In-hospital and long-term outcomes after percutaneous coronary intervention for chronic total occlusion in elderly patients: A consecutive, prospective, single-centre study

André, Romain; Dumonteil, Nicolas; Lhermusier, Thibault; Lairez, Olivier; Rothem, Jérôme Van; Fournier, Pauline; Elbaz, Meyer; Carrié, Didier; Boudou, Nicolas

doi:10.1016/j.acvd.2015.08.003

Cited by 22 publications

(22 citation statements)

References 23 publications

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“…Older age was the most important predictor for complications in our study: the incidence of complications was 7% in patients aged >75 years versus 4% in patients aged 66 to 75 years versus 1% in patients aged ≤65 years (P<0.001). This finding is consistent with prior studies 10,23,24 and is likely related to more complex coronary anatomy with increasing age, higher prevalence of tortuosity and calcification, higher prevalence of prior CABG, and possibly lower tolerance to inadvertent guidewire exits. Older patients are more likely to have diffuse aortic atheroma, predisposing them to strokes during coronary intervention.…”

Section: Discussionsupporting

confidence: 91%

Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score

Danek

Karatasakis

Karmpaliotis

et al. 2016

JAHA

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BackgroundHigh success rates are achievable for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using the hybrid approach, but periprocedural complications remain of concern. Although scores estimating success and efficiency in CTO PCI have been developed, there is currently no available score for estimation of the risk for periprocedural complications. We sought to develop a scoring tool for prediction of periprocedural complications during CTO PCI.Methods and ResultsWe analyzed data from 1569 CTO PCIs in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) using a derivation and validation sampling ratio of 2:1. Variables independently associated with periprocedural complications in multivariable analysis in the derivation set were assigned points based on their respective odds ratios. Forty‐four (2.8%) patients experienced complications. Three factors were independent predictors of complications and were included in the score: patient age >65 years, +3 points (odds ratio, OR=4.85, CI 1.82‐16.77); lesion length ≥23 mm, +2 points (OR=3.22, CI 1.08‐13.89); and use of the retrograde approach +1 point (OR=2.41, CI 1.04‐6.05). The resulting score showed good calibration and discriminatory capacity in the derivation (Hosmer‐Lemeshow χ2 6.271, P=0.281, receiver‐operating characteristic [ROC] area=0.758) and validation (Hosmer‐Lemeshow χ2 4.551, P=0.473, ROC area=0.793) sets. Score values of 0 to 2, 3 to 4, and ≥5 were defined as low, intermediate, and high risk of complications (derivation cohort 0.4%, 1.8%, 6.5%, P<0.001; validation cohort 0.0%, 2.5%, 6.8%, P<0.001).ConclusionsThe PROGRESS CTO complication score is a useful tool for prediction of periprocedural complications in CTO PCI.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02061436.

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Section: Discussionsupporting

confidence: 91%

Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score

Danek

Karatasakis

Karmpaliotis

et al. 2016

JAHA

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“…[10] Emergency procedure was reported to be an independent risk factor of CI-AKI, and CI-AKI rate in emergency PCI patients is significantly higher than in those undergoing selective intervention. [1112] However, previous studies of CI-AKI were mostly based on data from selective cases. To those undergoing emergency PCI, the estimation of the risk of CI-AKI is always limited for being pressed for time after admission, and so far, the risk factor profile of CI-AKI in emergency PCI patients is still unclear and needed to investigate.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Contrast-induced Acute Kidney Injury in Patients Undergoing Emergency Percutaneous Coronary Intervention

Yuan

Qiu

et al. 2017

Chinese Medical Journal

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Background:Previous studies of contrast-induced acute kidney injury (CI-AKI) were mostly based on selective percutaneous coronary intervention (PCI) cases, and risk factors of CI-AKI after emergency PCI are unclear. The aim of this study was to explore the risk factors of CI-AKI in a Chinese population undergoing emergency PCI.Methods:A total of 1061 consecutive patients undergoing emergency PCI during January 2013 and June 2015 were enrolled and divided into CI-AKI and non-CI-AKI group. Univariable and multivariable analyses were used to identify the risk factors of CI-AKI in emergency PCI patients. CI-AKI was defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dl (44.2 μmol/L) above baseline within 3 days after exposure to contrast medium.Results:The incidence of CI-AKI in patients undergoing emergency PCI was 22.7% (241/1061). Logistic multivariable analysis showed that body surface area (BSA) (odds ratio [OR] 0.213, 95% confidence interval [CI]: 0.075–0.607, P = 0.004), history of myocardial infarction (MI) (OR 1.642, 95% CI: 1.079–2.499, P = 0.021), left ventricular ejection fraction (LVEF) (OR 0.969, 95% CI: 0.944–0.994, P = 0.015), hemoglobin (Hb) (OR 0.988, 95% CI: 0.976–1.000, P = 0.045), estimated glomerular filtration rate (OR 1.027, 95% CI: 1.018–1.037, P < 0.001), left anterior descending (LAD) stented (OR 1.464, 95% CI: 1.000–2.145, P = 0.050), aspirin (OR 0.097, 95%CI: 0.009–0.987, P = 0.049), and diuretics use (OR 1.850, 95% CI: 1.233–2.777, P = 0.003) were independent predictors of CI-AKI in patients undergoing emergency PCI.Conclusion:History of MI, low BSA, LVEF and Hb level, LAD stented, and diuretics use are associated with increased risk of CI-AKI in patients undergoing emergency PCI.

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“…3 Recent studies indicate that older patients could, paradoxically, benefit more from appropriate interventional revascularization than their younger counterparts. 5 Even in the case of chronic total occlusions (CTOs), which are present in more than 30% of older patients with myocardial ischemia, 6 PCI can be considered as a valid option. 7 Historically, however, CABG or medical therapy (MT) was the preferred treatments for CTO 8 and despite the more extended use of PCI, there is still a lack of evidence regarding its effectiveness in older patients, compared to these traditional options.…”

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confidence: 99%

Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients

Flores‐Umanzor

Vázquez

Cepas‐Guillén

et al. 2019

Cathet Cardio Intervent

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Background Chronic total occlusions (CTOs) are present in more than one third of older patients with myocardial ischemia, but controversy remains about the best therapeutic approach. Aims To compare long‐term survival after CTO revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass graft [CABG]) versus medical treatment (MT) alone in patients aged 75 and older. Methods and results A total of 1,252 consecutive patients with at least one CTO were identified from 2010 to 2014 in our center. Patients were stratified by age (<75 years vs. ≥75 years) in the present analysis. All‐cause and cardiac mortality were assessed at a median follow‐up of 3.5 years. In the older subgroup (26%), patients were more likely to be treated with MT alone (71% vs. 43% of younger patients; p < 0.001). Patients undergoing revascularization were younger and had higher left ventricular ejection fraction (LVEF) and lower age, creatinine, ejection fraction (ACEF) score (age/LVEF +1 if creatinine >2.0 mg/dL), compared to the MT group (p < 0.05). As compared to MT, revascularization predicted lower rates of cardiac mortality and all‐cause mortality in older patients, both in the subgroups treated with CABG (hazard ratio [HR] 0.35, 95% confidence interval [CI] 0.17–0.71; HR 0.39, 95%CI 0.18–0.81) and PCI (HR 0.57, 95%CI 0.33–0.98; HR 0.59, 95%CI 0.28–1.2). No differences in mortality were observed according to type of revascularization procedure. Conclusions Among patients aged at least 75 years with a CTO, revascularization (PCI or CABG) rather than MT alone may portend a better outcome in terms of all‐cause and cardiac mortality.

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In-hospital and long-term outcomes after percutaneous coronary intervention for chronic total occlusion in elderly patients: A consecutive, prospective, single-centre study

Cited by 22 publications

References 23 publications

Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score

Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score

Risk Factors of Contrast-induced Acute Kidney Injury in Patients Undergoing Emergency Percutaneous Coronary Intervention

Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients

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