Prevalence and management of coronary chronic total occlusions in a tertiary veterans affairs hospital

Jeroudi, Omar M.; Alomar, Mohammed; Michael, Tesfaldet T.; Sabbagh, Abdallah El; Patel, Vishal; Mogabgab, Owen; Fuh, Eric; Sherbet, Daniel; Lo, Nathan; Roesle, Michele; Rangan, Bavana V.; Abdullah, Shuaib; Hastings, Jeffrey L.; Grodin, Jerrold; Banerjee, Subhash; Brilakis, Emmanouil S.

doi:10.1002/ccd.25264

Cited by 206 publications

(114 citation statements)

References 19 publications

(25 reference statements)

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“…CTOs have received this attention because they are prevalent among patients with coronary artery disease [1][2][3][4][5] and are present in as many as 10% to 20% of all patients referred for diagnostic angiography. 6,7 However, PCI success rates for CTO have been demonstrated in earlier studies to be only in the 60% to 70% range, 8 although some centers have reported success rates >80%.…”

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confidence: 99%

Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Interventions

Hannan

Jacobs

et al. 2016

Circ: Cardiovascular Interventions

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T reatment of chronic total occlusions (CTO) using percutaneous coronary interventions (PCI) is a topic that has received considerable interest. CTOs have received this attention because they are prevalent among patients with coronary artery disease [1][2][3][4][5] and are present in as many as 10% to 20% of all patients referred for diagnostic angiography. 6,7 However, PCI success rates for CTO have been demonstrated in earlier studies to be only in the 60% to 70% range, 8 although some centers have reported success rates >80%.9-11 Nevertheless, these rates are considerably lower than the rates for nonoccluded lesions, 2,8,12 and there is much controversy about the importance of performing CTO PCI. 13 Furthermore, little is known about the use of CTO in population-based regions and about regional hospital practice pattern variations.The purposes of this study were to examine the prevalence and hospital variation of CTO PCIs in a population-based PCI registry, determine the success and hospital variation in success for CTO PCIs, identify the factors associated with success of CTO PCIs, and compare 2.5-year mortality for patients with successful and unsuccessful CTO PCIs. Methods End PointAll CTO PCI procedures performed in New York nonfederal hospitals between July 1, 2009, and June 30, 2012, were followed for 2 and a half years or until December 31, 2012, whichever came first. The end point in the study is 2.5-year mortality, with a median follow up time of 1.8 years. DatabasesThe primary database used in the study is New York State's PCI registry, the Percutaneous Coronary Interventions Reporting System (PCIRS). This registry contains detailed information on patient demographics, risk factors, hemodynamic state, left ventricular function, coronary vessels diseased and treated, complications, Background-Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) has been identified as a beneficial treatment, but there is limited information about its use in everyday practice. Methods and Results-Data from New York's PCI registry between July 1, 2009, and June 30, 2012, were used to examine the utilization and variation in use of CTO PCI, the success rates across providers, the multivariable correlates of success, and the mortality of successful CTO PCI. A total of 4030 (3.1%) patients undergoing PCI underwent CTO PCI with a success rate of 61.3%. Patients with successful CTO PCIs were younger; had higher ejection fractions; were less likely to have had previous revascularization or carotid/cerebrovascular disease; and were more likely to have the CTO in the left anterior descending artery. Operators with annual CTO PCI volumes of at least 48 per year (the top volume quartile) had odds of achieving success that were more than twice as high as the half of all operators who performed <9 CTO PCIs per year. Patients with unsuccessful CTO PCIs had significantly higher 2.5-year mortality (adjusted hazard ratio, 1.63; 95% confidence interval, 1.28-2.08) than patients who had complete revascularization (...

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confidence: 99%

Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Interventions

Hannan

Jacobs

et al. 2016

Circ: Cardiovascular Interventions

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“…22 Similar distributions of CTOs have been reported by other investigators. 2,4,[22][23][24] The anatomic location of CTOs within each coronary artery can be either the proximal/mid segment or at the mid/distal segment. This may have treatment implications because PCI procedures are in the majority of cases not suitable for distal coronary segments (hence are not able to treat distal CTOs), whereas CABG procedures are generally performed in distal coronary segments and hence are able to treat both proximal and distal CTOs (Figure 1).…”

Section: Coronary Anatomic Variability Of Ctosmentioning

confidence: 99%

Should Chronic Total Occlusion Be Treated With Coronary Artery Bypass Grafting?

2016

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“…1 They are commonly found in patients with coronary artery disease undergoing coronary angiography (13.3%-52%). [2][3][4][5][6] Percutaneous coronary intervention (PCI) of a CTO is traditionally considered a procedure with low success and high complication rates, ''a temptation to be avoided.'' Significant improvements, however, have been achieved in recent years resulting in high success rates by several expert operators and centers.…”

Section: N Introductionmentioning

confidence: 99%

Update in Chronic Total Occlusion Percutaneous Coronary Interventions

Brilakis¹,

Burke²

2017

Journal of the Minneapolis Heart Institute Foundation

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Outcomes of chronic total occlusion-percutaneous coronary intervention have significantly improved in recent years. Chronic total occlusion-percutaneous coronary intervention can provide significant clinical benefits, such as angina reduction. At experienced centers, high success rates can currently be achieved, with use of all chronic total occlusion crossing techniques (antegrade wire escalation, antegrade dissection/ reentry, and the retrograde approach) orchestrated by use of procedural algorithms, such as the hybrid algorithm. Growth of chronic total occlusion-percutaneous coronary intervention is also fueled by continuous development of novel equipment, such as guidewires, microcatheters, support catheters, and dissection/reentry equipment. Readiness and ability to treat complications, such as perforation and donor vessel closure, is critical for all centers performing the procedure. Chronic total occlusionpercutaneous coronary intervention is a powerful and continuously developing tool for achieving complete coronary revascularization.

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Prevalence and management of coronary chronic total occlusions in a tertiary veterans affairs hospital

Cited by 206 publications

References 19 publications

Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Interventions

Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Interventions

Should Chronic Total Occlusion Be Treated With Coronary Artery Bypass Grafting?

Update in Chronic Total Occlusion Percutaneous Coronary Interventions

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