DECISION-CTO: A “negative” clinical trial? Really?

Gutiérrez‐Chico, Juan Luis; Louvard, Yves

doi:10.5603/cj.a2017.0049

Cited by 12 publications

(9 citation statements)

References 6 publications

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“…Periprocedural MI an event possible only in the PCI arm was included in the primary combined endpoint, a significant crossover was observed, namely 18% from the OMT arm to the PCI arm. Finally, overall mortality in the PCI arm was lower than in the OMT arm (3.0% vs. 4.4% at 3 years follow-up, and 4.5% vs. 7.9% at 5 years follow-up), with a reduction of 50% in the particular case of cardiac death at the 3rd year (1.9% vs. 3.6%) [100].…”

Section: Short and Long Term Results Of Cto-pcimentioning

confidence: 81%

Current approaches for treatment of coronary chronic occlusions

Iannaccone

Scarparo

Wilschut

et al. 2019

Expert Review of Medical Devices

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Introduction: Coronary chronic total occlusions (CTO) represent a challenging subset in interventional cardiology. Areas covered: During the last decade, improvements in materials, techniques, and meticulous preprocedural lesion assessment have increased the success rate in CTO lesions. Several scores have been developed to address overall lesion evaluation and help select the most appropriate treatment strategy. In addition, specific algorithms such as the hybrid algorithm have been introduced to provide a framework for CTO operators and a rapid management of the various challenging aspects of the procedure. The hybrid approach requires operator's ability to switch from one treatment strategy to another when the first one appears to be unsuccessful. Adequate training and operators' experience remain crucial to improve the likelihood of success. Expert opinion: The aim of this review is to provide insights and guidance for operators on current approaches for treatment of CTO and complication management.

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Section: Short and Long Term Results Of Cto-pcimentioning

confidence: 81%

Current approaches for treatment of coronary chronic occlusions

Iannaccone

Scarparo

Wilschut

et al. 2019

Expert Review of Medical Devices

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“…Literatures reported only 1/3 of patients with CTO was intervened to their CTO lesion [2], but, we have managed to almost 2/3 of patients by PCI except those with CTO PCI failure. DECISION-CTO trial [31] randomized 834 patients and divided into CTO PCI + OMT group and OMT group, follow up for 3.1 years and reported similar clinical efficacy and quality of life between these groups. According ACC/AHA appropriate use criteria, if patients had better symptomatic relief, better functional and quality of life, they were indicated to revascularization [32].…”

Section: Discussionmentioning

confidence: 97%

Percutaneous Intervention of CTO Lesion and Non-CTO Lesion in Patients with Coronary Chronic Total Occlusion

Adhikari¹,

Wang²,

Cheng³

et al. 2019

WJCD

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Background: With the improved lifestyle of people, the incidence of coronary artery disease is gradually increasing. Approximately 15%-20% of patients undergoing diagnostic catheterization had one or more chronically occluded coronary arteries. Method: The patients who were diagnosed with chronic total occlusion (CTO) in our hospital within one year period have been included. They were initially divided into two groups based on angiographic reports: single vessel disease (SVD) and non-single vessel disease (non-SVD) group, then into optimal medical therapy (OMT) group, percutaneous coronary intervention (PCI) group and coronary artery bypass graft (CABG) group. Finally, PCI group is further divided into PCI of CTO lesion (CTO PCI group) and PCI of non-CTO lesion (non-CTO PCI group). Results: A total of 261 patients were enrolled as CTO patients, mean age was 62.83 years, 70.1% were male patients. The incidence rate of common risk factors was hypertension (64.4%), followed by smoking (48.3%), diabetes (34.5%) and hyperlipidaemia (27.2%). SVD, DVD and TVD were present in 39 patients (14.94%), 81 patients (31.03%) and 141 patients (54.02%) respectively. Comparing the long term efficacy, the rates of MACE and non-target vessel revascularization were higher in CTO PCI than non-CTO PCI group, and were statistically significant (p < 0.05). The rates of target vessel revascularization, CABG and all cause death were also lower in CTO PCI group, but were not statistically significant (p > 0.05). Conclusion: The rates of MACE, non-target vessel revascularization, CABG and all cause death are lower if PCI is successfully performed in CTO patients. CTO PCI success also improves quality of life, decreases myocardial ischemia induced angina, and overall improves long term efficacy.

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“…Unfortunately, details regarding the adequacy and methods of revascularization are yet not available, and the scientific community yearningly awaits such data for further argumentations. As an example, it would be interesting to know the prevalence of bifurcations and chronic total occlusions on the total amount of PCI performed in both conservative and invasive strategy groups [28], as lesion complexity seems to affect periprocedural and long-term outcomes [29,30], and to have a relevant implication on the subsequent dual antiplatelet therapy [31,32] as well. Similarly, the complexity of the revascularization treatment might have affected the outcome [33].…”

Section: The Extent Of Revascularization In Multivessel Coronary Artementioning

confidence: 99%