Appropriateness of percutaneous revascularization of coronary chronic total occlusions: an overview

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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“…13 Furthermore, little is known about the use of CTO in population-based regions and about regional hospital practice pattern variations.…”

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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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“…Unfortunately the stiffness of these guidewires alone is often not enough to prevent buckling. Therefore, a stiff support catheter, supportive "buddy" guidewire, or balloon catheter is often placed over, or close proximity to the guidewire for increased support [2,5].…”

Section: ) Increase the Applied Forcementioning

confidence: 99%

“…Reopening CTOs is considered the "last frontier" in percutaneous interventions, substantiated by the fact that they represent the most technically challenging lesion subset that interventionists face [2][3][4][5]. Most data are available for PCI, with procedural success rates for CTO treatment that are in between 45% and 5% lower than those achieved in non-chronically occluded lesions [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Treating Total Occlusions: Applying Force for Recanalization

Sakes

Regar

Dankelman

et al. 2016

IEEE Rev. Biomed. Eng.

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“…This is a particularly complex issue that has been appropriately addressed in recent comprehensive overviews. 8,9 In general, several registries have shown promising results on the clinical benefits of CTO PCI in wideranging populations, but these data are still affected by some confounders (ie, higher comorbidities burden of medically treated patients) to drive effective indications change. 10 Medical and Invasive Approaches) trial assessing the impact of an invasive strategy versus optimal medical therapy in patients with moderate to severe ischemia will provide new important insights on optimal patient selection for CTO recanalization.…”

Section: See Article By Karmpaliotis Et Almentioning

confidence: 99%

Retrograde Approach for Chronic Total Occlusion Percutaneous Coronary Intervention

Tamburino

Capranzano

2016

Circ: Cardiovascular Interventions

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Appropriateness of percutaneous revascularization of coronary chronic total occlusions: an overview

Cited by 105 publications

References 71 publications

Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Interventions

Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Interventions

Treating Total Occlusions: Applying Force for Recanalization

Retrograde Approach for Chronic Total Occlusion Percutaneous Coronary Intervention

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