Association of Acute Procedural Results With Long-Term Outcomes After CTO PCI

Guan, Changdong; Yang, Wei; Song, Lei; Chen, Jue; Qian, Jie; Wu, Fan; Zou, Tongqiang; Shi, Yanpu; Sun, Zhongwei; Xie, Lihua; Gao, Lijian; Cui, Jingang; Zhao, Jie; Kirtane, Ajay J.; Yeh, Robert W.; Wu, Yongjian; Yang, Yuejin; Qiao, Shubin; Brilakis, Emmanouil S.; Xu, Bo

doi:10.1016/j.jcin.2020.10.003

Cited by 30 publications

(17 citation statements)

References 23 publications

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“…Occlusion of major side branches was a common cause of suboptimal recanalization, which was also a major reason for MI events in a previously reported group with suboptimal recanalization. 18,19 In addition, suboptimal recanalization may lead to worse run-off after stent implantation, which might be associated with restenosis and re-occlusion of the recanalized vessel. 20 The…”

Section: Discussionmentioning

confidence: 99%

Angiographic characteristics and long‐term outcomes of single‐vessel chronic total occlusion percutaneous coronary intervention in patients with and without previous myocardial infarction

Qiao

Guan

et al. 2021

Cathet Cardio Intervent

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Objective: This study evaluated the angiographic characteristics and clinical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) among patients with and without a history of myocardial infarction (MI).Background: The pathogenesis of CTO and myocardial viability are different in cases with or without previous MI. However, the lesion characteristics and clinical outcomes are unclear for these two groups.Methods: We reviewed consecutive patients who underwent single-vessel CTO PCI from 2010 to 2013. Patients were classified according to their history of MI. Acute procedural results were classified as optimal recanalization, suboptimal recanalization, or technical failure. The primary endpoint was the 5 year rate of cardiac death.Results: We identified 2,191 eligible patients, including 859 patients (39.2%) with previous MI. The overall technical success rate was 74.4%. Relative to the non-MI group, the MI group had a larger reference vessel diameter (3.0 ± 0.5 vs. 2.9 ± 0.4 mm, p = .002), a lower proportion of Werner grade ≥ 1 collateral circulation (65.4 vs. 79.2%, p < .001), a higher proportion of optimal recanalization (63.1 vs. 58.6%, p = .006), and a higher 5-year rate of cardiac death (3.9 vs. 2.1%, p = .02). In the MI group, suboptimal recanalization was associated with a significantly higher 5-year rate of spontaneous MI, relative to optimal recanalization and technical failure (11.7 vs. 4.6 vs. 4.1%, p = .006).Conclusions: Patients with CTO and previous MI had a larger reference vessel diameter, lower level of collateral circulation, and higher proportion of optimal recanalization. However, suboptimal recanalization in these patients was associated with an increased risk of spontaneous MI.

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Section: Discussionmentioning

confidence: 99%

Angiographic characteristics and long‐term outcomes of single‐vessel chronic total occlusion percutaneous coronary intervention in patients with and without previous myocardial infarction

Qiao

Guan

et al. 2021

Cathet Cardio Intervent

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“…As a registration trial with FDA oversight, this definition was required to maintain comparability with previous studies evaluating CTO‐specific technologies 7,8 . Also, as a study intended to evaluate the utility and effectiveness of guidewire and catheter technologies, clinical follow‐up was also limited to 30 days, thereby limiting insight to late‐term outcomes that may be related to early procedural failure or complications 29,30 . Finally, these results were observed among centers identified with expertise in CTO PCI and therefore may not be generalizable to a broader, less selected group of interventional operators.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of dedicated guidewire, microcatheter, and guide catheter extension technologies for chronic total coronary occlusion revascularization: Primary results of the Teleflex Chronic Total Occlusion Study

Kandzari

Alaswad

Jaffer

et al. 2021

Cathet Cardio Intervent

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Background: Description of procedural outcomes using contemporary techniques that apply specialized coronary guidewires, microcatheters, and guide catheter extensions designed for chronic total occlusion (CTO) percutaneous revascularization is limited.Methods: A prospective, multicenter, single-arm study was conducted to evaluate procedural and in-hospital outcomes among 150 patients undergoing attempted CTO revascularization utilizing specialized guidewires, microcatheters and guide extensions. The primary endpoint was defined as successful guidewire recanalization and absence of in-hospital cardiac death, myocardial infarction (MI), or repeat target lesion revascularization (major adverse cardiac events, MACE).Results: The prevalence of diabetes was 32.7%; prior MI, 48.0%; and previous bypass surgery, 32.7%. Average (mean ± standard deviation) CTO length was 46.9 ± 20.5 mm, and mean J-CTO score was 1.9 ± 0.9. Combined radial and femoral arterial access was performed in 50.0% of cases. Device utilization included: support microcatheter, 100%; guide catheter extension, 64.0%; and mean number of study guidewires/procedure was 4.8 ± 2.6. Overall, procedural success was achieved in 75.3% of patients. The rate of successful guidewire recanalization was 94.7%, and in-hospital MACE was 19.3%.Achievement of TIMI grade 2 or 3 flow was observed in 93.3% of patients. Crossing strategies included antegrade (54.0%), retrograde (1.3%) and combined antegrade/ retrograde techniques (44.7%). Clinically significant perforation resulting in hemodynamic instability and/or requiring intervention occurred in 16 (10.7%) patients.

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“…3 Second, acute procedural results of CTO recanalization (optimal recanalization, suboptimal recanalization, or failure) were not associated with the improvement of long-term cardiac death. 4 From various perspectives, our series of work with large-scale data from real world illustrated the viewpoint of no long-term survival benefit in indiscriminate selection of CTO recanalization, although there is currently no large randomized controlled trial to support this point.…”

Section: In Responsementioning

confidence: 99%

Response by Lin et al to Letter Regarding Article, “Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion and Multivessel Disease”

Lin

Guan

et al. 2022

Circ: Cardiovascular Interventions

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Association of Acute Procedural Results With Long-Term Outcomes After CTO PCI

Cited by 30 publications

References 23 publications

Angiographic characteristics and long‐term outcomes of single‐vessel chronic total occlusion percutaneous coronary intervention in patients with and without previous myocardial infarction

Angiographic characteristics and long‐term outcomes of single‐vessel chronic total occlusion percutaneous coronary intervention in patients with and without previous myocardial infarction

Safety and efficacy of dedicated guidewire, microcatheter, and guide catheter extension technologies for chronic total coronary occlusion revascularization: Primary results of the Teleflex Chronic Total Occlusion Study

Response by Lin et al to Letter Regarding Article, “Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion and Multivessel Disease”

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