of evidence regarding clinical benefit of CTO revascularization. However, until recently majority of the evidence was observational and based on data from large multicenter registries. Recent randomized studies have reported on clinical benefits of CTO revascularization particularly with relief of angina. However, there is heterogeneity of results among different studies and the magnitude of benefit is not consistently seen in all studies. This article reviews the existing literature on the current evidence regarding clinical benefits and other rationale for CTO revascularization.
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15
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Manning WJ. Journal of Cardiovascular Magnetic Resonance 2017. J Cardiovasc Magn Reson 2018; 20:89. [PMID: 30593280 PMCID: PMC6309095 DOI: 10.1186/s12968-018-0518-z] [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] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023] Open
Abstract
There were 106 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 92 original research papers, 3 reviews, 9 technical notes, and 1 Position paper, 1 erratum and 1 correction. The volume was similar to 2016 despite an increase in manuscript submissions to 405 and thus reflects a slight decrease in the acceptance rate to 26.7%. The quality of the submissions continues to be high. The 2017 JCMR Impact Factor (which is published in June 2018) was minimally lower at 5.46 (vs. 5.71 for 2016; as published in June 2017), which is the second highest impact factor ever recorded for JCMR. The 2017 impact factor means that an average, each JCMR paper that were published in 2015 and 2016 was cited 5.46 times in 2017.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in continuus fashion and in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or theme, so that readers can view areas of interest in a single article in relation to each other and other contemporary JCMR articles. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, I have elected to use this format to convey information regarding the editorial process to the readership.I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your very best, high quality manuscripts to JCMR for consideration. I thank our very dedicated Associate Editors, Guest Editors, and Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the forefront journal of our field. And finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 3rd year as your editor-in-chief. It has been a tremendous learning experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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16
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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: 0.2] [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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17
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Megaly M, Saad M, Tajti P, Burke MN, Chavez I, Gössl M, Lips D, Mooney M, Poulose A, Sorajja P, Traverse J, Wang Y, Kohl LP, Bradley SM, Brilakis ES. Meta-analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling. J Interv Cardiol 2018; 31:562-571. [DOI: 10.1111/joic.12538] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/14/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
- Division of Cardiology; Department of Medicine, Hennepin County Medical Center; Minneapolis Minnesota
| | - Marwan Saad
- Department of Cardiovascular Medicine; University of Arkansas; Little Rock Arkansas
| | - Peter Tajti
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - M. Nicholas Burke
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Ivan Chavez
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Mario Gössl
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Daniel Lips
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Michael Mooney
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Anil Poulose
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Jay Traverse
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Yale Wang
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Louis P. Kohl
- Division of Cardiology; Department of Medicine, Hennepin County Medical Center; Minneapolis Minnesota
| | - Steven M. Bradley
- Minneapolis Heart Institute; Abbott Northwestern Hospital; Minneapolis Minnesota
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18
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Huang R, Song X, Zhang H, Tian W, Huang Z, Zhang X, Yang J, Zhang D, Wu J, Zhong L, Ting HH. The success of opening single chronic total occlusion lesions to improve myocardialviabilitytrial (SOS-COMEDY): Study protocol of a prospective multicenter study. Medicine (Baltimore) 2018; 97:e0443. [PMID: 29668609 PMCID: PMC5916680 DOI: 10.1097/md.0000000000010443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/26/2018] [Indexed: 11/26/2022] Open
Abstract
AIMS Success of opening single (SOS)-comedy is a prospective multicenter study to compare the improvement in the decrease of myocardial viability by percutaneous coronary intervention (PCI) with that by optimal medical therapy (OMT) alone in patients with chronic total occlusion (CTO) of a single coronary artery. METHODS AND RESULTS The risks and the benefits of both options (PCI and OMT) were listed in a CTO decision aid (DA). Eligible participants detected by invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) were divided into PCI or OMT groups according to patients' choice after shared-decision making process with DA. Participants will undergo positron emission tomography/computed tomography (PET/CT), cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE), and proceed to ICA and revascularization if possible. Blinded core laboratory interpretation will be performed for ICA, CCTA, PET/CT, CMR, and TTE. All participants will be followed up for 12 months. The primary endpoint is the improvement to the decrease of myocardial viability from baseline assessed with the use of PET/CT after 12-month follow-up. CONCLUSIONS All of the patients are appropriately consented before enrolling in this study, which has been approved by the Ethics Committee. Results of SOS-COMEDY will be helpful to develop a strategy for single CTO patients.
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Affiliation(s)
- Rongchong Huang
- The Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City
| | - Xiantao Song
- The Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing City
| | - Haishan Zhang
- The Department of Cardiology, First Affiliated Hospital of China Medical University, Shenyang City
| | - Wen Tian
- The Department of Cardiology, First Affiliated Hospital of China Medical University, Shenyang City
| | - Zheng Huang
- The Department of Cardiology, Southern Hospital, Southern Medical University, Guangzhou City
| | - Xingwei Zhang
- The Department of Cardiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou City
| | - Junqing Yang
- The Department of Cardiology, Guangdong General Hospital, Guangzhou City, China
| | - Dongfeng Zhang
- The Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing City
| | - Jian Wu
- The Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City
| | - Lei Zhong
- The Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City
| | - Henry H. Ting
- Division of Cardiology, Mayo Clinic, Jacksonville, FL
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19
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Wang Z, Jin L, Zhou W, Lei D, Yan H, Yu H, Zeng Z, Zhu G, Zheng J, Dai Y, Wang H. A single-center observational study on the efficacy of percutaneous coronary intervention for ischemic heart failure: A cohort study. Medicine (Baltimore) 2018; 97:e0238. [PMID: 29595676 PMCID: PMC5895416 DOI: 10.1097/md.0000000000010238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/10/2018] [Accepted: 03/01/2018] [Indexed: 11/26/2022] Open
Abstract
The effects of revascularization by percutaneous coronary intervention (PCI) on cardiac function and clinical outcomes in patients with confirmed coronary artery disease (CAD) and heart failure (HF), on the basis of the optimal medical treatment recommended by current guidelines, remain to be determined.A cohort study was performed to evaluate the efficacy of PCI on the basis of optimal medical treatment in patients with CAD and HF. Patients who received PCI were subsequently grouped according to partial and complete revascularization (CR) depending on the PCI outcome. The primary outcome was defined as a composite outcome of major adverse cardiovascular events (MACEs). Changes in left ventricular ejection fraction (LVEF) also were compared.A total of 69 patients (12 who received medical treatment and 57 who received PCI) were included. Patients in the PCI group showed significantly improved LVEF (P < .001), but patients in the medical treatment group did not (P > .05) after 3 months of follow-up. MACEs occurred in 50% patients in the medical treatment group and 19.3% patients of the PCI group, with this difference almost reaching statistical significance (P = .06). Compared with patients who received medical therapy only, patients who received PCI experienced better survival (P = .02). Moreover, survival seemed to be better in patients who achieved CR with PCI of the coronary arteries than in those who had partial revascularization of the coronary arteries (P = .06).PCI may be effective for improving survival in patients with CAD and HF.
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Affiliation(s)
- Zongtao Wang
- The First Affiliated Hospital of Guangdong Pharmaceutical University, School of Clinical Medicine of Guangdong Pharmaceutical University
| | - Lijun Jin
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science
| | - Wanxing Zhou
- The First Affiliated Hospital of Guangdong Pharmaceutical University, School of Clinical Medicine of Guangdong Pharmaceutical University
| | - Da Lei
- The First Affiliated Hospital of Guangdong Pharmaceutical University, School of Clinical Medicine of Guangdong Pharmaceutical University
| | - Hong Yan
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science
| | - Huimin Yu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science
| | - Zhihuan Zeng
- The First Affiliated Hospital of Guangdong Pharmaceutical University, School of Clinical Medicine of Guangdong Pharmaceutical University
| | - Guiping Zhu
- The First Affiliated Hospital of Guangdong Pharmaceutical University, School of Clinical Medicine of Guangdong Pharmaceutical University
| | - Jianyi Zheng
- The First Affiliated Hospital of Guangdong Pharmaceutical University, School of Clinical Medicine of Guangdong Pharmaceutical University
| | - Yining Dai
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science
| | - Haifang Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
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20
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Manning WJ. Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston. J Cardiovasc Magn Reson 2017; 19:108. [PMID: 29284487 PMCID: PMC5747150 DOI: 10.1186/s12968-017-0423-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
The Journal of Cardiovascular Magnetic Resonance (JCMR) is the official publication of the Society for Cardiovascular Magnetic Resonance (SCMR). In 2016, the JCMR published 93 manuscripts, including 80 research papers, 6 reviews, 5 technical notes, 1 protocol, and 1 case report. The number of manuscripts published was similar to 2015 though with a 12% increase in manuscript submissions to an all-time high of 369. This reflects a decrease in the overall acceptance rate to <25% (excluding solicited reviews). The quality of submissions to JCMR continues to be high. The 2016 JCMR Impact Factor (which is published in June 2016 by Thomson Reuters) was steady at 5.601 (vs. 5.71 for 2015; as published in June 2016), which is the second highest impact factor ever recorded for JCMR. The 2016 impact factor means that the JCMR papers that were published in 2014 and 2015 were on-average cited 5.71 times in 2016.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in the order that they are accepted with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes with previously published JCMR papers to guide continuity of thought in the journal. In addition, I have elected to open this publication with information for the readership regarding the transition of the JCMR editorial office to the Beth Israel Deaconess Medical Center, Boston and the editorial process.Though there is an author publication charge (APC) associated with open-access to cover the publisher's expenses, this format provides a much wider distribution/availability of the author's work and greater manuscript citation. For SCMR members, there is a substantial discount in the APC. I hope that you will continue to send your high quality manuscripts to JCMR for consideration. Importantly, I also ask that you consider referencing recent JCMR publications in your submissions to the JCMR and elsewhere as these contribute to our impact factor. I also thank our dedicated Associate Editors, Guest Editors, and reviewers for their many efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the leading publication in our field.
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Affiliation(s)
- Warren J Manning
- From the Journal of Cardiovascular Magnetic Resonance Editorial Office and the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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21
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Elbaz-Greener G, Wijeysundera HC. Coronary Chronic Total Occlusions: Time to Abandon a Culture of Therapeutic Nihilism? Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.004295. [PMID: 29237747 DOI: 10.1161/circoutcomes.117.004295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gabby Elbaz-Greener
- From the Division of Cardiology and Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (G.E.G., H.C.W.); University of Toronto, Ontario, Canada (G.E.G., H.C.W.); Institute for Clinical Evaluative Sciences, Ontario, Canada (H.C.W.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (H.C.W.)
| | - Harindra C Wijeysundera
- From the Division of Cardiology and Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada (G.E.G., H.C.W.); University of Toronto, Ontario, Canada (G.E.G., H.C.W.); Institute for Clinical Evaluative Sciences, Ontario, Canada (H.C.W.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (H.C.W.).
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22
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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: 66] [Impact Index Per Article: 9.4] [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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23
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Shuvy M, Qiu F, Chee-A-Tow A, Graham JJ, Abuzeid W, Buller C, Strauss BH, Wijeysundera HC. Management of Chronic Total Coronary Occlusion in Stable Ischemic Heart Disease by Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Versus Medical Therapy. Am J Cardiol 2017; 120:759-764. [PMID: 28716335 DOI: 10.1016/j.amjcard.2017.05.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/11/2017] [Accepted: 05/23/2017] [Indexed: 01/24/2023]
Abstract
Coronary chronic total occlusions (CTOs) are found in approximately 20% of angiograms. We sought to assess the variation in the management of patients with CTOs and to compare the clinical outcomes of CTO lesions with those of non-CTO lesions. We conducted a population-based cohort study and included all patients with stable angina who underwent cardiac catheterization from October 1, 2012, to June 30, 2013, in Ontario, Canada. The primary outcome was a composite of mortality and hospitalization for myocardial infarction. A total of 7,864 patients were included, of whom 2,279 (29%) had a CTO. There were substantial differences in revascularization rates for patients with CTOs across hospitals in Ontario (44.9% to 94.1%). Revascularization was associated with improved outcomes in the overall cohort. Although the advantage of coronary artery bypass grafting over medical therapy was consistent in both patients with CTOs and patients without CTOs, the benefit of percutaneous coronary intervention (PCI) was limited to patients without CTOs (hazard ratio 0.56, 95% confidence interval 0.40- to 0.78), with no difference in patients with CTOs. The CTO lesion, however, was revascularized in few of the PCI cases (41.1%), with PCI limited to the non-CTO lesion in most patients.
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24
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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: 7.4] [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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