Does the effectiveness of recanalization of chronic occlusion depend on the location of the obstruction?

Bryniarski, Leszek; Klima, Łukasz; Surowiec, Sławomir; Bryniarski, Krzysztof; Terlecki, Michał; Dudek, Dariusz

doi:10.5114/aic.2018.78328

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…The incidence of chronic total occlusion (CTO) is reported to reach 18.2–52% [1–4] in patients undergoing coronary angiography. Right coronary artery (RCA) CTO has been observed in approximately 38–50% [1, 5–7] of the entire CTO population. Although CTO revascularization was observed to have an acceptable success rate and to gain more clinical benefits from successful procedures [8, 9], the RCA-CTO patients who are treated with revascularization, either by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), are fewer than those patients with left anterior descending branch (LAD) CTO [1, 3, 4, 10].…”

Section: Introductionmentioning

confidence: 99%

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Yan

Zhang

Yuan

et al. 2019

Cardiovasc Diabetol

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Background The territory of the right coronary artery (RCA) is smaller than that of the left anterior descending artery. Previous studies have reported conflicting results when considering whether stable RCA-chronic total occlusion (CTO) should be reopened. The coexistence of diabetic and coronary artery diseases represents a severe situation. Therefore, we aimed to determine if stable RCA-CTO in diabetic patients was necessary to be reopened. To our knowledge, no studies have focused on this topic to date. Methods We enrolled diabetic patients with RCA-CTO who had clinical presentations of symptomatic stable angina or silent ischemia. RCA-CTO was treated with either successful revascularization (the CTO-SR group) or medical therapy (the CTO-MT group). The primary endpoint was all-cause death. Both Cox regression and propensity score matching analyses were used. Sensitivity analysis was performed based on subgroup populations and relevant baseline variables. Results A total of 943 patients were included: 443 (46.98%) patients in the CTO-MT group and 500 (53.02%) patients in the CTO-SR group. After a mid-term follow-up (CTO-SR: 48 months; CTO-MT: 42 months), we found that CTO-SR was superior to CTO-MT in terms of all-cause death (adjusted hazard ratio [HR] [model 1]: 0.429, 95% conference interval [CI] 0.269–0.682; adjusted HR [model 2]: 0.445, 95% CI 0.278–0.714). The superiority of CTO-SR was consistent for cardiac death, possible/definite cardiac death, repeat revascularization, target vessel revascularization (TVR) and repeat nonfatal myocardial infarction. Subgroup analysis confirmed the mortality benefit of CTO-SR by percutaneous coronary intervention (the successful CTO-PCI subgroup, 309 patients in total). While CTO-SR by coronary artery bypass grafting (the CTO-CABG subgroup, 191 patients in total) offered patients more benefit from repeat revascularization and TVR than that offered by successful CTO-PCI. Conclusions For stable RCA-CTO patients with diabetes, successful revascularization offered patients more clinical benefits than medical therapy. CTO-CABG might be a more recommended way to accomplish revascularization. Trial registration This study was not registered in an open access database Electronic supplementary material The online version of this article (10.1186/s12933-019-0911-4) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Yan

Zhang

Yuan

et al. 2019

Cardiovasc Diabetol

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“…Если говорить о локализации ХОКА, то в большинстве исследований, в т.ч. и в рассматриваемом, показано, что локализация ХОКА в ОА является предиктором безуспешного вмешательства [27][28][29]. Этому факту есть анатомические объяснение.…”

Section: Discussionunclassified

Predictors of unsuccessful endovascular recanalization of coronary chronic total occlusion

Васильев¹,

Руденко²,

Шаноян³

et al. 2021

Cardiovasc Ther Prev

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The prevalence of endovascular interventions for coronary chronic total occlusion (CTO) remains small worldwide. This is due to the complexity of procedure and the risk of intraoperative complications. In this regard, the search for predictors of unsuccessful endovascular intervention in CTO plays a special role. This will allow for a careful selection of patients with the most favorable expectation effect of the operation. Aim. To identify predictors of unsuccessful endovascular recanalization of CTO.Material and methods. This retrospective study included 180 patients with chronic coronary artery disease (CAD) in the period from November 2017 to June 2019, who had multivessel lesion in combination with CTO. In all patients, an attempt was made to achieve complete myocardial revascularization. Depending on the success of procedure, the patients were divided into two groups: complete and incomplete myocardial revascularization. The follow-up period was 12 months.Results. All baseline characteristics of patients in the compared groups were similar. The successful recanalization rate of occlusion was 79,5%. Multivariate regression analysis showed that calcified CTO (p<0,001), baseline SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score >32 (p=0,006), CTO length >30 mm (p=0,046) and CTO of circumflex artery (p<0,01) are significant predictors of unsuccessful endovascular recanalization of CTO. To assess the predictive value of the model, a ROC analysis was carried out, and the area under the curve (AUC) was calculated. The AUC was 0,87, which indicates a high predictive quality of the model. The sensitivity and specificity of the model were 78 and 81%, respectively.Conclusion. The study showed that the presence of calcified CTO, SYNTAX score >32 points, CTO length >30 mm, and CTO of circumflex artery are significant predictors of unsuccessful CTO recanalization.

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“…In addition, some variables in the previous scoring systems ( Table 1 ) were greatly affected by the subjective and technical differences in the operator; still, disputes, such as “fuzzy proximal fibrous cap, treatable collateral, and circumflex CTO lesions,” existed [ 9 ]. In recent studies, when the most difficult vessel was opened, the variable of progress score “circumflex CTO lesion” showed that the success rate of the left circumflex artery (LCX) was similar to that of the right coronary artery (RCA) and anterior descending artery (LAD) (RCA: 84.5%, LAD: 81.9%, and LCX: 89.2%), which benefited from the progress of technology and the operator's experience [ 13 ]. The progress score system was related to CTO lesions.…”

Section: Discussionmentioning

confidence: 99%

A Novel Clinical Scoring Model for Interventional Therapy in Chronic Total Occlusion of the Coronary Artery

Xiao

Liu

Cai

et al. 2021

Journal of Interventional Cardiology

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Objective. With the rapid development of technology and experience, the current percutaneous coronary intervention of chronic total occlusion (CTO-PCI) preoperative scoring model needs to be updated. This study aimed to evaluate the clinical value of the operator-CTO score in predicting the outcome of interventional therapy for chronic total occlusion of the coronary artery. Methods. The data of 144 lesions in 130 patients with CTO were analyzed prospectively. The CTO procedures were performed by 10 operators with different skills and experiences. Before the procedures, J-CTO, progress, ORA, recharge, and operator-CTO scores were determined. Then, the clinical, imaging, and procedural data of patients in different operator-CTO score groups and between different operators were compared. The final focus was on comparing the predictive ability of each score on the outcome of CTO-PCI. Results. The overall technical and procedural success rates were 90.9% and 88.9%, respectively. A decreasing trend in the technical success of CTO-PCI was observed according to the operator-CTO score hierarchy of “easy (≤2 points), moderate (3 points), difficult (4 points), and extremely difficult (≥5 points)” (99.0%, 87.5%, 53.8%, and 25.0%, respectively). All five scoring models were well calibrated, and the area under the curve (AUC) for the operator-CTO score was 0.901 (95% CI: 0.821–0.982, P < 0.01 ), larger than the AUC for the remaining four scoring models, showing excellent ability to predict technical outcomes. Conclusion. The operator-CTO score is a new clinical scoring tool that can predict the outcome of CTO-PCI and can be used to grade the difficulty of the procedure, with the potential to work well with a broad group of operators.

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Does the effectiveness of recanalization of chronic occlusion depend on the location of the obstruction?

Cited by 3 publications

References 16 publications

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Predictors of unsuccessful endovascular recanalization of coronary chronic total occlusion

A Novel Clinical Scoring Model for Interventional Therapy in Chronic Total Occlusion of the Coronary Artery

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