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An Z, Tian J, Zhao X, Zhang M, Zhang L, Yang X, Liu L, Chen L, Song X. PET evaluation of myocardial perfusion function after percutaneous coronary intervention in patients with chronic total occlusion: a systematic review and meta-analysis. SCAND CARDIOVASC J 2024; 58:2302174. [PMID: 38317518 DOI: 10.1080/14017431.2024.2302174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/01/2024] [Indexed: 02/07/2024]
Abstract
Objective. The benefit of percutaneous coronary intervention (PCI) in chronic complete coronary artery occlusion (CTO) remains controversial. PCI is currently indicated only for symptom and myocardial ischemia abolition, but large chronically occluded vessels with extensive afferent myocardial territories may benefit most from this procedure. The noninvasive evaluation of myocardial perfusion is critical before and after revascularization, and positron emission tomography (PET) can determine absolute myocardial perfusion. Here, we aimed to explore and compare myocardial perfusion in CTO territories and their remote associated areas before and after PCI. Design. We searched for relevant articles published before November 28, 2022, in the Cochrane Library and PubMed. We calculated 95% confidence intervals (CIs) and standardized mean differences (SMDs) for parameters related to myocardial perfusion in CTO territories and remote areas in CTO patients before and after PCI. Results. We included five studies published between 2017 and 2022, with a total of 592 patients. Stress myocardial blood flow (MBF) was increased in CTO territories after PCI when compared to pre-PCI (mean difference [MD]: 1.70, 95% confidence interval [CI] 1.33-2.08, p < 0.001). Coronary flow reserve (CFR) in CTO regions was also higher after PCI (MD 1.37,95% [CI]1.13-1.61, p < 0.001). Stress MBF in remote regions was also increased after PCI (MD 0.27,95% [CI]0.99 ∼ 0.45, p = 0.004), as was CFR in remote regions (MD 0.32,95% [CI] 0.14-0.5, p = 0.001). Conclusions. According to our pooled analysis of current literature, there was an increase in stress MBF and CFR in both CTOs and remote regions after PCI, suggesting that patients with CTO have widespread recovery of blood perfusion after the procedure. These results provide evidence that patients with CTO arteries and high ischemic burdens would indeed benefit from CTO-PCI. Future research on the correlation of ischemia burden reduction with hard clinical endpoints would contribute to a clearer demarcation of the role of CTO PCI with prognostic potential.
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Affiliation(s)
- Ziyu An
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinfan Tian
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mingduo Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lijun Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xueyao Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Libo Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, P.R. China
| | - Liying Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Bavishi C, Davies RE, Matsuno S, Kobayashi N, Katoh H, Obunai K, Maran A, Kearney K, Kohsaka S, Hirai T. Practice differences and knowledge gaps in complex and high-risk interventions between Japan and the USA: A case-based discussion. J Cardiol 2024; 83:272-279. [PMID: 37863185 DOI: 10.1016/j.jjcc.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/08/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
Advances in percutaneous coronary intervention (PCI) devices and techniques have expanded the pool of eligible patients for revascularization, including those with comorbidities, reduced left ventricular function, or anatomical complexity (defined as CHIP: complex and high-risk interventions in indicated patients). CHIP interventions are typically performed by selected operators who specialize in complex PCI. This review presents two cases performed in the USA, to discuss the similarities and differences in practice patterns between CHIP operators in Japan and the USA. The first case involves a 58-year-old male presenting with myocardial infarction and cardiogenic shock, and the second case involves a 51-year-old female with a history of coronary artery bypass grafting presenting with a chronic total occlusion and PCI complicated by vessel perforation. The discussion focuses on appropriate patient selection, the role of the heart team approach for decision-making, the use of hemodynamic support devices, and other relevant factors. By comparing practices in Japan and the USA, this review highlights opportunities for knowledge exchange and potential areas for improving patient outcomes.
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Yan Y, Yuan F, Liu X, Luo T, Feng X, Yao J, Zhang M, Gu F, Song G, Lyu S. Percutaneous Coronary Intervention Offers Clinical Benefits to Diabetic Patients With Stable Chronic Total Occlusion. Angiology 2024; 75:375-385. [PMID: 36809177 DOI: 10.1177/00033197231153246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Whether percutaneous coronary intervention for chronic total occlusion (CTO-PCI) in diabetic patients offers more benefits compared with initial medical therapy (CTO-MT) is unclear. In this study, diabetic patients with one CTO (clinical manifestations: stable angina or silent ischemia) were enrolled. Consecutively, enrolled patients (n = 1605) were assigned to different groups: CTO-PCI (1044 [65.0%]) and initial CTO-MT (561 [35%]). After a median follow-up of 44 months, CTO-PCI tended to be superior to initial CTO-MT in major adverse cardiovascular events (adjusted hazard-ratio [aHR]: .81, 95% conference-interval: .65-1.02) and significantly superior in cardiac death (aHR: .58 [.39-.87]) and all-cause death (aHR: .678[.473-.970]). Such superiority mainly attributed to a successful CTO-PCI. CTO-PCI tended to be performed in patients with younger age, good collaterals, left anterior descending branch CTO, and right coronary artery CTO. While, those with left circumflex CTO and severe clinical/angiographic situations were more likely to be assigned to initial CTO-MT. However, none of these variables influenced the benefits of CTO-PCI. Thus, we concluded that for diabetic patients with stable CTO, CTO-PCI (mainly successful CTO-PCI) offered patients survival benefits over initial CTO-MT. These benefits were consistent regardless of clinical/angiographic characteristics.
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Affiliation(s)
- Yunfeng Yan
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Fei Yuan
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Xinmin Liu
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Taiyang Luo
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Xu Feng
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Jing Yao
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Mingduo Zhang
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Feifei Gu
- Department of Cardiology, Emergency General Hospital, Beijing, China
| | - Guangyuan Song
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Shuzheng Lyu
- Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Beijing, China
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Costa H, Espírito-Santo M, Bispo J, Guedes J, Mimoso J, Palmeiro H, Baptista Gonçalves R, Vinhas H. Clinical outcomes of percutaneous coronary intervention in chronic total occlusion in patients with type 2 diabetes mellitus. Rev Port Cardiol 2024; 43:167-174. [PMID: 38141872 DOI: 10.1016/j.repc.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 12/25/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Coronary chronic total occlusions (CTOs) are relatively common findings in patients with type 2 diabetes mellitus (T2DM). However, the indication for percutaneous coronary intervention (PCI) and its clinical benefit in these patients remain controversial. METHODS A single-center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020. Patients were divided into two groups according to previous T2DM diagnosis (T2DM and non-T2DM). The primary outcome was recurrence of angina and/or heart failure symptoms and secondary outcomes were myocardial infarction and all-cause mortality. RESULTS A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65±11 years. The primary outcome (total symptom recurrence) occurred in 16.6% of the sample, with no difference between groups (non-T2DM 13.6% vs. T2DM 21.2%, p=0.194) in a two-year follow-up. Angina recurrence was significantly more frequent in T2DM patients (15.2%, p=0.043). The presence of T2DM was not an independent predictor of symptom recurrence (p=0.429, HR 1.37, 95% CI 0.62-2.98). Myocardial infarction and all-cause mortality were also not different between groups (T2DM 1.5%, p=0.786 and 4.5%, p=0.352, respectively, on survival analysis). Independent predictors of all-cause mortality were left ventricular function and creatine clearance (p=0.039, HR 0.92, 95% CI 0.85-0.99 and p=0.013, HR 0.96, 95% CI 0.93-0.99, respectively). CONCLUSIONS T2DM did not influence outcomes in CTO patients undergoing PCI, and its presence should not be a limiting factor in deciding on CTO revascularization.
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Affiliation(s)
- Hugo Costa
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal.
| | | | - João Bispo
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
| | - João Guedes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
| | - Jorge Mimoso
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
| | - Hugo Palmeiro
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
| | | | - Hugo Vinhas
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Portugal
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O'Brien JM, Dautov R, Sapontis J. Chronic Total Occlusions: A State-of-the-Art Review. Heart Lung Circ 2024:S1443-9506(24)00066-0. [PMID: 38565438 DOI: 10.1016/j.hlc.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
The percutaneous management of chronic total occlusions (CTO) is a well-established sub-specialty of Interventional Cardiology, requiring specialist equipment, training, and techniques. The heterogeneity of approaches in CTO has led to the generation of multiple algorithms to guide operators in their management. The evidence base for management of CTOs has suffered from inconsistent descriptive and quantitative terminology in defining the nature of lesions and techniques utilised, as well as seemingly contradictory data about improvement in ventricular function, symptoms of angina, and mortality from large-scale registries and randomised controlled trials. Through this review, we explore the history of CTO management and its supporting evidence in detail, with an outline of limitations of CTO-percutaneous coronary intervention and a look at the future of this growing field within cardiology.
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Affiliation(s)
- Joseph M O'Brien
- Victorian Heart Hospital, Cardiology, Monash Health, Melbourne, Vic, Australia; Victorian Heart Institute, Monash University, Melbourne, Vic, Australia. joseph.o'
| | - Rustem Dautov
- Heart and Lung Institute, The Prince Charles Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - James Sapontis
- Victorian Heart Hospital, Cardiology, Monash Health, Melbourne, Vic, Australia; Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
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Rempakos A, Brilakis ES. Life After Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2024; 216:91-92. [PMID: 38272201 DOI: 10.1016/j.amjcard.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Athanasios Rempakos
- XXX, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- XXX, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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7
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Xiao K, Cao H, Yang B, Xv Z, Xiao L, Wang J, Ni S, Feng H, He Z, Xv L, Li J, Xv D. Association between the triglyceride glucose index and chronic total coronary occlusion: A cross-sectional study from southwest China. Nutr Metab Cardiovasc Dis 2024; 34:850-859. [PMID: 38161119 DOI: 10.1016/j.numecd.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND AIM Insulin resistance (IR) plays an important role in the atherosclerotic process, and the triglyceride glucose (TyG) index is a reliable indicator of IR and is strongly associated with cardiovascular disease. However, there are few studies regarding the relationship between the TyG index and chronic total coronary occlusion (CTO). Herein, the correlation between the TyG index and CTO, as well as their interactions with other traditional cardiovascular risk factors, were investigated. METHODS AND RESULTS We enrolled 2691 patients who underwent coronary angiography at Guangyuan Central Hospital from January 2019 to October 2021. TyG index results were used to create three groups using the trichotomous method. CTO was defined as complete occlusion of the coronary artery for ≥3 months. Univariate and multivariate logistic regression models, restricted cubic splines, receiver operating characteristic (ROC) curves, and subgroup analyses was performed. A significant correlation between the TyG index and CTO was noted. The risk of CTO was increased 2.09-fold in the group with the highest TyG compared with the lowest (OR, 2.09; 95 % CI, 1.05-4.17; P = 0.036). In addition, there was a linear dose-response relationship between the TyG index and CTO (nonlinear P = 0.614). The area under the ROC curve was 0.643 (95 % CI, 0.572-0.654). Using subgroup analyses, we observed that the TyG index was associated with a significantly higher risk of CTO in males and smokers. CONCLUSIONS An elevated TyG index was related to the risk of CTO and may constitute a meaningful predictor of CTO, particularly in males and in smokers.
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Affiliation(s)
- Kaiyong Xiao
- Department of Cardiology, Guangyuan Central Hospital, 16 Jingxiangzi, Guangyuan, Sichuan 628017, China.
| | - Huili Cao
- Department of Cardiology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030000, China
| | - Bin Yang
- Department of Cardiology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030000, China
| | - Zhe Xv
- Department of Pediatric, Guangyuan Central Hospital, 16 Jingxiangzi, Guangyuan, Sichuan 628017, China
| | - Lian Xiao
- Department of Cardiology, Guangyuan Central Hospital, 16 Jingxiangzi, Guangyuan, Sichuan 628017, China
| | - Jianping Wang
- Department of Cardiology, Guangyuan Central Hospital, 16 Jingxiangzi, Guangyuan, Sichuan 628017, China
| | - Shuiqing Ni
- Department of Cardiology, Guangyuan Central Hospital, 16 Jingxiangzi, Guangyuan, Sichuan 628017, China
| | - Hui Feng
- Medical Laboratory Center, Guangyuan Central Hospital, 16 Jingxiangzi, Guangyuan, Sichuan 628017, China
| | - Zhongwei He
- Department of Cardiology, Guangyuan Central Hospital, 16 Jingxiangzi, Guangyuan, Sichuan 628017, China
| | - Lei Xv
- Department of Cardiology, Guangyuan Central Hospital, 16 Jingxiangzi, Guangyuan, Sichuan 628017, China
| | - Juan Li
- Department of Cardiology, Guangyuan Central Hospital, 16 Jingxiangzi, Guangyuan, Sichuan 628017, China
| | - Dongmei Xv
- Department of Ultrasonography, Guangyuan Central Hospital, 16 Jingxiangzi, Guangyuan, Sichuan 628017, China
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Goyal A, Maheshwari S, Shahbaz H, Shah V, Shamim U, Shrestha AB, Sulaiman SA, Mhatre P, Sohail AH, Sheikh AB, Dani SS. The Presence of Chronic Total Occlusion in Noninfarct-Related Arteries Is Associated With Higher Mortality and Worse Patient Outcomes Following Percutaneous Coronary Intervention for STEMI: A Systematic Review, Meta-Analysis and Meta-Regression. Cardiol Rev 2024:00045415-990000000-00228. [PMID: 38456689 DOI: 10.1097/crd.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Reperfusion therapy with percutaneous coronary intervention improves outcomes in patients with ST-elevation myocardial infarction. We conducted a meta-analysis to assess the impact of chronic total occlusion (CTO) in noninfarct-related artery on the outcomes of these patients. Comprehensive searches were performed using PubMed, Google Scholar, and EMBASE. The primary endpoint was the 30-day mortality rate, with secondary endpoints including all-cause mortality, repeat myocardial infarction, and stroke. Forest plots were created for the pooled analysis of the results, with statistical significance set at P < 0.05. A total of 19 studies were included in this meta-analysis, with 23,989 patients (3589 in CTO group and 20,400 in no-CTO group). The presence of CTO was associated with significantly higher odds of 30-day mortality [18.38% vs 5.74%; relative risk (RR), 3.69; 95% confidence intervals (CI), 2.68-5.07; P < 0.00001], all-cause mortality (31.00% vs 13.40%; RR, 2.79; 95% CI, 2.31-3.37; P < 0.00001), cardiovascular-related deaths (12.61% vs 4.1%; RR, 2.61; 95% CI, 1.99-3.44; P < 0.00001), and major adverse cardiovascular events (13.64% vs 9.88%; RR, 2.08; 95% CI, 1.52-2.86; P < 0.00001) than the non-CTO group. No significant differences in repeated myocardial infarction or stroke were observed between the CTO and non-CTO groups. Our findings underscore the need for further research on the benefits and risks of performing staged or simultaneous percutaneous coronary intervention for CTO in the noninfarct-related artery in patients with ST-elevation myocardial infarction.
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Affiliation(s)
- Aman Goyal
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Surabhi Maheshwari
- Department of Internal Medicine, G.M.E.R.S. Medical College and Hospital, Sola, India
| | - Haania Shahbaz
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Viraj Shah
- Department of Cardiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Urooj Shamim
- Department of Internal Medicine, Aga Khan University, Karachi, Pakistan
| | - Abhigan Babu Shrestha
- Department of Internal Medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | - Samia Aziz Sulaiman
- Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Pauras Mhatre
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Amir Humza Sohail
- Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM; and
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA
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Costa H, Espirito-Santo M, Bispo J, Guedes J, Mimoso J, Palmeiro H, Baptista Gonçalves R, Vinhas H. Clinical results of percutaneous coronary intervention in chronic total occlusions of the right coronary artery. Rev Port Cardiol 2024; 43:131-138. [PMID: 38244775 DOI: 10.1016/j.repc.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/21/2023] [Accepted: 07/26/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Coronary chronic total occlusions (CTOs) of the right coronary artery (RCA) are a relatively common finding in the context of coronary angiography. However, the benefit of revascularization remains controversial. METHODS A single-center retrospective cohort analysis prospectively collected outcomes of CTO patients undergoing percutaneous coronary intervention (PCI) in 2019 and 2020. Patients were divided into two groups according to the CTO vessel treated (left coronary artery [LCA]-CTO or RCA-CTO). The primary outcome was defined as the recurrence of angina and/or heart failure (HF) symptoms and secondary outcomes were myocardial infarction (MI) and all-cause mortality. RESULTS A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65±11 years. The primary outcome occurred in 28 (16.6%) patients and was significantly more frequent in RCA-CTO patients (19, 24.7%, p=0.010) in a mean follow-up of 18 months. This was mainly driven by recurrence of HF symptoms (12, 15.6%, p=0.013). Treated RCA-CTO was an independent predictor of the primary outcome (p=0.019, HR 2.66, 95% CI 1.17-6.05). MI and mortality rates were no different between groups (RCA-CTO with 1.3%, p=0.361 and 2.6%, p=0.673, respectively, on survival analysis). Left ventricular ejection fraction was an independent predictor of mortality (p=0.041, HR 0.93, 95% CI 0.87-0.99). CONCLUSIONS Revascularization of CTO lesions by PCI was associated with low rates of symptom recurrence, and clinical outcomes showed no differences regardless of which artery was treated. Recanalization of RCA-CTO was less beneficial in reducing the recurrence of HF symptoms.
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Affiliation(s)
- Hugo Costa
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
| | | | - João Bispo
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - João Guedes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Jorge Mimoso
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Hugo Palmeiro
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | | | - Hugo Vinhas
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
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Gold DA, Sandesara PB, Jain V, Gold ME, Vatsa N, Desai SR, Hassan ME, Yuan C, Ko YA, Ejaz K, Alvi Z, Jaber WA, Nicholson WJ, Quyyumi AA. Long-Term Outcomes in Patients With Chronic Total Occlusion. Am J Cardiol 2024; 214:59-65. [PMID: 38195045 PMCID: PMC10947430 DOI: 10.1016/j.amjcard.2023.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/24/2023] [Indexed: 01/11/2024]
Abstract
Although a chronic total occlusion (CTO) in the setting of an acute coronary syndrome is associated with greater risk, the prognosis of patients with a CTO and stable coronary artery disease (CAD) remains unknown. This study aimed to investigate adverse event rates in patients with stable CAD with and without a CTO. In 3,597 patients with stable CAD (>50% coronary luminal stenosis) who underwent cardiac catheterization, all-cause mortality, cardiovascular mortality, and the composite major adverse cardiac event (MACE) rates for cardiovascular death, myocardial infarction, and heart failure hospitalization were evaluated. Cox proportional hazards and Fine and Gray subdistribution hazard models were used to compare event-free survival in patient subsets after adjustment for covariates. Event rates were higher in patients with CTOs than in those without CTOs after adjusting for demographic and clinical characteristics (cardiovascular death hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.05 to 1.57, p = 0.012). Patients with CTO revascularization had lower event rates than those of patients without CTO revascularization (cardiovascular death HR 0.43, CI 0.26 to 0.70, p = 0.001). Those with nonrevascularized CTOs were at particularly great risk when compared with those without CTO (cardiovascular death HR 1.52, CI 1.25 to 1.84, p <0.001). Moreover, those with revascularized CTOs had similar event rates to those of patients with CAD without CTOs. Patients with CTO have higher rates of adverse cardiovascular events than those of patients with significant CAD without CTO. This risk is greatest in patients with nonrevascularized CTO.
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Affiliation(s)
- Daniel A Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Vardhmaan Jain
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew E Gold
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nishant Vatsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shivang R Desai
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Malika Elhage Hassan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chenyang Yuan
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kiran Ejaz
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zain Alvi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wissam A Jaber
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - William J Nicholson
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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Xu W, Ma J, Chen Y, Zhou F, Zhou C, Zhang LJ. Coronary chronic total occlusion on coronary CT angiography: what radiologists should know? Insights Imaging 2024; 15:55. [PMID: 38411752 PMCID: PMC10899151 DOI: 10.1186/s13244-024-01621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/11/2024] [Indexed: 02/28/2024] Open
Abstract
Coronary chronic total occlusion (CTO) often occurs in patients with obstructive coronary artery disease, which remains one of the greatest challenges for interventional cardiologists. Coronary computed tomography angiography (CCTA) with its emerging post-processing techniques can provide a detailed assessment of CTO lesions before percutaneous coronary intervention (PCI), playing an important role in the clinical management of CTO PCI, from early diagnosis, pre-procedural outcome prediction, the crossing algorithm planning, intraprocedural guidance, and finally post-procedural assessment and follow-up. In addition, the feasibility of CT perfusion (CTP) in patients with CTO has been validated. Combined CCTA and CTP have the great potential to be the one-stop-shop imaging modality for assessing both anatomy and function of CTO lesions. This review aims to make radiologists understand the role of CCTA in the diagnosis and assessment of CTO lesions, thus assisting interventionalists in optimizing CTO PCI crossing strategies with the expertise of radiologists.Critical relevance statement The anatomical features of CTO on CCTA can reveal the complexity of CTO lesions and are associated with CTO PCI outcome, thus helping interventionalists optimize CTO PCI crossing strategies.Key points • CTO is the common lesion in invasive coronary angiography, and CTO PCI is technically difficult and its success rate is relatively low.• Length, collaterals, and attenuation-related signs can help distinguish CTO from subtotal occlusion.• The anatomical features of CTO lesions can help grade the difficulty of CTO PCI and predict procedural outcomes and long-term outcomes of CTO PCI.• The real-time fusion of CCTA with fluoroscopic angiography can be applied in highly complicated CTO lesions.• After CTO PCI, CCTA can help guide a second CTO PCI re-entry or follow up stent patency.
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Affiliation(s)
- Wei Xu
- Department of Radiology, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Nanjing, China
| | - Junfeng Ma
- Emergency Medical Center, Xi'an Xianyang International Airport Co., Ltd., Xianyang, China
| | - Yiwen Chen
- Department of Radiology, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Nanjing, China
| | - Fan Zhou
- Department of Radiology, Affiliated Jinling Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, China
| | - Changsheng Zhou
- Department of Radiology, Affiliated Jinling Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Nanjing, China.
- Department of Radiology, Affiliated Jinling Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, China.
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12
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Cilia L, Megaly M, Davies R, Tehrani BN, Batchelor WB, Truesdell AG. A non-interventional cardiologist's guide to coronary chronic total occlusions. Front Cardiovasc Med 2024; 11:1350549. [PMID: 38380179 PMCID: PMC10876789 DOI: 10.3389/fcvm.2024.1350549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Coronary chronic total occlusions (CTO) are present in up to one-third of patients with coronary artery disease (CAD). It is thus essential for all clinical cardiologists to possess a basic awareness and understanding of CTOs, including optimal evaluation and management. While percutaneous coronary intervention (PCI) for CTO lesions has many similarities to non-CTO PCI, there are important considerations pertaining to pre-procedural evaluation, interventional techniques, procedural complications, and post-procedure management and follow-up unique to patients undergoing this highly specialized intervention. Distinct from other existing topical reviews, the current manuscript focuses on key knowledge relevant to non-interventional cardiologists.
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Affiliation(s)
- Lindsey Cilia
- Virginia Heart, Falls Church, VA, United States
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Michael Megaly
- Willis Knighton Medical Center, Shreveport, LA, United States
| | | | - Behnam N. Tehrani
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Wayne B. Batchelor
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Alexander G. Truesdell
- Virginia Heart, Falls Church, VA, United States
- Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
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13
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Galassi AR, Vadalà G, Werner GS, Cosyns B, Sianos G, Hill J, Dudek D, Picano E, Novo G, Andreini D, Gerber BLM, Buechel R, Mashayekhi K, Thielmann M, McEntegart MB, Vaquerizo B, Di Mario C, Stojkovic S, Sandner S, Bonaros N, Lüscher TF. Evaluation and management of patients with coronary chronic total occlusions considered for revascularisation. A clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the European Association of Cardiovascular Imaging (EACVI) of the ESC, and the ESC Working Group on Cardiovascular Surgery. EUROINTERVENTION 2024; 20:e174-e184. [PMID: 38343372 PMCID: PMC10836390 DOI: 10.4244/eij-d-23-00749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/05/2023] [Indexed: 02/15/2024]
Abstract
Chronic total occlusions (CTOs) of coronary arteries can be found in the context of chronic or acute coronary syndromes; sometimes they are an incidental finding in those apparently healthy individuals undergoing imaging for preoperative risk assessment. Recently, the invasive management of CTOs has made impressive progress due to sophisticated preinterventional assessment, including advanced non-invasive imaging, the availability of novel and dedicated tools for CTO percutaneous coronary intervention (PCI), and experienced interventionalists working in specialised centres. Thus, it is crucial that referring physicians who see patients with CTO be aware of recent developments and of the initial evaluation requirements for such patients. Besides a careful history and clinical examination, electrocardiograms, exercise tests, and non-invasive imaging modalities are important for selecting the patients most suitable for CTO PCI, while others may be referred to coronary artery bypass graft or optimal medical therapy only. While CTO PCI improves angina and reduces the use of antianginal drugs in patients with symptoms and proven ischaemia, hibernation and/or wall motion abnormalities at baseline or during stress, the effect of CTO PCI on major cardiovascular events is still controversial. This clinical consensus statement specifically focuses on referring physicians, providing a comprehensive algorithm for the preinterventional evaluation of patients with CTO and the current evidence for the clinical effectiveness of the procedure. The proposed care track has been developed by members and with the support of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Association of Cardiovascular Imaging (EACVI), and the European Society of Cardiology (ESC) Working Group on Cardiovascular Surgery.
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Affiliation(s)
| | - Giuseppe Vadalà
- Department of PROMISE, University of Palermo, Palermo, Italy
| | - Gerald S Werner
- Medical Department I (Cardiology), Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Bernard Cosyns
- Cardiology, Universitair Ziekenhuis Brussel, Centrum voor Hart en Vaatziekten, Brussels, Belgium
| | - Georgios Sianos
- AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Jonathan Hill
- Royal Brompton & Harefield Hospitals GSTT, London, United Kingdom
| | - Dariusz Dudek
- Cardiac Catheterization Laboratories, Jagiellonian University Medical College, Krakow, Poland
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Giuseppina Novo
- Department of PROMISE, University of Palermo, Palermo, Italy
| | | | - Bernhard L M Gerber
- Cardiology Department, Cliniques Universitaires St. Luc UCL, Brussels, Belgium
| | - Ronny Buechel
- Department of Nuclear Medicine, Cardiovascular Imaging, University Hospital of Zurich, Zurich, Switzerland
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Mathias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Essen, Germany
| | | | | | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Sinisa Stojkovic
- Faculty of Medicine, University of Belgrade, Clinic for Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Sigrid Sandner
- Cardiovascular Surgery, Medical University of Vienna, Vienna, Austria
| | - Nikolaos Bonaros
- Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas F Lüscher
- Royal Brompton & Harefield Hospitals GSTT, London, United Kingdom
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
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14
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Qin Q, Chen L, Ge L, Qian J, Ma J, Ge J. Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions. Coron Artery Dis 2023; 34:555-561. [PMID: 37721311 PMCID: PMC10602222 DOI: 10.1097/mca.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/12/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES This study aims to compare the clinical outcomes of patients with de novo chronic total occlusion (CTO) lesions treated by hybrid strategy and drug-coated balloons (DCB)-only strategy. BACKGROUNDS DCBs have been used as an alternative to or in combination with drug-eluting stents in CTO lesions. However, the clinical impact of DCB treatment on CTO lesion remains uncertain. METHODS We retrospectively enrolled 154 patients with de novo CTO lesions treated by DCB, including 57 cases in hybrid group and 97 cases in DCB-only group. RESULTS The lesions in hybrid group were more complicated than those in DCB-only group as shown by higher J-CTO score, and therefore higher percentage of retrograde approach, more IVUS guidance, more CTO guidewires, and longer procedural time were demonstrated. Although the percentage of non-flow-limiting dissection and residual stenosis of more than 30% were lower in hybrid group, TIMI flow grade, satisfactory and acceptable recanalization rate were not significantly different between two groups. During a median follow-up was 470 days, the incidence of target lesion revascularization (TLR), myocardial infarction and cardiac death was 11.0%, 1.3% and 1.9%, respectively. The long-term TLR-free survival was comparable between hybrid and DCB-only groups. By multivariate analysis, DCB length and age were predictors of TLR. CONCLUSION DCB treatment appears effective and safe in selected de novo CTO lesions during long-term follow up. The recanalization results and long-term outcomes are comparable between hybrid and DCB-only group despite more complicated lesions in hybrid group.
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Affiliation(s)
- Qing Qin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lu Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lei Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease
- National Clinical Research Center for Interventional Medicine, Shanghai, China
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15
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Winther NS, Holck EN, Mogensen LJH, Karim SR, Eftekhari A, Christiansen EH. Early and long-term prognosis in patients with remaining chronic total occlusions after revascularization attempt. A cohort study from the SKEJ-CTO registry. Scand Cardiovasc J Suppl 2023; 57:17-24. [PMID: 36428263 DOI: 10.1080/14017431.2022.2150787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The present study aimed to compare safety and long-term prognosis of patients with chronic total coronary occlusions (CTO) stratified for remaining CTOs after percutaneous coronary intervention (PCI). DESIGN The study cohort consisted of patients with coronary artery disease who underwent CTO PCI in a high volume tertiary center from 2009 to 2019 and were registered in Danish high-quality registers. Patients with successful PCI of all CTOs were compared to patients with ≥1 remaining CTO post-procedural. Primary endpoints were analysed using Cox-regression and Kaplan-Meier estimates, and included all-cause mortality, major adverse cardio- and cerebrovascular events (MACCE) and a 30-day safety endpoint. RESULTS Procedural success rate was 87.7%, and 76.5% of patients had all CTO(s) opened post-PCI. Safety endpoint occurred in 4.6% of patients, and more frequently in patients with remaining CTO(s) (RD 4.9, 95%CI 0.1, 9.8). All-cause mortality was higher in patients with remaining CTO(s) (Unadjusted HR 1.65, 95% CI 1.03, 2.47, p = .015. Adjusted HR 1.32, 95%CI 0.88-1.99, p = .18) after eight years of follow-up. Risk of MACCE was significantly higher in patients with remaining CTO(s) (Unadjusted HR 1.79, 95% CI 1.34-2.41, p < .001. Adjusted HR 1.51, 95% CI 1.11-2.05, p = .009). CONCLUSIONS In our centre, CTO PCI was associated with high success rate and low risk of 30-days complications. Presence of remaining CTO(s) after final revascularization attempt was associated with higher but statistically insignificant long-term mortality but was an independent predictor of MACCE.
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Affiliation(s)
- Naja Stausholm Winther
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Emil Nielsen Holck
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Salma Raghad Karim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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16
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Miyashita H, Mansikkaniemi L, Sinisalo J, Stewart J, Laine P. Long-term improvement of symptoms of angina pectoris after successful revascularization of coronary artery chronic total occlusions. SCAND CARDIOVASC J 2023; 57:2161621. [PMID: 36587829 DOI: 10.1080/14017431.2022.2161621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives. To compare long-term angina pectoris relief of successful versus failed percutaneous coronary intervention of chronic total occlusions (CTO PCI). Background. Previous studies demonstrate better short-term angina pectoris relief of CTO PCI than with optimal medical treatment (OMT), however, data on the long-term effects are lacking. Methods. 295 patients undergoing CTO PCI were analyzed retrospectively, with a follow-up evaluation of symptoms of angina pectoris and all-cause death one to four years after the intervention. The primary outcome was long-term relief of symptoms of angina pectoris. Secondary outcomes included a composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and later target vessel revascularization (TVR). At follow-up, patients were interviewed for symptoms of angina pectoris at 1, 6, 12, and 22 to 48 months after the intervention. Results. CTO PCI was successful in 225 (76%) patients and failed in 70 (24%) patients. Short-term (six months) relief of angina pectoris was observed in both groups, but only the successful CTO PCI group showed long-term relief. The Kaplan-Meier curves of all-cause death did not differ between the groups (p = .715). The final follow-up was a mean (range) of 37 (25 to 44) months after the intervention in the successful CTO PCI group, and 33 (28 to 48) months in the failed CTO PCI group. Conclusions. Successful CTO PCI is associated with better long-term relief of symptoms of angina pectoris compared to failed CTO PCI.
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Affiliation(s)
- Hirokazu Miyashita
- Department of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | | | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Juhani Stewart
- Department of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Petri Laine
- Department of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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17
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Ge X, Wu H, Zang Z, Xie J. Application of checklist-based nursing care process in patients undergoing intervention for coronary chronic total occlusions: a quasi-randomized study. BMC Cardiovasc Disord 2023; 23:591. [PMID: 38036972 PMCID: PMC10688462 DOI: 10.1186/s12872-023-03627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Coronary chronic total occlusion (CTO) interventions are more complex than general percutaneous coronary intervention (PCI) procedures. However, only a few nursing methods are specifically applied to patients undergoing CTO interventions. And the conventional nursing effect is not ideal, urgent need to explore more effective nursing methods. The checklist is a simple and effective tool for error management and performance improvement that has been widely used in many fields. But there have been no reports of the checklist being used to improve care for CTO patients. OBJECTIVE This study aimed to investigate the effectiveness of a checklist-based nursing care process in patients undergoing Coronary chronic total occlusion (CTO) interventions, including duration of care, patient anxiety, improved patient satisfaction, and occurrence of adverse events. METHODS A total of 120 CTO patients undergoing percutaneous coronary intervention (PCI) were selected at our hospital and divided into an intervention group (n = 60, adopted the checklist-based nursing care process for patient care) and a control group (n = 60, adopted nursing care according to the existing workflow) according to different nursing interventions. After surgery, the nurse in charge of the patient completed the nursing according to the "List of postoperative care for CTO patients" filled in by the patient within 24 h after surgery, conducted a doctor satisfaction survey, recorded adverse events, and completed the postoperative Self-Rating Anxiety Scale (SAS) score and patient satisfaction survey before the patient was discharged. Subsequently, the Qc team checks the completion of the patient's checklist for safety and the completion of the questionnaire. Finally, the differences between the two groups in preoperative nursing time, incidence of adverse events caused by nurses' omission or inadequate guidance, patient anxiety, and doctor and patient satisfaction were compared. RESULTS The intervention grouphad significantly shorter preoperative nursing care time and significantly lower the total number of adverse events than the control group (P < 0.05).The postoperative Self-Rating Anxiety Scale (SAS) score of the intervention group was significantly lower than that of the control group (P < 0.05).The satisfaction of doctors and patients in the intervention groupwas significantly higher than that in the control group (P < 0.05). CONCLUSION The application of the checklist-based nursing care process in patients with CTO intervention can significantly reduce the preoperative nursing care time, reduce patient anxiety, improve patients' and doctors' satisfaction with nursing care, and effectively reduce the occurrence of adverse events caused by nurses' omissions or inadequate instructions. TRIAL REGISTRATION The protocol of the trial was registered retrospectively of Chinese Clinical Trial Registry (registration number ChiCTR2200056804, reg date17/02/2022).
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Affiliation(s)
- Xia Ge
- Cardiovascular ward, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China
| | - Haiyang Wu
- Cardiovascular ward, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China
| | - Zhe Zang
- Cardiovascular ward, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China
| | - Jiayi Xie
- Cardiovascular ward, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China.
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18
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Liang S, Bai Y, Zhang J, Wang A, Li J, Diao K, He Y. The added value of coronary CTA in chronic total occlusion percutaneous coronary intervention: a systematic review and meta-analysis. Eur Radiol 2023:10.1007/s00330-023-10341-8. [PMID: 37951854 DOI: 10.1007/s00330-023-10341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES To systematically investigate and summarize the utility of coronary computed tomographic angiography (CCTA) in the management of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). METHODS The authors searched the four databases between 2005 and 2023 for studies investigating the role of CCTA and invasive coronary angiograms (ICA) images when used as the pre-procedural tool for CTO-PCI. Efficacy and safety of CCTA in CTO-PCI treatment as a pre-procedural assessment tool was evaluated. RESULTS Forty-seven studies were finally chosen for this systematic review. CCTA had a high degree of agreement with ICA when applied for J-CTO scoring system. A J-CTO (Multicenter CTO Registry in Japan) score > 3, together with calcification, occlusion length ≥ 20 mm, blunt stump, and bending > 45° were shared imaging risk factors on both ICA and CCTA for technique failure and guidewire crossing over 30 min. Additionally, negative remodeling and multiple diseased vessel were significant indicators on CCTA. Although patients with pre-procedural CCTA showed a trend of higher success rate and easier guidewire crossing, and CCTA showed a slightly higher predictive accuracy for process success, no significant improvement in post-PCI major adverse cardiac events of using CCTA for assessment has been achieved. CONCLUSIONS CCTA is a safe and effective pre-operative tool of CTO-PCI. Except for the shared imaging risk factors with ICA for a hard CTO-PCI including calcification, occlusion length ≥ 20 mm, blunt stump, bending > 45°, and J-CTO score > 3, factors like negative remodeling and multiple diseased vessel were also recognized as significant pre-operative assessment indicators on CCTA. CLINICAL RELEVANCE STATEMENT A pre-procedural assessment based on coronary computed tomographic angiography has the potential to aid in the management of chronic total occlusion percutaneous coronary intervention. KEY POINTS • A coronary computed tomographic angiography-based pre-procedural assessment can help chronic total occlusion-percutaneous coronary intervention management. • The recognized high-risk features detected via coronary computed tomographic angiography and invasive coronary angiograms are comparable in detecting difficult lesions and chronic total occlusion-percutaneous coronary intervention failure. • Coronary computed tomographic angiography has an additional value to be a safe and effective pre-procedural assessment tool for chronic total occlusion-percutaneous coronary intervention.
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Affiliation(s)
- Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China
| | - Yanlin Bai
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Aijie Wang
- Department of Radiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China
| | - Jing Li
- Research Center of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyue Diao
- Department of Radiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China.
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, Sichuan, China.
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19
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Fagu A, Berger T, Pingpoh C, Kondov S, Kreibich M, Minners J, Czerny M, Siepe M. In-Hospital Outcomes Following Surgical Revascularization of Chronic Total Coronary Occlusions. Medicina (Kaunas) 2023; 59:1967. [PMID: 38004016 PMCID: PMC10673513 DOI: 10.3390/medicina59111967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Patients with chronic total occlusions of the coronary arteries are either treated with PCI or referred for surgical revascularization. We analyzed the patients with chronic occluded coronary arteries that were surgically treated and aimed to describe the anatomical characteristics, revascularization rates, and in-hospital outcomes achieved with coronary artery bypass grafting. Methods: Angiographic data of 2005 patients with coronary artery disease treated in our institution between January 2005 and December 2014 were retrospectively analyzed. A total of 1111 patients with at least one coronary total occlusion were identified. We reviewed the preoperative coronary angiograms and surgical protocols to determine the presence, localization, and revascularization of coronary occlusions. We also evaluated the perioperative data and in-hospital outcomes. Results: The median age of the study population was 68 years (25th-75th percentiles, 61.0-74.0). Three-vessel disease was present in 94.8% of patients and the rest (5.8%) had a two-vessel disease. The localizations of the occlusions were as follows: 68.4% in the RCA system, 26.4% in the LAD, and 28.5% in the LCX system. Multiple occlusions were present in 22.6% of the patients. Complete coronary total occlusion revascularization was achieved in 86.1% of the patients. The overall in-hospital mortality was 2.3%. The median in-hospital stay was 14.0 days. After logistic regression analysis, age (odds ratio 3.44 [95% confidence interval, 1.81-6.53], p < 0.001, for a 10-year increase) and the presence of peripheral artery disease (odds ratio 3.32 [1.39-7.93], p = 0.007) were the only statistically significant independent predictors of in-hospital mortality. Conclusions: A high revascularization rate and favorable in-hospital outcomes are achieved with coronary artery bypass surgery in patients with multi-vessel diseases and coronary total occlusions. Older age and the presence of peripheral artery disease are independent predictors of in-hospital mortality. A long-term follow-up and the type of graft (arterial vs. venous) used would bring more useful data for this type of revascularization.
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Affiliation(s)
- Albi Fagu
- Department of Cardiovascular Surgery, Heart Centre Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany (M.K.)
- Division of Cardiac Surgery, University Hospital “Shefqet Ndroqi”, University of Medicine, 1005 Tirana, Albania
| | - Tim Berger
- Department of Cardiovascular Surgery, Heart Centre Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany (M.K.)
| | - Clarence Pingpoh
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, 3012 Bern, Switzerland
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, Heart Centre Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany (M.K.)
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Centre Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany (M.K.)
| | - Jan Minners
- Department of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, 79189 Bad Krozingen, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Centre Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany (M.K.)
| | - Matthias Siepe
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, 3012 Bern, Switzerland
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Yang Y, Ma M, Zhang J, Jin S, Zhang D, Lin X. Triglyceride-glucose index in the prediction of clinical outcomes after successful recanalization for coronary chronic total occlusions. Cardiovasc Diabetol 2023; 22:304. [PMID: 37940976 PMCID: PMC10634094 DOI: 10.1186/s12933-023-02037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Triglyceride-glucose index (TyG) has been widely used to predict cardiovascular outcomes. However, it remains unclear whether TyG holds prognostic significance for patients with coronary chronic total occlusions (CTO). Thus, our study aimed to evaluate the predictive accuracy and prognostic value of TyG in individuals who underwent successful percutaneous coronary intervention (PCI) for CTO. METHODS A total of 331 consecutive patients with ≥ 1 successful CTO-PCI were included. The baseline and angiographic data were acquired. The duration of follow-up ranged from 32 to 79 months, with a median of 44 months and an interquartile range of 39 to 67 months. The primary outcome measured was the occurrence of major adverse cardiac and cerebrovascular events (MACCE), including mortality, target vessel revascularization, recurrent myocardial infarction, and stroke. RESULTS After controlling for confounders, multivariate Cox regression analysis revealed that TyG remained statistically significant, regardless of being a continuous or categorical variable. In the partially adjusted regression model, the Hazard ratio (95%CI) for MACCE was 2.54 (1.12-5.79) in tertile 3 and 1.61 (1.22-2.12) per SD increase in the TyG.Kaplan-Meier survival analysis demonstrated significant differences in MACCE-free survival rates across tertiles of the TyG, as indicated by the log-rank test (p = 0.001). ROC analysis was conducted to evaluate the predictive ability of TyG for MACCE, resulting in an AUC of 0.677. CONCLUSION The TyG index demonstrates independent predictive capabilities for MACCE in patients who have undergone successful CTO-PCI. These findings suggest that TyG holds the potential as a valuable tool in risk stratification and the identification of patients who may benefit from early intervention in the management of CTO.
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Affiliation(s)
- Yu Yang
- Department of cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei city, 230022, Anhui province, China
| | - Mengqing Ma
- Department of cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei city, 230022, Anhui province, China
| | - Jian Zhang
- Department of cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei city, 230022, Anhui province, China
| | - Shiyu Jin
- Department of cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei city, 230022, Anhui province, China
| | - Dingxin Zhang
- Department of cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei city, 230022, Anhui province, China
| | - Xianhe Lin
- Department of cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei city, 230022, Anhui province, China.
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21
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Panuccio G, Carabetta N, Torella D, De Rosa S. Clinical impact of coronary revascularization over medical treatment in chronic coronary syndromes: A systematic review and meta-analysis. Hellenic J Cardiol 2023:S1109-9666(23)00194-X. [PMID: 37949356 DOI: 10.1016/j.hjc.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE To provide a quantitative comparison between myocardial revascularization (REVASC) and optimal medical treatment (OMT) alone in patients with chronic coronary syndrome (CCS). METHODS Pertinent studies were searched for in PubMed/Medline until 12/03/2023. Randomized controlled trials that compare REVASC to OMT reporting clinical outcomes were selected according to PRISMA guidelines. The primary outcome was cardiovascular death. Two investigators independently assessed the study quality and extracted data. RESULTS Twenty-eight randomized controlled studies (RCTs) including 20692 patients were included in this meta-analysis. The rate of cardiovascular mortality was significantly lower among patients treated with myocardial revascularization [risk ratio (RR) 0.79, 95% CI 0.69-0.90]. Age (p = 0.03), multivessel disease (p < 0.001), and follow-up duration (p = 0.001) were significant moderators of CV mortality. Subgroup analyses showed a larger benefit in patients treated with drug-eluting stents and those without chronic total occlusion. Among secondary outcomes, myocardial infarction was less frequent in the REVASC group (RR = 0.74; p < 0.001), while no significant difference was found for all-cause mortality (p = 0.09) nor stroke (p = 0.26). CONCLUSIONS The present analysis showed lower rates of CV mortality and myocardial infarction in CCS patients treated with myocardial revascularization compared to OMT. This benefit was larger with increasing follow-up duration. Personalized treatment based on patient characteristics and lesion complexity may optimize clinical outcomes in patients with CCS.
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Affiliation(s)
| | | | - Daniele Torella
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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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23
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Hirao Y, Seki T, Watanabe N, Matoba S. Health-Related Quality of Life After Percutaneous Coronary Intervention for Stable Ischemic Heart Disease: A Systematic Review and Meta-analysis. Can J Cardiol 2023; 39:1539-1548. [PMID: 37422259 DOI: 10.1016/j.cjca.2023.06.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/07/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND There has been no meta-analysis of whether percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) improves health-related quality of life (HRQL) compared with OMT alone in patients with stable ischemic heart disease (SIHD). METHODS We searched MEDLINE, Cochrane Central Registry of Controlled Trials, Embase, ClinicalTrials.gov, and International Clinical Trials Registry Platform in November 2022. We included randomized controlled trials (RCTs) that compared PCI with OMT vs OMT alone with HRQL in patients with SIHD. The primary outcome was the aggregated physical HRQL, including physical functioning using the Short Form (SF)-36 or RAND-36, physical limitation using the Seattle Angina Questionnaire (SAQ) or SAQ-7, McMaster Health Index Questionnaire, and Duke Activity Status Index within 6 months. Data were analyzed using a random effects model when substantial heterogeneity was identified or a fixed effect model otherwise. RESULTS Among 14 systematically reviewed RCTs, 12 RCTs with 12,238 patients were meta-analyzed. Only 1 trial had a low risk of bias in all domains. PCI with OMT improved aggregated physical HRQL (standardized mean difference, 0.16; 95% confidence interval [CI], 0.1-0.23; P < 0.0001) at 6 months. Also, PCI with OMT improved physical functioning on the SF-36/RAND-36 (mean difference 3.65; 95% CI, 1.88-5.41) and physical limitation on the SAQ/SAQ-7 (mean difference, 3.09; 95% CI, 0.93-5.24) compared with OMT alone at 6 months. However, all of the aggregated physical HRQL domains were classified into small effects, and no HRQL domain exceeded the prespecified minimal clinically important difference. CONCLUSIONS These findings showed that PCI with OMT improved HRQL compared with OMT alone in patients with SIHD, but the benefit was not large.
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Affiliation(s)
- Yu Hirao
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomotsugu Seki
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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24
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Mohebbi B, Sadeghipour P, Zolfaghari R, Vadalà G, Khalilipur E, Zahedmehr A, Diana D, Maadani M, Shakerian F, Kiani R, Hosseini Z, Rashidinejad A, Rouzitalab M, Khalesi S, Toulabi V, Sucato V, Di Fazio L, Taherian M, Amiripouya S, Ashuri S, Bayatian A, Naderi S, Bakhshandeh H, Moosavi J, Abdi S, Firouzi A, Alemzadeh-Ansari MJ, Galassi AR. Outcomes of chronic total occlusion percutaneous coronary intervention from the RAIAN (RAjaie - Iran) registry. Indian Heart J 2023; 75:429-435. [PMID: 37866775 PMCID: PMC10774591 DOI: 10.1016/j.ihj.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 05/24/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE While most of the evidence in CTO interventions emerge from Western and Japanese studies, few data have been published up today from the Middle East. Objective of this study was to evaluate technical success rates and clinical outcomes of an Iranian population undergoing CTO PCI in a tertiary referral hospital. Moreover, we sought to evaluate the efficacy of our CTO teaching program. METHODS This is a retrospective single-center cohort study including 790 patients who underwent CTO PCI performed by operators with different volumes of CTOs PCI performed per year. According to PCI result, all patients have been divided into successful (n = 555, 70.3 %) and unsuccessful (n = 235, 29.7 %) groups. Study endpoints were Major Adverse Cardiovascular Events and Health Status Improvement evaluated using the Seattle Angina Questionnaire at one year. RESULTS A global success rate of 70 % for antegrade and 80 % for retrograde approach was shown despite the lack of some CTO-dedicated devices. During the enrollment period, the success rate increased significantly among operators with a lower number of CTO procedures per year. One-year MACE rate was similar in both successful and unsuccessful groups (13.5 % in successful and 10.6 % in unsuccessful group, p = 0.173). One year patients' health status improved significantly only in successful group. CONCLUSIONS No significant differences of in-hospital and one-year MACE were found between the successful and unsuccessful groups. Angina symptoms and quality of life significantly improved after successful CTO PCI. The RAIAN registry confirmed the importance of operator expertise for CTO PCI success.
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Affiliation(s)
- Bahram Mohebbi
- Cardiovascular Intervention Research Center, Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Zolfaghari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Giuseppe Vadalà
- Cardiology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", Paolo Giaccone Hospital, University of Palermo, Italy.
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Zahedmehr
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Davide Diana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Mohsen Maadani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Shakerian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Kiani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahara Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rashidinejad
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Rouzitalab
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Khalesi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Toulabi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vincenzo Sucato
- Cardiology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", Paolo Giaccone Hospital, University of Palermo, Italy
| | - Luca Di Fazio
- Cardiology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", Paolo Giaccone Hospital, University of Palermo, Italy
| | - Maisam Taherian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Amiripouya
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Ashuri
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ayatollah Bayatian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sajad Naderi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alfredo R Galassi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
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25
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Abdelaziz A, Elsayed H, Atta K, Mechi A, Kadhim H, Aboutaleb AM, Elaraby A, Hafez A, Bakr A, Mohamed Rzk F, Elshahat A, Bakr M, Zawaneh EA, Ezzat M, Abdelaziz M, Fadel S, Ghaith HS, Singer E, Suppah M. Short- and Long-term Outcomes of Percutaneous Coronary Interventions in Chronic and Non-chronic Total Occlusions: A Meta-analysis of 690,123 Patients. Curr Probl Cardiol 2023; 48:101890. [PMID: 37336307 DOI: 10.1016/j.cpcardiol.2023.101890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
The use of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is still a subject of debate, with conflicting outcomes reported in different studies when compared to non-CTO lesions. This meta-analysis aims to clarify the clinical outcomes of PCI in CTO cases compared to non-CTO lesions, both in the short and long-term. PubMed, Scopus, Web of Science, Ovid, and Cochrane Central were searched until March 2023 for relevant studies addressing short- and long-term outcomes of PCI in CTO vs non-CTO lesions. Dichotomous data were pooled as odds ratio (OR) with its 95% confidence interval (CI) in a random Der-Simonian lair effect model using STATA 17 MP. Eight studies with a total of 690,123 patients were included. In terms of short-term outcomes, CTO PCI was associated with higher rates of vessel perforation (OR = 2.16, 95% CI: 1.31-3.57) and cardiac tamponade (OR = 5.19, 95% CI: 4.29-6.28). Additionally, CTO PCI showed lower rates of procedural success (OR = 0.84, 95% CI: 0.73-0.96). Moreover, in the long-term, CTO PCI had higher rates of MACE (OR = 1.02, 95% CI: 1.01-1.04), however, it showed lower rates of cardiac death (OR = 0.61, 95% CI: 0.38-0.98), with no significant difference in other reported outcomes. Our findings underscore the challenges and adverse outcomes associated with using PCI to treat CTO lesions in the short term. This suggests that interventional cardiologists should carefully evaluate the risks and benefits before proceeding with PCI in CTO lesions.
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Affiliation(s)
- Ahmed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Hanaa Elsayed
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Karim Atta
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Ahmed Mechi
- Department of Internal Medicine, University of Kufa, Medicine College, Najaf, Iraq
| | | | - Aya Moustafa Aboutaleb
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elaraby
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman Hafez
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali Bakr
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fayed Mohamed Rzk
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Elshahat
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Bakr
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Emad Addin Zawaneh
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of medicine, Jordan university of science and technology, Irbid, Jordan
| | - Mahmoud Ezzat
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Shaimaa Fadel
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hazem S Ghaith
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Emad Singer
- University of Texas MD Anderson, Houston, TX
| | - Mustafa Suppah
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ
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26
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Park DY, Hu JR, Kanitsoraphan C, Al-Ogaili A, Murthi M, Vardar U, Ahmad Y, Nanna MG, Vij A. Trends and Inhospital Outcomes of Intravascular Imaging on Single-Vessel Coronary Chronic Total Occlusion Treated With Percutaneous Coronary Intervention. Am J Cardiol 2023; 206:79-85. [PMID: 37683583 PMCID: PMC10901566 DOI: 10.1016/j.amjcard.2023.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/10/2023]
Abstract
Intravascular imaging (IVI), including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), improves outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). We sought to quantify temporal trends in the uptake of IVI for CTO-PCI in the United States. We identified adults who underwent single-vessel PCI for CTO between 2008 and 2020. We quantified yearly trends in the number of IVUS-guided and OCT-guided single-vessel CTO-PCIs by Cochran-Armitage and linear regression tests. We also examined the rates of inhospital mortality and other prespecified inhospital outcomes in patients who underwent CTO-PCIs with and without IVI, using logistic regression. Our study included a total of 151,998 PCIs on single-vessel CTOs, with the absolute number of CTO-PCIs decreasing from 12,345 in 2008 to 8,525 in 2020 (p trend <0.001). IVUS use has increased dramatically from 6% in 2008 to 18% in 2020 for single-vessel CTO-PCIs (p trend <0.001). Rates of OCT use have increased as well, from 0% in 2008 to 7% in 2020 (p trend <0.001). There was no difference in inhospital mortality between patients who underwent CTO-PCI with and without IVI (p logistic = 0.60). In the largest national analysis of single-vessel CTO-PCI trends to date, we found that the use of IVUS has increased substantially accompanied by a similar but lesser increase in the use of OCT. There were no differences in rates of inhospital mortality between patients who underwent single-vessel CTO-PCIs with and without IVI.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, Illinois
| | - Jiun-Ruey Hu
- Division of Cardiology, Cook County Health, Chicago, Illinois
| | | | - Ahmed Al-Ogaili
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | | | - Ufuk Vardar
- Department of Medicine, Cook County Health, Chicago, Illinois
| | - Yousif Ahmad
- Division of Cardiology, Cook County Health, Chicago, Illinois
| | - Michael G Nanna
- Division of Cardiology, Cook County Health, Chicago, Illinois
| | - Aviral Vij
- Section of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Connecticut; Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
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27
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Masoomi R, Azzalini L. Survival Following Recanalization of Chronic Total Occlusion: The Devil Is in the Details. J Am Heart Assoc 2023; 12:e032178. [PMID: 37830351 PMCID: PMC10757515 DOI: 10.1161/jaha.123.032178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- Reza Masoomi
- Division of Cardiology, Department of MedicineUniversity of WashingtonSeattleWA
| | - Lorenzo Azzalini
- Division of Cardiology, Department of MedicineUniversity of WashingtonSeattleWA
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28
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Holck EN, Winther NS, Mogensen LJ, Christiansen EH. Chronic Total Occlusion is Not a Risk Factor for Mortality in Patients With Successful Percutaneous Coronary Intervention: A Cohort Study. J Am Heart Assoc 2023; 12:e030989. [PMID: 37830355 PMCID: PMC10757529 DOI: 10.1161/jaha.123.030989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 10/14/2023]
Abstract
Background Fifteen percent of patients with coronary artery disease undergoing angiography have a chronic total occlusion (CTO). The current study aimed to investigate the long-term prognosis after successful and unsuccessful CTO percutaneous coronary intervention (PCI) compared with PCI for non-CTO lesions. Methods and Results The current study was designed as an observational, region-wide, register-based cohort study enrolling all patients undergoing PCI in the Central Region of Denmark in 2009 to 2019. Patients were stratified into non-CTO, successful CTO, and unsuccessful CTO revascularization. Patients were followed until an event or January 1, 2022. The primary end point was all-cause mortality. In 21 141 patients enrolled, 2108 underwent CTO PCI. Clinical presentation was acute coronary syndrome in 11 879 patients and chronic coronary syndrome in 7887 patients. After a median of 5.7 years (interquartile range, 3.3-8.8), long-term all-cause mortality was higher after CTO PCI compared with non-CTO PCI, but the difference was statistically insignificant when adjusting for clinical factors (unadjusted hazard ratio [HR], 1.19 [95% CI, 1.09-1.29], adjusted HR, 1.08 [95% CI, 0.97-1.20]; P=0.165). After successful CTO PCI, no difference compared with non-CTO PCI was observed (unadjusted HR, 0.99 [95% CI, 0.90-1.10], adjusted HR, 0.99 [95% CI, 0.87-1.12]; P=0.873). After unsuccessful CTO PCI, long-term all-cause mortality was higher than non-CTO PCI (unadjusted HR, 1.82 [95% CI, 1.59-2.08], adjusted HR, 1.35 [95% CI, 1.13-1.63]; P<0.001). Conclusions Patients undergoing PCI for CTO have elevated long-term mortality compared with patients without CTO. Successful opening of the CTO(s) is associated with equal mortality compared with non-CTO PCI. In contrast, failed CTO PCI is associated with worse long-term mortality. These findings suggest the need for CTO programs with high success rates and low complication rates.
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Affiliation(s)
- Emil N. Holck
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Institute of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Naja S. Winther
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Institute of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Lone Juul‐Hune Mogensen
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Institute of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Evald Høj Christiansen
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Institute of Clinical MedicineAarhus UniversityAarhusDenmark
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Nathan A, Hashemzadeh M, Movahed MR. Percutaneous Coronary Intervention of Chronic Total Occlusion Associated with Higher Inpatient Mortality and Complications Compared With Non-CTO Lesions. Am J Med 2023; 136:994-999. [PMID: 37356643 DOI: 10.1016/j.amjmed.2023.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) in patients with chronic total occlusion is commonly performed despite unclear long-term benefits. The goal of this study was to evaluate the postprocedural outcome of patients with chronic total occlusion intervention. METHODS The National Inpatient Sample database, years 2016-2020, was studied using International Classification of Diseases, Tenth Revision codes. Patients with chronic total occlusion interventions were compared with patients without chronic total occlusion. We evaluated postprocedural mortality and complications. RESULTS PCI in patients with chronic total occlusion was associated with higher total inhospital mortality and all postprocedural complications. A weighted total of 10,059,269 patients underwent PCI, with 259,574 having chronic total occlusion. The chronic total occlusion group had a 3.17% mortality rate vs 2.57% of nonchronic total occlusion PCIs (odds ratio [OR] 1.24; 95% confidence interval [CI], 1.18-1.31; P < .001). Using multivariate analysis adjusting for basline charcteristics and high risk features such as age, sex, race, diabetes mellitus, chronic kidney disease, systolic heart failure, 3-vessel PCI, hypertension, chronic obstructive pulmonary disease, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, prior PCI, history of coronary artery bypass graft, history of anemia, smoking status, atrial fibrillation/flutter, valvular heart disease, and , history of stroke, chronic total occlusion PCI remained significantly associated with higher total mortality (OR 1.07; 95% CI, 1.02-1.13; P = .02). Patients with chronic total occlusion compared with nonchronic total occlusion PCI had also higher rates of myocardial infarction (OR 2.85; 95% CI, 2.54-3.21; P < .001), coronary perforation (OR 6.01; 95% CI, 5.25-6.89; P < .001), tamponade (OR 3.36; 95% CI, 2.91-3.88; P < .001), contrast-induced nephropathy (OR 2.05; 95% CI, 1.45-2.90; P < .001), procedural bleeding (OR 3.57; 95% CI, 3.27-3.89; P < .001), and acute postprocedural respiratory failure (OR 2.07; 95% CI, 1.81-2.36; P < .001). All postprocedural complications were more than 3 times the nonchronic total occlusion patients (OR 3.45; 95% CI, 3.24-3.67; P < .001). CONCLUSION Using a large national inpatient database, PCI performed in patients with chronic total occlusion was associated with significantly much higher mortality and postprocedural complications compared with PCI in nonchronic total occlusion patients.
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Affiliation(s)
| | | | - Mohammad Reza Movahed
- University of Arizona College of Medicine-Phoenix; University of Arizona Sarver Heart Center, Tucson.
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Blessing R, Drosos I, Molitor M, Münzel T, Wenzel P, Gori T, Dimitriadis Z. Evaluation of right-ventricular function by two-dimensional echocardiography and two-dimensional speckle-tracking echocardiography in patients with successful RCA CTO recanalization. Clin Res Cardiol 2023; 112:1454-1462. [PMID: 37526696 PMCID: PMC10562279 DOI: 10.1007/s00392-023-02259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Chronic total occlusion (CTO) of the right coronary artery (RCA) is common in patients with coronary artery disease. Although revascularization techniques and success rates have improved significantly in recent years, there are still no studies investigating possible effects of successful recanalization of RCA CTO on the right-ventricular (RV) function. With this study, we aimed to evaluate RV function after recanalization of the RCA by two-dimensional transthoracic echocardiography (2DE) and additional two-dimensional speckle-tracking echocardiography (2DSTE). METHODS AND RESULTS Our analysis included 102 patients undergoing successful RCA CTO recanalization at the University Medical Center of Mainz. All patients underwent 2DE and 2DSTE to assess RV function before PCI procedure and 6 months after successful revascularization. We found an altered RV function in our collective at baseline assessed by 2DSTE with a significant improvement at 6 month follow-up (baseline RV free wall strain: - 20.7 [- 6.3 to - 32.0] % vs. - 23.4 [- 8.3 to - 39.3] % at follow-up, p < 0.001 and baseline RV global strain - 15.9 [- 6.0 to - 25.7] % vs. - 17.9 [- 7.0 to - 29.5] % at follow-up, p < 0.001). CONCLUSION RV function was altered in patients with RCA CTO and showed significant improvement after successful recanalization. We also noticed an improvement in patient-reported clinical symptoms. Our study suggests that CTO procedure is a beneficial treatment option in symptomatic patients with RCA CTO.
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Affiliation(s)
- Recha Blessing
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Ioannis Drosos
- Division of Cardiology, Department of Medicine III, Center of Internal Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Michael Molitor
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Philip Wenzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Zisis Dimitriadis
- Division of Cardiology, Department of Medicine III, Center of Internal Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Werner GS, Hildick-Smith D, Martin Yuste V, Boudou N, Sianos G, Gelev V, Rumoroso JR, Erglis A, Christiansen EH, Escaned J, Di Mario C, Teruel L, Bufe A, Lauer B, Galassi AR, Louvard Y. Three-year outcomes of A Randomized Multicentre Trial Comparing Revascularization and Optimal Medical Therapy for Chronic Total Coronary Occlusions (EuroCTO). EUROINTERVENTION 2023; 19:571-579. [PMID: 37482940 PMCID: PMC10493774 DOI: 10.4244/eij-d-23-00312] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO) improves clinical symptoms and quality of life. The longer-term safety of PCI compared to optimal medical therapy (OMT) remains uncertain. AIMS We sought to evaluate the long-term safety of PCI for CTO in a randomised trial as compared to OMT. METHODS A total of 396 patients with a symptomatic CTO were enrolled into a randomised, multicentre clinical trial comparing PCI and OMT. Half of the patients had a single CTO; the others had multivessel disease. Non-CTO lesions were treated prior to randomisation (2:1 ratio). During follow-up, crossover from OMT to PCI occurred in 7.3% (1 year) and 17.5% (3 years) of patients. RESULTS At 3 years, the incidence of cardiovascular death or nonfatal myocardial infarction was not significantly different between the groups (OMT 3.7% vs PCI 6.2%; p=0.29). By per-protocol analysis, the difference remained non-significant (OMT 5.7% vs PCI 4.7%; p=0.67). Overall, major adverse cardiovascular events (MACE) were more frequent with OMT (OMT 21.2% vs PCI 11.2%), largely because of ischaemia-driven revascularisation. The rates of stroke or hospitalisation for bleeding were not different between the groups. CONCLUSIONS At 3 years there was no difference in the rate of cardiovascular death or myocardial infarction between PCI or OMT among patients with a remaining single coronary CTO. The MACE rate was higher in the OMT group due largely to ischaemia-driven revascularisation. CTO PCI appears to be a safe option for patients with a single remaining significant coronary CTO. CinicalTrials.gov: NCT01760083.
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Affiliation(s)
| | | | | | - Nicolas Boudou
- Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France
| | | | | | | | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Javier Escaned
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Carlo Di Mario
- Department of Cardiology, University of Florence, Florence, Italy
| | - Luis Teruel
- Bellvitge University Hospital, Barcelona, Spain
| | | | - Bernward Lauer
- Medizinische Klinik 1, Klinikum der Friedrich-Schiller Universität, Jena, Germany
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Al-Lamee RK, Khan SA, Davies J. Reconsidering the evidence for CTO PCI: the devil is in the detail. EUROINTERVENTION 2023; 19:537-538. [PMID: 37720966 PMCID: PMC10493770 DOI: 10.4244/eij-e-23-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Rasha K Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sarosh A Khan
- Essex Cardiothoracic Centre, Basildon, Essex, UK
- Anglia Ruskin University, Chelmsford, Essex, UK
| | - John Davies
- Essex Cardiothoracic Centre, Basildon, Essex, UK
- Anglia Ruskin University, Chelmsford, Essex, UK
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Cartlidge T, Kovacevic M, Navarese EP, Werner G, Kunadian V. Role of percutaneous coronary intervention in the modern-day management of chronic coronary syndrome. Heart 2023; 109:1429-1435. [PMID: 36928242 DOI: 10.1136/heartjnl-2022-321870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Contemporary randomised trials of percutaneous coronary intervention (PCI) in chronic coronary syndrome (CCS) demonstrate no difference between patients treated with a conservative or invasive strategy with respect to all-cause mortality or myocardial infarction, although trials lack power to test for individual endpoints and long-term follow-up data are needed. Open-label trials consistently show greater improvement in symptoms and quality of life among patients with stable angina treated with PCI. Further studies are awaited to clarify this finding. In patients with severe left ventricular (LV) systolic dysfunction and obstructive coronary artery disease in the Revascularization for Ischemic Ventricular Dysfunction trial, PCI has not been found to improve all-cause mortality, heart failure hospitalisation or recovery of LV function when compared with medical therapy. PCI was, however, performed without additional hazard and so remains a treatment option when there are favourable patient characteristics. The majority of patients reported no angina, and the low burden of angina in many of the randomised PCI trials is a widely cited limitation. Despite contentious evidence, elective PCI for CCS continues to play a significant role in UK clinical practice. While PCI for urgent indications has more than doubled since 2006, the rate of elective PCI remains unchanged. PCI remains an important strategy when symptoms are not well controlled, and we should maximise its value with appropriate patient selection. In this review, we provide a framework to assist in critical interpretation of findings from most recent trials and meta-analysis evidence.
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Affiliation(s)
- Timothy Cartlidge
- Cardiothoracic Directorate, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mila Kovacevic
- Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Eliano Pio Navarese
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Nicolaus Copernicus University in Toruń Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
- Klinikum Darmstadt GmbH, Medizinische Klinik I (Cardiology and Intensive Care), Darmstadt, Germany
- SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - Gerald Werner
- Klinikum Darmstadt GmbH, Medizinische Klinik I (Cardiology and Intensive Care), Darmstadt, Germany
| | - Vijay Kunadian
- Cardiothoracic Directorate, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Hong D, Kim SM, Lee SY, Choi KH, Song YB, Lee JY, Lee SJ, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Lee JM. Prognostic Impact of Intravascular Imaging-Guided Percutaneous Coronary Intervention in Chronic Total Occlusion. Circulation 2023; 148:903-905. [PMID: 37695832 DOI: 10.1161/circulationaha.123.065876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
- David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.M.K.)
| | - Sang Yeub Lee
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea (S.Y.L.)
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-Y.L., S.-J.L.)
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-Y.L., S.-J.L.)
| | - Kyeong Ho Yun
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Jae Young Cho
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea (C.J.K., H.-S.A.)
| | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea (C.J.K., H.-S.A.)
| | - Chang-Wook Nam
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Hyuck-Jun Yoon
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Yong Hwan Park
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea (Y.H.P.)
| | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (W.S.L.)
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (J.-O.J., P.S.S.)
| | - Pil Sang Song
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (J.-O.J., P.S.S.)
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.)
| | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea (S.-H.J.)
| | - Chang-Hwan Yoon
- Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea (C.-H.Y.)
| | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.K.)
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.K.)
| | - Kwan Yong Lee
- The Catholic University of Korea, Incheon St Mary's Hospital, Seoul, Korea (K.Y.L.)
| | - Young-Hyo Lim
- Hanyang University Seoul Hospital, College of Medicine, Hanyang University, Seoul, Korea (Y.-H.L.)
| | - Yun-Hyeong Cho
- Hanyang University Myongji Hospital, Goyang, Korea (Y.-H.C.)
| | - Jin-Man Cho
- Kyung Hee University Hospital at Gangdong, Seoul, Korea (J.-M.C.)
| | - Woo Jin Jang
- Ewha Womans University College of Medicine, Seoul, Korea (W.J.J.)
| | - Kook-Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, Korea (K.-J.C.)
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (D.H., K.H.C., Y.B.S., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., J.M.L.)
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Blessing R, Keller K, Dimitriadis Z, Münzel T, Gori T, Hobohm L. Temporal trends of case-fatality in patients undergoing dual-injection coronary chronic total occlusion recanalization. Clin Res Cardiol 2023:10.1007/s00392-023-02298-x. [PMID: 37695528 DOI: 10.1007/s00392-023-02298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
AIMS Recently, interventional techniques and material to treat chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) have evolved significantly. Nevertheless, it is still unknown whether this progress improved treatment success and patients' outcome. In a nationwide sample, we sought to analyze trends of patients' characteristics, complications and in-hospital case-fatality of patients undergoing CTO revascularization in Germany. METHODS AND RESULTS We analyzed data on characteristics, treatments, and in-hospital outcomes for all coronary artery disease (CAD) patients (ICD-code I25) undergoing dual-injection CTO recanalization (OPS procedural code: 8-839.9) in Germany from 2009 to 2020. Overall, 4,998,457 inpatients aged ≥ 18 years with diagnosis of CAD were treated in German hospitals in this period. Among these, 52,879 patients (1.1%) underwent CTO recanalization. Annual number of CTO PCIs increased from 1263 in 2009 to 6435 in 2020 (β 3.48 [95% CI 3.44-3.52]; p < 0.001) in parallel with a significant decrease of case-fatality (2.2% in 2009 to 1.4% in 2020; β - 0.60 [95% CI - 0.82 to - 0.39]; p < 0.001). Overall, 754 (1.4%) patients with CTO recanalization died during the in-hospital stay and in-hospital case-fatality grew exponentially with age (β 0.82 [95% CI 0.73-0.90]; p < 0.001). Significant predictors of in-hospital case fatality with an OR > 3 were cancer, stroke, hemopericardium, acute renal failure, pulmonary embolism and shock. CONCLUSION Annual number of CTO procedures performed in Germany increased from 2009 to 2020 with a concomitant anti-proportional decrease in the case-fatality. Our findings may help to draw more attention to predictors of in-hospital case fatality in patients hospitalized for CTO recanalization.
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Affiliation(s)
- Recha Blessing
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Zisis Dimitriadis
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Berlin, Germany
| | - Tommaso Gori
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Berlin, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55131, Mainz, Germany.
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
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El Bizri A, Al-Mallah MH. Planning interventions in chronic total occlusions: A comprehensive approach. Atherosclerosis 2023; 381:117212. [PMID: 37604739 DOI: 10.1016/j.atherosclerosis.2023.117212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023]
Affiliation(s)
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.
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Adusumalli S, Mohebi R, McCarthy CP, Megaret CA, Rhyne RF, Jaffer FA, Januzzi JL. Multiple Biomarkers to Predict Major Adverse Cardiovascular Events in Patients With Coronary Chronic Total Occlusions. medRxiv 2023:2023.07.19.23292911. [PMID: 37503157 PMCID: PMC10371101 DOI: 10.1101/2023.07.19.23292911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background There are limited tools available to predict the long-term prognosis of persons with coronary chronic total occlusions (CTO). Objectives We evaluated performance of a blood biomarker panel to predict cardiovascular (CV) events in patients with CTO. Methods From 1251 patients in the CASABLANCA study, 241 participants with a CTO were followed for an average of 4 years for occurrence of major adverse CV events (MACE, CV death, non-fatal myocardial infarction or stroke) and CV death/heart failure (HF) hospitalization. Results of a biomarker panel (kidney injury molecule-1, N-terminal pro-B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) from baseline samples were expressed as low-, moderate-, and high-risk. Results By 4 years, a total of 67 (27.8%) MACE events and 56 (23.2%) CV death/HF hospitalization events occurred. The C-statistic of the panel for MACE through 4 years was 0.79. Considering patients in the low-risk group as a reference, the hazard ratio of MACE by 4 years was 6.65 (95% confidence interval [CI]: 2.98-14.8) and 12.4 (95% CI:5.17-29.6) for the moderate and high-risk groups (both P <0.001). The C-statistic for CVD/HF hospitalization by 4 years was 0.84. Compared to the low-risk score group, the moderate and high-risk groups had hazard ratios of 5.61 (95% CI: 2.33-13.5) and 15.6 (95% CI: 6.18, 39.2; both P value <0.001). Conclusion A multiple biomarker panel assists in evaluating the risk of adverse outcomes in patients with coronary CTO. These results may have implications for patient care and could have a role for clinical trial enrichment. Clinical Trial CASABLANCA, ClinicalTrials.gov Identifier: NCT00842868.
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Kucukseymen S, Iannaccone M, Grantham JA, Sapontis J, Juricic S, Ciardetti N, Mattesini A, Stojkovic S, Strauss BH, Wijeysundera HC, Werner GS, D'Ascenzo F, Di Mario C. Association of Successful Percutaneous Revascularization of Chronic Total Occlusions With Quality of Life: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2324522. [PMID: 37471086 PMCID: PMC10359963 DOI: 10.1001/jamanetworkopen.2023.24522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Importance Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is not usually offered because of skepticism about long-term clinical benefits. Objective To assess the association of successful CTO-PCI with quality of life by analyzing the relevant domains of the Seattle Angina Questionnaire (SAQ). Data Sources PubMed, EMBASE, Web of Science, Google Scholar, and Cochrane databases were searched to identify randomized trials and observational studies specifically addressing quality of life domains of SAQ from January 2010 to June 2022. Study Selection Studies included reporting SAQ metrics such as angina frequency, physical limitation, and quality of life, before and after CTO-PCI. Data Extraction and Synthesis The present study was performed according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements, in which fixed-effect or random-effect models with generic inverse-variance weighting depending on statistical homogeneity were applied. Data were extracted by 3 independent reviewers. Outcomes and Measures The primary outcome was angina frequency; physical limitation and quality of life were assessed as secondary outcomes. Results Seven prospective randomized or observational studies (2500 patients) were included, with a mean (SD) participant age of 61.2 (2.1) years. CTO-PCI was associated with significantly improved quality-of-life metrics during a mean (SD) follow-up of 14.8 (16.3) months. In patients with successful procedures, angina episodes became less frequent (mean [SD] difference for SAQ angina frequency of 12.9 [3.1] survey points [95% CI, 7.1-19.8 survey points]; standardized mean difference was 0.54 [95% CI, 0.21-0.92]; P = .002; I2 = 86.4%) and they experienced less physical activity limitation (mean [SD] difference for SAQ physical limitation of 9.7 [6.2] survey points [95% CI, 3.5-16.2 survey points]; standardized mean difference was 0.42 [95% CI, 0.24-0.55]; P < .001; I2 = 20.9%), and greater quality-of-life domain (mean [SD] difference for SAQ quality of life of 14.9 [3.5] survey points [95% CI, 7.7-22.5 survey points]; standardized mean difference was 0.41 [95% CI, 0.25-0.61]; P < .001; I2 = 58.8%) compared with patients with optimal medical therapy or failed procedure. Furthermore, follow-up duration (point estimate, 0.03; 95% CI, 0.01-0.04; P = .01) was associated with a significant decrease in angina frequency in meta-regression analysis. Conclusions and Relevance In this systematic review and meta-analysis examining quality of life following CTO-PCI, successful procedures were associated with improved quality-of-life parameters compared with patients on optimal medical therapy or after failed CTO-PCI. These findings suggest support for using PCI to treat CTOs in symptomatic patients unresponsive to medical treatment.
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Affiliation(s)
- Selcuk Kucukseymen
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Mario Iannaccone
- Cardiology Department, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - James A Grantham
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | - Stefan Juricic
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Niccolò Ciardetti
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Sinisa Stojkovic
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bradley H Strauss
- Schulich Heart Program, Division of Cardiology, University of Toronto, Ontario, Canada
| | | | - Gerald S Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Science, University of Turin, Turin, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
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Dąbrowski EJ, Święczkowski M, Dudzik JM, Grunwald O, Januszko T, Muszyński P, Pogorzelski P, Tokarewicz J, Południewski M, Kożuch M, Dobrzycki S. Percutaneous Coronary Intervention for Chronic Total Occlusion-Contemporary Approach and Future Directions. J Clin Med 2023; 12:jcm12113762. [PMID: 37297958 DOI: 10.3390/jcm12113762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
In the aging society, the issue of coronary chronic total occlusion (CTO) has become a challenge for invasive cardiologists. Despite the lack of clear indications in European and American guidelines, the rates of percutaneous coronary interventions (PCI) for CTO increased over the last years. Well-conducted randomized clinical trials (RCT) and large observational studies brought significant and substantial progress in many CTO blind spots. However, the results regarding the rationale behind revascularization and the long-term benefit of CTO are inconclusive. Knowing the uncertainties regarding PCI CTO, our work sought to sum up and provide a comprehensive review of the latest evidence on percutaneous recanalization of coronary artery chronic total occlusion.
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Affiliation(s)
- Emil Julian Dąbrowski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Michał Święczkowski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Joanna Maria Dudzik
- Second Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Oliwia Grunwald
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Tomasz Januszko
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Paweł Muszyński
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Piotr Pogorzelski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Justyna Tokarewicz
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Maciej Południewski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Marcin Kożuch
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
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Navarese EP, Lansky AJ, Farkouh ME, Grzelakowska K, Bonaca MP, Gorog DA, Raggi P, Kelm M, Yeo B, Umińska J, Curzen N, Kubica J, Wijns W, Kereiakes DJ. Effects of Elective Coronary Revascularization vs Medical Therapy Alone on Noncardiac Mortality: A Meta-Analysis. JACC Cardiovasc Interv 2023; 16:1144-1156. [PMID: 37225285 DOI: 10.1016/j.jcin.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Uncertainty exists whether coronary revascularization plus medical therapy (MT) is associated with an increase in noncardiac mortality in chronic coronary syndrome (CCS) when compared with MT alone, particularly following recent data from the ISCHEMIA-EXTEND (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial. OBJECTIVES This study conducted a large-scale meta-analysis of trials comparing elective coronary revascularization plus MT vs MT alone in patients with CCS to determine whether revascularization has a differential impact on noncardiac mortality at the longest follow-up. METHODS We searched for randomized trials comparing revascularization plus MT vs MT alone in patients with CCS. Treatment effects were measured by rate ratios (RRs) with 95% CIs, using random-effects models. Noncardiac mortality was the prespecified endpoint. The study is registered with PROSPERO (CRD42022380664). RESULTS Eighteen trials were included involving 16,908 patients randomized to either revascularization plus MT (n = 8,665) or to MT alone (n = 8,243). No significant differences were detected in noncardiac mortality between the assigned treatment groups (RR: 1.09; 95% CI: 0.94-1.26; P = 0.26), with absent heterogeneity (I2 = 0%). Results were consistent without the ISCHEMIA trial (RR: 1.00; 95% CI: 0.84-1.18; P = 0.97). By meta-regression, follow-up duration did not affect noncardiac death rates with revascularization plus MT vs MT alone (P = 0.52). Trial sequential analysis confirmed the reliability of meta-analysis, with the cumulative Z-curve of trial evidence within the nonsignificance area and reaching futility boundaries. Bayesian meta-analysis findings were consistent with the standard approach (RR: 1.08; 95% credible interval: 0.90-1.31). CONCLUSIONS In patients with CCS, noncardiac mortality in late follow-up was similar for revascularization plus MT compared with MT alone.
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Affiliation(s)
- Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada; SIRIO MEDICINE Research Network, Bydgoszcz, Poland.
| | | | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; Cedars Sinai Health System, Los Angeles, CA
| | - Klaudyna Grzelakowska
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - Marc P Bonaca
- CPC Clinical Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
| | - Paolo Raggi
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Malte Kelm
- Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany; Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf, Düsseldorf, Germany
| | - Brandon Yeo
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - Julia Umińska
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - Nick Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; University of Southampton, Southampton, United Kingdom
| | - Jacek Kubica
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - William Wijns
- Lambe Institute for Translational Medicine and CÚRAM, National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | - Dean J Kereiakes
- Christ Hospital and Lindner Research Center, Cincinnati, Ohio, USA
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Blach A, Kwiecinski J. The Role of Positron Emission Tomography in Advancing the Understanding of the Pathogenesis of Heart and Vascular Diseases. Diagnostics (Basel) 2023; 13:1791. [PMID: 37238275 PMCID: PMC10217133 DOI: 10.3390/diagnostics13101791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. For developing new therapies, a better understanding of the underlying pathology is required. Historically, such insights have been primarily derived from pathological studies. In the 21st century, thanks to the advent of cardiovascular positron emission tomography (PET), which depicts the presence and activity of pathophysiological processes, it is now feasible to assess disease activity in vivo. By targeting distinct biological pathways, PET elucidates the activity of the processes which drive disease progression, adverse outcomes or, on the contrary, those that can be considered as a healing response. Given the insights provided by PET, this non-invasive imaging technology lends itself to the development of new therapies, providing a hope for the emergence of strategies that could have a profound impact on patient outcomes. In this narrative review, we discuss recent advances in cardiovascular PET imaging which have greatly advanced our understanding of atherosclerosis, ischemia, infection, adverse myocardial remodeling and degenerative valvular heart disease.
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Affiliation(s)
- Anna Blach
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
- Nuclear Medicine Department, Voxel Diagnostic Center, 40-514 Katowice, Poland
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, 04-628 Warsaw, Poland
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da Silva ACB, de Paula JET, Campos CM, Ribeiro MH, Martins E, Oliveira MDP, Côrtes LA, Abelin AP, Zukowski CN, Martinelli GC, de Brito FS, Muniz AJ, Cantarelli MJDC, de Andrade PB, Medeiros CR, Falcão BDAA, Fuchs FC, Silva LS, Fattah T, Degrazia RC, Mangione JA, Bezerra CG, Baradel S, Silveira JB, Ybarra LF, Weillenmann D, Gottschall C, Lemke V, da Silva FR, Schmidt MM, Belli KC, de Oliveira PP, de Quadros AS. Overview of Percutaneous Coronary Interventions for Chronic Total Occlusions Treated at Brazilian Centers Participating in the LATAM CTO Registry. Arq Bras Cardiol 2023; 120:e20210462. [PMID: 37132671 PMCID: PMC10263433 DOI: 10.36660/abc.20210462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/10/2022] [Accepted: 12/14/2022] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries. OBJECTIVES To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil. METHODS Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months. RESULTS Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%. CONCLUSIONS CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers.
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Affiliation(s)
| | - João Eduardo Tinoco de Paula
- Instituto Cardiovascular de LinharesUNICORLinharesESBrasilInstituto Cardiovascular de Linhares UNICOR, Linhares, ES – Brasil
| | - Carlos M. Campos
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | | | - Evandro Martins
- Santa Casa de MisericórdiaMaceióALBrasilSanta Casa de Misericórdia, Maceió, AL – Brasil
| | - Marcos Danillo Peixoto Oliveira
- Hospital São PauloEscola Paulista de MedicinaUNIFESPSão PauloSPBrasilHospital São Paulo – Escola Paulista de Medicina – UNIFESP, São Paulo, SP – Brasil
| | - Leandro Assumpção Côrtes
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Aníbal Pereira Abelin
- Instituto do Coração de Santa MariaSanta MariaRSBrasilInstituto do Coração de Santa Maria (ICOR), Santa Maria, RS – Brasil
| | | | - Gustavo Cervino Martinelli
- Hospital Santa IzabelSanta Casa Misericórdia de SalvadorSalvadorBABrasilHospital Santa Izabel Santa Casa Misericórdia de Salvador, Salvador, BA – Brasil
| | - Fábio Sândoli de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Hospital São CamiloSão PauloSPBrasilHospital São Camilo, São Paulo, SP – Brasil
| | - Antônio José Muniz
- Santa Casa de Misericórdia Juiz de ForaJuiz de ForaMGBrasilSanta Casa de Misericórdia Juiz de Fora, Juiz de Fora, MG – Brasil
| | | | | | | | | | - Felipe Costa Fuchs
- Hospital Mãe de DeusPorto AlegreRSBrasilHospital Mãe de Deus, Porto Alegre, RS – Brasil
| | | | - Tammuz Fattah
- Instituto de Cardiologia do Estado de Santa CatarinaSão JoseSCBrasilInstituto de Cardiologia do Estado de Santa Catarina, São Jose, SC – Brasil
| | - Ramiro Caldas Degrazia
- Hospital Círculo Operário CaxienseCaxias do SulRSBrasilHospital Círculo Operário Caxiense, Caxias do Sul, RS – Brasil
- Hospital Nossa Senhora do PompeiaSalvadorBABrasilHospital Nossa Senhora do Pompeia, Salvador, BA – Brasil
- Hospital UnimedRio de JaneiroRJBrasilHospital Unimed, Rio de Janeiro, RJ – Brasil
| | - José Armando Mangione
- Beneficência Portuguesa de São PauloSão PauloSPBrasilBeneficência Portuguesa de São Paulo, São Paulo, SP – Brasil
| | - Cristiano Guedes Bezerra
- Rede D’OrHospitais Aliança, São Rafael e CardioPulmonarSalvadorBABrasilRede D’Or – Hospitais Aliança, São Rafael e CardioPulmonar, Salvador, BA – Brasil
| | - Sandra Baradel
- Sociedade Brasileira de Hemodinâmica e Cardiologia IntervencionistaSão PauloSPBrasilSociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista, São Paulo, SP – Brasil
| | - João Brum Silveira
- Centro Hospitalar e Universitário do PortoHospital Santo AntôniPortoPortugalCentro Hospitalar e Universitário do Porto, Hospital Santo Antônio, Porto – Portugal
| | - Luiz Fernando Ybarra
- London Health Sciences CentreSchulich School of Medicine and DentistryWestern UniversityOntarioCanadáLondon Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, Ontario – Canadá
| | | | - Carlos Gottschall
- Hospital das NaçõesCuritibaPRBrasilHospital das Nações, Curitiba, PR – Brasil
| | - Viviana Lemke
- Hospital das NaçõesCuritibaPRBrasilHospital das Nações, Curitiba, PR – Brasil
| | - Franciele Rosa da Silva
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Marcia Moura Schmidt
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Karlyse Claudino Belli
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Pedro Piccaro de Oliveira
- Hospital Divina ProvidênciaPorto AlegreRSBrasilHospital Divina Providência, Porto Alegre, RS – Brasil
| | - Alexandre Schaan de Quadros
- Hospital Mãe de DeusPorto AlegreRSBrasilHospital Mãe de Deus, Porto Alegre, RS – Brasil
- Instituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS – Brasil
- Hospital Divina ProvidênciaPorto AlegreRSBrasilHospital Divina Providência, Porto Alegre, RS – Brasil
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Li Z, Zhou Z, Guo L, Zhong L, Xiao J, Meng S, Wang Y, Ding H, Zhang B, Zhu H, Zhou X, Huang R. Effect of complete percutaneous revascularization on improving long-term outcomes of patients with chronic total occlusion and multi-vessel disease. Chin Med J (Engl) 2023; 136:959-966. [PMID: 37014764 PMCID: PMC10278713 DOI: 10.1097/cm9.0000000000002653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Limited data are available on the comparison of clinical outcomes of complete vs. incomplete percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) and multi-vessel disease (MVD). The study aimed to compare their clinical outcomes. METHODS A total of 558 patients with CTO and MVD were divided into the optimal medical treatment (OMT) group ( n = 86), incomplete PCI group ( n = 327), and complete PCI group ( n = 145). Propensity score matching (PSM) was performed between the complete and incomplete PCI groups as sensitivity analysis. The primary outcome was defined as the occurrence of major adverse cardiovascular events (MACEs), and unstable angina was defined as the secondary outcome. RESULTS At a median follow-up of 21 months, there were statistical differences among the OMT, incomplete PCI, and complete PCI groups in the rates of MACEs (43.0% [37/86] vs. 30.6% [100/327] vs. 20.0% [29/145], respectively, P = 0.016) and unstable angina (24.4% [21/86] vs. 19.3% [63/327] vs. 10.3% [15/145], respectively, P = 0.010). Complete PCI was associated with lower MACE compared with OMT (adjusted hazard ratio [HR] = 2.00; 95% confidence interval [CI] = 1.23-3.27; P = 0.005) or incomplete PCI (adjusted HR = 1.58; 95% CI = 1.04-2.39; P = 0.031). Sensitivity analysis of PSM showed similar results to the above on the rates of MACEs between complete PCI and incomplete PCI groups (20.5% [25/122] vs. 32.6% [62/190], respectively; adjusted HR = 0.55; 95% CI = 0.32-0.96; P = 0.035) and unstable angina (10.7% [13/122] vs. 20.5% [39/190], respectively; adjusted HR = 0.48; 95% CI = 0.24-0.99; P = 0.046). CONCLUSIONS For treatment of CTO and MVD, complete PCI reduced the long-term risk of MACEs and unstable angina, as compared with incomplete PCI and OMT. Complete PCI in both CTO and non-CTO lesions can potentially improve the prognosis of patients with CTO and MVD.
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Affiliation(s)
- Zeya Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Xuan Wu District, Beijing 100050, China
| | - Ziru Zhou
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Lei Zhong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Jingnan Xiao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Shaoke Meng
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Yingdong Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Huaiyu Ding
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Bo Zhang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Hao Zhu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Xuchen Zhou
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Rongchong Huang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Xuan Wu District, Beijing 100050, China
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
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Avran A, Zuffi A, Gobbi C, Gasperetti A, Schiavone M, Werner GS, Kambis M, Boudou N, Galassi AR, Sianos G, Idali M, Garbo R, Gagnor A, Gasparini G, Bufe A, Bryniarski L, Kalnins A, Weilenmann D, Wojcik J, Agostoni P, Bozinovic NZ, Carlino M, Furkalo S, Hildick-Smith D, Drogoul L, Lemoine J, Serra A, Carugo S, Ungi I, Dens J, Reifart N, Cosma J, Mallia V, Vadalà G, Biondi-Zoccai G, Di Mario C. Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study. Catheter Cardiovasc Interv 2023; 101:918-931. [PMID: 36883958 DOI: 10.1002/ccd.30616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/01/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Gender-specific data addressing percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in female patients are scarce and based on small sample size studies. AIMS We aimed to analyze gender-differences regarding in-hospital clinical outcomes after CTO-PCI. METHODS Data from 35,449 patients enrolled in the prospective European Registry of CTOs were analyzed. The primary outcome was the comparison of procedural success rate in the two cohorts (women vs. men), defined as a final residual stenosis less than 20%, with Thrombolysis In Myocardial Infarction grade flow = 3. In-hospital major adverse cardiac and cerebrovascular events (MACCEs) and procedural complications were deemed secondary outcomes. RESULTS Women represented 15.2% of the entire study population. They were older and more likely to have hypertension, diabetes, and renal failure, with an overall lower J-CTO score. Women showed a higher procedural success rate (adjusted OR [aOR] = 1.115, confidence interval [CI]: 1.011-1.230, p = 0.030). Apart from previous myocardial infarction and surgical revascularization, no other significant gender differences were found among predictors of procedural success. Antegrade approach with true-to-true lumen techniques was more commonly used than retrograde approach in females. No gender differences were found regarding in-hospital MACCEs (0.9% vs. 0.9%, p = 0.766), although a higher rate of procedural complications was observed in women, such as coronary perforation (3.7% vs. 2.9%, p < 0.001) and vascular complications (1.0% vs. 0.6%, p < 0.001). CONCLUSIONS Women are understudied in contemporary CTO-PCI practice. Female sex is associated with higher procedural success after CTO-PCI, yet no sex differences were found in terms of in-hospital MACCEs. Female sex was associated with a higher rate of procedural complications.
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Affiliation(s)
| | - Andrea Zuffi
- Cardiology Unit, Saint Martin Private Hospital Center, Caen, France
| | - Cecilia Gobbi
- Cardiology Unit, Saint Martin Private Hospital Center, Caen, France
| | - Alessio Gasperetti
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marco Schiavone
- Cardiology Unit, ASST Fatebenefratelli Sacco-Luigi Sacco, University Hospital, University of Milan, Milan, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Gerald S Werner
- Medizinische Klinik I Klinikum Darmstadt, Darmstadt, Germany
| | - Mashayekhi Kambis
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Nicolas Boudou
- Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France
| | - Alfredo R Galassi
- Department of Promise, Cardiovascular Medicine, University of Palermo, Palermo, Italy
| | | | - Moussa Idali
- Cardiology Unit, Saint Martin Private Hospital Center, Caen, France
| | - Roberto Garbo
- Maria Pia Hospital, GVM Care & Research, Turin, Italy
| | - Andrea Gagnor
- Department of Invasive Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Gabriele Gasparini
- Department of Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Alexander Bufe
- Heart Center Krefeld, University Witten/Herdecke, Witten, Germany
| | - Leszek Bryniarski
- II Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Artis Kalnins
- Clinic of Cardiovascular Diseases, Riga East Clinical University Hospital, Riga, Latvia
| | | | | | | | | | - Mauro Carlino
- Cardio-Thoracic-Vascular Department, Interventional Cardiology Unit, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Sergey Furkalo
- National Institute of Surgery and Transplantology NAMS, Kiev, Ukraine
| | | | | | - Julien Lemoine
- Department of Cardiology, Clinique Louis Pasteur, Nancy, France
| | - Antonio Serra
- Department of Cardiology, Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, University of Barcelona, Barcelona, Spain
| | - Stefano Carugo
- Department of Cardiology, Fondazione IRCCS Ospedale Maggiore Policlinico di Milano and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Imre Ungi
- Department of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | | | - Nicolaus Reifart
- Department of Cardiology, Main Taunus Heart Institute, Bad Soden, Germany
| | - Joseph Cosma
- Cardiology Unit, Saint Martin Private Hospital Center, Caen, France
| | - Vincenzo Mallia
- Department of Cardiology, Fondazione IRCCS Ospedale Maggiore Policlinico di Milano and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giuseppe Vadalà
- Division of Cardiology, University Hospital "P. Giaccone", Palermo, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Carlo Di Mario
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
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Zhao S, Zhou L, Wang Q, Cao JH, Chen Y, Wang W, Zhu BD, Wei ZH, Li R, Li CY, Zhou GY, Tan ZJ, Zhou HP, Li CX, Gao HK, Qin XJ, Lian K. Elevated branched-chain amino acid promotes atherosclerosis progression by enhancing mitochondrial-to-nuclear H2O2-disulfide HMGB1 in macrophages. Redox Biol 2023; 62:102696. [PMID: 37058999 PMCID: PMC10130699 DOI: 10.1016/j.redox.2023.102696] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
As the essential amino acids, branched-chain amino acid (BCAA) from diets is indispensable for health. BCAA supplementation is often recommended for patients with consumptive diseases or healthy people who exercise regularly. Latest studies and ours reported that elevated BCAA level was positively correlated with metabolic syndrome, diabetes, thrombosis and heart failure. However, the adverse effect of BCAA in atherosclerosis (AS) and its underlying mechanism remain unknown. Here, we found elevated plasma BCAA level was an independent risk factor for CHD patients by a human cohort study. By employing the HCD-fed ApoE-/- mice of AS model, ingestion of BCAA significantly increased plaque volume, instability and inflammation in AS. Elevated BCAA due to high dietary BCAA intake or BCAA catabolic defects promoted AS progression. Furthermore, BCAA catabolic defects were found in the monocytes of patients with CHD and abdominal macrophages in AS mice. Improvement of BCAA catabolism in macrophages alleviated AS burden in mice. The protein screening assay revealed HMGB1 as a potential molecular target of BCAA in activating proinflammatory macrophages. Excessive BCAA induced the formation and secretion of disulfide HMGB1 as well as subsequent inflammatory cascade of macrophages in a mitochondrial-nuclear H2O2 dependent manner. Scavenging nuclear H2O2 by overexpression of nucleus-targeting catalase (nCAT) effectively inhibited BCAA-induced inflammation in macrophages. All of the results above illustrate that elevated BCAA promotes AS progression by inducing redox-regulated HMGB1 translocation and further proinflammatory macrophage activation. Our findings provide novel insights into the role of animo acids as the daily dietary nutrients in AS development, and also suggest that restricting excessive dietary BCAA consuming and promoting BCAA catabolism may serve as promising strategies to alleviate and prevent AS and its subsequent CHD.
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Stazi F. Dilemmas in cardiology: when to recanalize a chronic total occlusion. Eur Heart J Suppl 2023; 25:B149-B154. [PMID: 37091662 PMCID: PMC10120947 DOI: 10.1093/eurheartjsupp/suad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
The decision whether or not to recanalize a chronic total occlusion (CTO) of a coronary artery is truly a dilemma for the cardiologist. The procedure is in fact complex, with a non-negligible rate of complications and with a probability of success lower than that of non-obstructive lesions. The analysis of the data available in the literature, with the significant discrepancy between the results of the randomized studies and the observational studies, does not currently allow conclusive statements on the role of the percutaneous coronary interventions in CTO. It is therefore essential to incorporate clinical, anatomical and procedural elements into the decision-making algorithm. While awaiting new randomized clinical trials of greater dimensions and better methodology, a careful selection of patients is certainly essential, limiting the procedure to those who are symptomatic or who have a high ischaemic burden and excluding those who have no evidence of vitality, without which it is not legitimate to expect any benefit from the intervention. Finally, the presence of the collateral circulation does not in itself appear to be an element that should have a significant decision-making role.
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Simsek B, Tajti P, Carlino M, Ojeda S, Pan M, Rinfret S, Vemmou E, Kostantinis S, Nikolakopoulos I, Karacsonyi J, Dens JA, Agostoni P, Alaswad K, Megaly M, Avran A, Choi JW, Jaffer FA, Doshi D, Karmpaliotis D, Khatri JJ, Knaapen P, La Manna A, Spratt JC, Tanabe M, Walsh S, Mastrodemos OC, Allana S, Rempakos A, Rangan BV, Goktekin O, Gorgulu S, Poommipanit P, Kearney KE, Lombardi WL, Grantham JA, Mashayekhi K, Brilakis ES, Azzalini L. External validation of the PROGRESS-CTO complication risk scores: Individual patient data pooled analysis of 3 registries. Int J Cardiol 2023; 375:14-20. [PMID: 36565956 DOI: 10.1016/j.ijcard.2022.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with a considerable risk of complications, and risk stratification is of utmost importance. AIMS To assess the clinical usefulness of the recently developed PROGRESS-CTO (NCT02061436) complication risk scores in an independent cohort. METHODS Individual patient data pooled analysis of 3 registries was performed. RESULTS Of the 4569 patients who underwent CTO PCI, 102 (2.2%) had major adverse cardiovascular events (MACE). Patients with MACE were older (69 ± 11 vs. 65 ± 10, p < 0.001), more likely to have a history of prior coronary artery bypass graft surgery, and unfavorable angiographic characteristics J-CTO score (2.4 ± 1.2 vs. 2.1 ± 1.3, p = 0.007), including blunt stump (59% vs. 49%, p = 0.047). Technical success was lower in patients with MACE (59% vs. 86%, p < 0.001). The area under the receiver operating characteristic curve of the PROGRESS-CTO complication risk models were as follows: MACE 0.72 (95% confidence interval [CI], 0.67-0.76), mortality 0.73 (95% CI, 0.61-0.85), and pericardiocentesis 0.69 (95% CI, 0.62-0.77) in the validation dataset. The observed complication rates increased with higher PROGRESS-CTO complication scores. The PROGRESS-CTO MACE score showed good calibration in this external cohort, with MACE rates similar to the original study: 0.7% (score 0-1), 1.5% (score 2), 2.2% (score 3), 3.8% (score 4), 4.9% (score 5), 5.8% (score 6-7). CONCLUSION Given the good discriminative performance, calibration, and ease of calculation, the PROGRESS-CTO complication scores could help assess the risk of complications in patients undergoing CTO PCI.
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48
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Sahu AK, Kazmi DH, Kaushik A. Is it Worthy Enough to Revascularize Chronically Occluded Coronaries? Cardiol Rev 2023. [PMID: 36912530 DOI: 10.1097/CRD.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Chronic total occlusions (CTOs) represent the "final frontier" of coronary interventions with the lowest procedural success rates and the most common reason for incomplete revascularization and referral to coronary artery bypass graft surgery (CABG). CTO lesions are not an infrequent finding during coronary angiography. They are often responsible for enhancing the complexity of the coronary disease burden thereby affecting the final interventional decision in the process. Notwithstanding the modest technical success of CTO-PCI, most of the earlier observational data demonstrated a clear survival benefit free of major cardiovascular events (MACE) in patients undergoing successful CTO revascularization. However, data from recent randomized trials fail to uphold the same survival advantage albeit, showing some trend toward improvement in left ventricular function, quality of life indicators and freedom from fatal ventricular arrythmia. Various guidance statements propose a well-defined role for CTO intervention in specific situations provided criterions for patient selection, appreciable inducible ischemia, myocardial viability and cost-risk-benefit analysis are met.
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49
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Megaly M, Zakhour S, Karacsonyi J, Basir MB, Kunkel K, Gupta A, Neupane S, Alqarqaz M, Brilakis ES, Alaswad K. Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention of the Left Anterior Descending Artery. Am J Cardiol 2023; 193:75-82. [PMID: 36878056 DOI: 10.1016/j.amjcard.2023.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/17/2022] [Accepted: 01/27/2023] [Indexed: 03/07/2023]
Abstract
The left anterior descending artery (LAD) subtends a large myocardial territory. The outcomes of LAD chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study. We performed a retrospective analysis of all patients who underwent LAD CTO PCI at a high-volume single center. Outcomes included in-hospital and long-term major adverse cardiovascular events (MACEs) and changes in left ventricular ejection fraction (LVEF). We performed a subgroup analysis of patients with ischemic cardiomyopathy, defined as an LVEF of 40% or less. From December 2014 to February 2021, 237 patients underwent LAD CTO PCI. The technical success rate was 97.4%, and the in-hospital MACE rate was 5.4%, A landmark analysis after hospital discharge showed an overall survival of 92% and 85% MACE-free survival at 2 years. There was no difference in overall survival or MACE-free survival between those who had ischemic cardiomyopathy versus those who did not. In patients with ischemic cardiomyopathy, LAD CTO PCI was associated with significant improvement in LVEF (10.9% at 9 months), which was further pronounced when these patients had a proximal LAD CTO and were on optimal medical therapy (14% at 6 months). In a single high-volume center, LAD CTO PCI was associated with 92% overall survival at 2 years, with no difference in survival between patients with or without ischemic cardiomyopathy. LAD CTO PCI was associated with an absolute 10% increase in LVEF at 9 months in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Samer Zakhour
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Judit Karacsonyi
- Department of Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Katherine Kunkel
- Department of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Ankur Gupta
- Department of Cardiology, HonorHealth Heart Group - Shea, Phoenix, Arizona
| | - Saroj Neupane
- Department of Cardiology, WakeMed Hospital, Raleigh, North Carolina
| | | | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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50
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Tsao AL, Boden WE. Chronic Total Occlusion PCI and Optimal Medical Therapy: Are We Still Putting the Cart Before the Horse? Circ Cardiovasc Qual Outcomes 2023; 16:e009604. [PMID: 36722335 DOI: 10.1161/circoutcomes.122.009604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Allison L Tsao
- VA Boston Healthcare System and Harvard Medical School, MA (A.L.T.)
| | - William E Boden
- VA Boston Healthcare System and Boston University School of Medicine, MA (W.E.B.)
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