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AlAshry AMA, Nagiub MN, Ismael MFA, Alghonaimy W. Value of different CTO scoring systems in predicting procedural success in coronary chronic total occlusion intervention in Egyptian patients. Egypt Heart J 2024; 76:30. [PMID: 38441828 PMCID: PMC10914646 DOI: 10.1186/s43044-024-00458-6] [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: 12/22/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Chronic total occlusion (CTO) lesions in coronary arteries pose a significant challenge for coronary interventionists, often leading to referrals for coronary artery bypass graft surgery (CABG). Successful percutaneous coronary intervention (PCI) for CTOs requires accurate assessment of procedural potential. This study, comprising 100 Egyptian patients aged 37-81, compares the predictive efficacy of various CTO scoring systems in PCI success determination. Patients with CTO in at least one coronary artery, planned for elective PCI based on objective evidence of ischemia, were included. Experienced operators performed PCI, recording procedural variables, and assessing complications. Logistic regression analysis revealed an inverse linear relationship between success rates and score values across all systems. RESULTS Although, the predictive capacity of the scores was similar, with slight differences. The Euro CTO (CASTLE) score10 exhibited superior predictive efficacy, followed by the CL score9, while PROGRESS8 and J-CTO7 scores showed lower significance. ORA CTO11 score demonstrated intermediate predictive ability, and PROGRESS score8 had the least predictive value. CONCLUSION The CASTLE score10 proved most effective in predicting PCI success for CTO cases in Egyptian patients, with operators advised to choose scoring systems based on experience and case characteristics. Proper planning remains crucial for optimizing success rates in CTO PCI procedures, irrespective of the scoring system employed.
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Affiliation(s)
| | - Muhammed Nagy Nagiub
- Cardiology Department, Faculty of Medicine, Helwan University, Third East District, Area 9, Villa 28, El Sherouk City, Cairo, Egypt.
| | - Magdy Farouk Ahmed Ismael
- Cardiology Department, Faculty of Medicine, Helwan University, Third East District, Area 9, Villa 28, El Sherouk City, Cairo, Egypt
| | - Wesam Alghonaimy
- Cardiology Department, Faculty of Medicine, Helwan University, Third East District, Area 9, Villa 28, El Sherouk City, Cairo, Egypt
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Ahn J, Yu H, Rha SW, Choi BG, Park S, Park EJ, Kang DO, Choi CU. Long-term clinical outcomes following successful percutaneous coronary intervention in patients with extremely long coronary chronic total occlusion lesions. Catheter Cardiovasc Interv 2023; 102:878-884. [PMID: 37681968 DOI: 10.1002/ccd.30829] [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: 07/10/2023] [Revised: 08/20/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Lesion length is related to worse clinical outcomes following percutaneous coronary intervention (PCI) for the treatment of chronic total occlusion (CTO). However, the data to confirm the association between extremely long lesions and clinical hard endpoints have been limited. Therefore, we investigated the impact of extremely long CTO lesions (≥50 mm, treated lesion length) on the long-term clinical outcomes following successful PCI. METHODS A total of 333 consecutive patients with CTO who underwent successful PCI with drug-eluting stents (DESs) were allocated to either the extremely long or the short CTO group according to their CTO lesion length. The 5-year clinical outcomes were compared between the two groups. The incidence of myocardial infarction, cardiac death (CD), revascularization, and major adverse cardiovascular events (MACE) was higher in the extremely long CTO group. The 5-year clinical outcomes were analyzed using the Cox hazard ratio (HR) model. RESULTS In the entire study population, the extremely long CTO lesion was an independent predictor for higher rate of revascularization, MACE, CD, or mortality. CONCLUSIONS In our study, CTO patients with extremely long lesions (≥50 mm) who underwent successful PCI were associated with a higher risk of worse long-term clinical outcomes, including hard clinical endpoints such as CD and mortality even in the DESs era.
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Affiliation(s)
- Jihun Ahn
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - HyeYon Yu
- School of Nursing, College of Medicine, Soonchunhyang University, Asan, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eun Jin Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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Ngonge AL, Nso N, Mbome Y, Brgdar A, Tabot MT, Ahmad B, Taha M, Alebna P, Munawar M, Asangmbeng N, Effoe V, Mehrotra P, Fatima U. Comparison of Percutaneous Coronary Intervention-Related Adverse Cardiac Outcomes in Patients With in-stent vs de novo Chronic Total Occlusion: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101797. [PMID: 37178988 DOI: 10.1016/j.cpcardiol.2023.101797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Contemporary literature reveals a range of cardiac complications in patients who receive the percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study compared the adverse cardiac outcomes and procedural/technical success rates between the patients groups of in-stent (IS) CTO PCI and de novo CTO PCI. This systematic review and meta-analysis compared odds for primary (all-cause mortality, MACE, cardiac death post PCI, stroke) and secondary (bleeding requiring blood transfusion, ischemia-driven target-vessel revascularization, PCI procedural success, PCI technical success, and target-vessel MI) endpoints between 2734 patients who received PCI for IS CTO and 17,808 for de novo CTO. Odds ratios for outcome variables were calculated within 95% confidence intervals (CIs) via the Mantel-Haenszel method. The pooled analysis was undertaken for observational (retrospective/prospective) single- and multicentered studies published between January 2005 and December 2021. We found 57% higher, 166% higher, 129% higher, and 57% lower odds for MACE (OR: 1.57, 95% CI 1.31, 1.89, P < 0.001), ischemia-driven target-vessel revascularization (OR: 2.66, 95% CI 2.01, 3.53, P < 0.001), target-vessel myocardial infarction (MI) (OR: 2.29, 95% CI 1.70, 3.10, P < 0.001), and bleeding requiring blood transfusion (OR: 0.43, 95% CI 0.19, 1.00, P = 0.05), respectively, in patients with IS CTO PCI as compared to that of the de novo CTO PCI. No statistically significant differences between the study groups were recorded for the other primary/secondary outcome variables. The findings from this study indicated a high predisposition for MACE, ischemia-driven target-vessel revascularization, target vessel MI, and a lower incidence of bleeding episodes among IS CTO PCI patients as compared to those with de novo CTO PCI. The prognostic outcomes in CTO PCI cases require further investigation with randomized controlled trials.
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Affiliation(s)
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Queens New York, NY
| | - Yolanda Mbome
- Department of Medicine, Richmond University Medical Center, Staten Island, NY
| | - Ahmed Brgdar
- Department of Medicine, Howard University Hospital, Washington, DC
| | - Mpey Tabot Tabot
- Department of Medicine, Howard University Hospital, Washington, DC
| | - Basharat Ahmad
- Department of Medicine, Howard University Hospital, Washington, DC
| | - Mohamed Taha
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC
| | - Prince Alebna
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC
| | - Muhammad Munawar
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC
| | - Nformbuh Asangmbeng
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA
| | - Valery Effoe
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA
| | - Prafulla Mehrotra
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC
| | - Urooj Fatima
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC
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Munirwan H, Kusyanto FA, Zanisa Z, Latief MH. Chronic total occlusion percutaneous coronary intervention (CTO PCI) in an intractable heart failure patient: Is there any benefit? NARRA J 2023; 3:e140. [PMID: 38454973 PMCID: PMC10919745 DOI: 10.52225/narra.v3i2.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/08/2023] [Indexed: 03/09/2024]
Abstract
One of the most difficult procedures in interventional cardiology is the percutaneous coronary intervention (PCI) on a chronic total occlusion (CTO) lesion case. To rate the difficulty of guidewire crossing, several angiographic scoring methods have been developed such as the Japan CTO (J-CTO) score. Here we demonstrate the advantages of revascularization using PCI procedure in a CTO case with intractable heart failure. A 53-year-old man presented to the emergency room of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia with acute decompensated heart failure. The patient had a history of past PCI with two patent drug eluting stents (DES): one in the left main (LM)-left anterior descending (LAD) artery and one in the distal left circumflex (LCX) artery. The patient had three times rehospitalizations in the last three months. According to single-photon emission computed tomography (SPECT) imaging, the right coronary artery was remained functional; however, the lesion was categorized into very difficult level (J-CTO >3). The PCI was carried out on the right coronary artery and the blood vessel was successfully revascularized after applying multiple techniques. Following the procedure, the heart failure was treated and the 6-minute walking test (6MWT) that performed 12 days after the PCI increased from 220 to 260 meters. The success of this case depended on a comprehensive history taking, adequate imaging methods, and the selection of the proper tools and PCI strategy. In conclusion, despite the challenges, PCI is still an option for patients with persistent complete occlusion. The PCI requires comprehensive preparation and the use of angiographic scoring systems, such as the J-CTO score, to determine the approach and the likelihood of success.
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Affiliation(s)
- Haris Munirwan
- Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Cardiology and Vascular Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Fahmi A. Kusyanto
- Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Cardiology and Vascular Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Zanisa Zanisa
- Department of Public Health, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Muhammad H. Latief
- Division of Interventional Cardiology, Siloam Hospital, Makassar, Indonesia
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Li QY, Lin XL, Li FQ, Cheng ZC, Tian JY, Zhao DH, Lau WB, Liu JH, Fan Q. A Chinese scoring system for predicting successful retrograde collateral traverse in patients with chronic total coronary occlusion. BMC Cardiovasc Disord 2023; 23:380. [PMID: 37516887 PMCID: PMC10386207 DOI: 10.1186/s12872-023-03405-6] [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: 10/13/2022] [Accepted: 07/18/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Retrograde approach technique has been challenging in percutaneous coronary interventional treatment of chronic total occlusion (CTO) coronary disease. The present study endeavors to determine a novel Chinese scoring system for predicting successful collateral channels traverse via retrograde approach. METHODS The demographic characteristics and angiographic characteristics of 309 CTO patient were analyzed by univariable and multivariable analysis for selecting potential predictors. And the nomogram was used to establish the scoring system. Then it was evaluated by the internal and external validation. RESULTS The predictors of Age, Connections between collateral channels and recipient vessels, and Channel Tortuosity (ACT) were identified with univariable and multivariable analysis and employed to the ACT score system. With acceptable calibrations, the area under curve of the scoring system and the external validation were 0.826 and 0.816 respectively. Based on score, the predictors were divided into three risk categories and it showed a consistent prediction power in the validation cohort. CONCLUSIONS The novel Chinese ACT score is a reliable tool for predicting successful retrograde collateral traverse.
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Affiliation(s)
- Qiu Yu Li
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Xiao Long Lin
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Fan Qi Li
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Zi Chao Cheng
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Jia Yu Tian
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Dong Hui Zhao
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Wayne Bond Lau
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Jing Hua Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China
| | - Qian Fan
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, 100029, China.
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Zuo W, Lin J, Sun R, Su Y, Ma G. Performance of the J-CTO score versus other risk scores for predicting procedural difficulty in coronary chronic total occlusion interventions. Ann Med 2022; 54:3117-3128. [PMID: 36322535 PMCID: PMC9635461 DOI: 10.1080/07853890.2022.2141466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Although the Japanese chronic total occlusion (J-CTO) score is widely used to assess the complexity of revascularization for CTO lesions, ambiguous and conflicting results are reported in validation studies. Therefore, we aimed to quantitatively evaluate the effectiveness of the J-CTO score and explore the heterogeneity of its comparison with other CTO scores. METHODS PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov databases were systematically searched from January 1st, 2011 to December 23rd, 2021. Studies that examined the accuracy of the J-CTO score were eligible. Where feasible, estimates of discrimination and calibration were pooled with a random-effects model. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) was used for risk-of-bias assessment. This study was reported according to PRISMA guidelines and prospectively registered with PROSPERO (CRD42019126161). RESULTS Of 28 included studies (N = 34,944 lesions), 24 were eligible for meta-analysis. The J-CTO score demonstrated significant discrimination for 30-min wire crossing (summary C-statistic 0.76; 95% CI 0.68-0.84) and technical success (0.68; 95% CI 0.61-0.74) despite significant heterogeneity. Only 19 (33%) of the 58 pairwise comparisons with 14 competing scores that were based on discrimination reported a statistical result. The J-CTO score performed worse (relative difference of C-statistics >5%) in eight out of 33 independent comparisons but better in another 13. Methodological shortcomings resulted from only one study evaluating model calibration appropriately. CONCLUSION The discrimination power of the J-CTO score was useful for time-efficient wire crossing and moderate for angiographic success. Head-to-head comparisons of CTO scores would benefit from standardized reporting and appropriate statistical methods.Key messagesThe J-CTO score has useful discrimination in predicting 30-min wire crossing while performing moderately for technical success.After excluding optimism bias, there is insufficient independent evidence supporting the superiority of newly introduced models over the J-CTO score.Standardized methodology and assessment are needed to achieve a better understanding of CTO scores, especially for their calibration.
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Affiliation(s)
- Wenjie Zuo
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jie Lin
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiology, Taizhou People's Hospital, Taizhou, China
| | - Renhua Sun
- Department of Cardiology, The First People's Hospital of Yancheng City, Yancheng, China
| | - Yamin Su
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Megaly M, Buda K, Mashayekhi K, Werner GS, Grantham JA, Rinfret S, McEntegart M, Brilakis ES, Alaswad K. Comparative Analysis of Patient Characteristics in Chronic Total Occlusion Revascularization Studies: Trials vs Real-World Registries. JACC Cardiovasc Interv 2022; 15:1441-1449. [PMID: 35863793 DOI: 10.1016/j.jcin.2022.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/18/2022] [Accepted: 05/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The few randomized controlled trials (RCTs) on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) are subject to selection bias. OBJECTIVES The purpose of this study was to evaluate the differences between real-world CTO patients and those enrolled in RCTs. METHODS This study performed a meta-analysis of national and dedicated CTO PCI registries and compared patient characteristics and outcomes with those of RCTs that randomized patients to CTO PCI versus medical therapy. Given the large sample size differences between RCTs and registries, the study focused on the absolute numbers and their clinical significance. The study considered a 5% relative difference between groups to be potentially clinically relevant. RESULTS From 2012 to 2022, 6 RCTs compared CTO PCI versus medical therapy (n = 1,047) and were compared with 15 registries (5 national and 10 dedicated CTO PCI registries). Compared with registry patients, RCT patients had fewer comorbidities, including diabetes, hypertension, previous myocardial infarction, and prior coronary artery bypass graft surgery. RCT patients had shorter CTO length (29.6 ± 19.7 mm vs 32.6 ± 23.0 mm, a relative difference of 9.2%) and lower Japan-Chronic Total Occlusion Score scores (2.0 ± 1.1 vs 2.3 ± 1.2, a relative difference of 13%) compared with those enrolled in dedicated CTO registries. Procedural success was similar between RCTs (84.5%) and dedicated CTO registries (81.4%) but was lower in national registries (63.9%). CONCLUSIONS There is a paucity of randomized data on CTO PCI outcomes (6 RCTs, n = 1,047). These patients have lower risk profiles and less complex CTOs than those in real-world registries. Current evidence from RCTs may not be representative of real-world patients and should be interpreted within its limitation.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kevin Buda
- Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Kambis Mashayekhi
- Department of Cardiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany; Department of Cardiology, MediClin Heartcenter Lahr, Lahr, Germany
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt, Darmstadt, Germany
| | - J Aaron Grantham
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Stephane Rinfret
- Department of Cardiology, Emory University, Atlanta, Georgia, USA
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA.
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Holck EN, Winther NS, Mogensen LJH, Christiansen EH. Cost-Effectiveness in Patients Undergoing Revascularization of Chronic Total Occluded Coronary Arteries—A Cohort Study. Front Cardiovasc Med 2022; 9:849942. [PMID: 35694673 PMCID: PMC9177990 DOI: 10.3389/fcvm.2022.849942] [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: 01/06/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Revascularization of patients with chronic total occluded coronary arteries (CTO) is recommended if they have symptoms despite medical treatment. The cost-effectiveness of treatment with percutaneous coronary intervention (PCI) was investigated in this cohort study. Materials and Methods The study was designed as a cohort study enrolling all patients undergoing PCI for a CTO in the Central Region of Denmark and recorded in the EUROCTO database. Major adverse cardio- and cerebrovascular events (MACCE) and admissions for cardiac symptoms were collected in the Western Denmark Heart Registry and through medical Journal Audits. Exposure was defined as successful revascularization of all CTO lesions compared with having one or more remaining CTOs after PCI attempt(s). Cost-effectiveness was evaluated as the net benefit (NB) at the patient level 3 years after treatment and through cost-effectiveness planes. The cost was defined as the cumulative cost of the index procedure and admissions due to MACCE and cardiac symptoms. Effectiveness was defined as the difference in MACCE for the primary analysis and the difference in death and symptomatic admissions for the secondary. Results Between 2009 and 2019, 441 patients with ≥ 3 years of follow-up were treated with PCI for at least one CTO lesion (342 in the successful arm and 99 in the unsuccessful arm). The technical success rate was 85.4%. In total, 155 MACCE and 184 symptomatic admissions occurred in the follow-up period. The mean total cost was EUR 11.719 (11.034; 12.406) in the successful group vs. EUR 13.565 (11.899; 15,231) (p = 0.02) in the unsuccessful group. Net-benefit was EUR 1.846 (64; 3,627) after successful revascularization for MACCE. The adjusted analysis found an NB of EUR 1,481 (–118; 3,079). Bootstrap estimates showed cost-effectiveness planes in favor of successful revascularization. Conclusion Patients fully revascularized for all CTO lesions had a more cost-efficient treatment. However, results need confirmation in a randomized controlled trial due to the risk of residual confounding after adjustment.
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Affiliation(s)
- Emil Nielsen Holck
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Emil Nielsen Holck,
| | - Naja Stausholm Winther
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Juul Hune Mogensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Brinza C, Popa IV, Basarab A, Crisan-Dabija R, Burlacu A. Procedural Success Prediction Scoring Systems Used in Percutaneous Coronary Interventions for Chronic Total Occlusions: A Systematic Evaluation. Healthcare (Basel) 2021; 9:1033. [PMID: 34442170 PMCID: PMC8393835 DOI: 10.3390/healthcare9081033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/21/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Data suggest that patients with coronary chronic total occlusion (CTO) managed with percutaneous coronary intervention (PCI) could have better outcomes than those treated with optimal medical therapy alone. We aimed to systematically review dedicated scoring systems used to predict successful PCI in patients with CTO. (2) Methods: Electronic databases of MEDLINE (PubMed), Embase, and Cochrane were searched. (3) Results: 32 studies were included. We provided insights into all available predictive models of PCI success in CTO including predictive performance, validations, and comparisons between different scores and models' limitations. Considering the differences in the population included, coronary lesions, and techniques applied across clinical studies, the most used scores displayed a modest to good predictive value, as follows: J-CTO (AUC, 0.55-0.868), PROGRESS-CTO (AUC, 0.557-0.788), CL (AUC, 0.624-0.800), CASTLE (AUC, 0.633-0.68), and KCCT (AUC, 0.703-0.776). As PCI for CTO is one of the most complex interventions, using dedicated scoring systems could ensure an adequate case selection as well as preparation for an appropriate recanalization technique in order to increase chances of successful procedure. (4) Conclusion: Clinical models appear to be valuable tools for the prediction of PCI success in CTO patients. Clinicians should be aware of the limitations of each model and should be able to correctly select the most appropriate score according to real-life case particularities such as lesion complexity and operator experience in order to maximize success and achieve the best patients' outcomes.
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Affiliation(s)
- Crischentian Brinza
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, 700503 Iasi, Romania; (C.B.); (A.B.); (A.B.)
| | - Iolanda Valentina Popa
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania;
| | - Alexandru Basarab
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, 700503 Iasi, Romania; (C.B.); (A.B.); (A.B.)
| | - Radu Crisan-Dabija
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania;
- Pulmonology Department, Clinic of Pulmonary Diseases, 700115 Iasi, Romania
| | - Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, 700503 Iasi, Romania; (C.B.); (A.B.); (A.B.)
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania;
- Romanian Academy of Medical Sciences, 030167 Bucharest, Romania
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