Effect of Chronic Total Coronary Occlusion on Treatment Strategy

Christofferson, Ryan D.; Lehmann, Kenneth G.; Martin, Gary V.; Every, Nathan R.; Caldwell, James H.; Kapadia, Samir

doi:10.1016/j.amjcard.2004.12.065

Cited by 388 publications

(265 citation statements)

References 13 publications

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“…Several studies demonstrated that successful CTO intervention was associated with improved survival rates and angina symptom relief when compared with the failed CTO intervention 1, 4, 5, 6. Despite previous study results, the proportion of patients who underwent PCI for CTO lesions was still lower,7, 8 and current guidelines recommend that the physicians should consider the clinical benefits regarding clinical, angiographic, and technical parameters when determining whether or not to perform PCI in patients with CTO lesions 9, 10…”

Section: Introductionmentioning

confidence: 95%

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Choi

Rha

et al. 2017

JAHA

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BackgroundThe impact of percutaneous coronary intervention (PCI) on chronic total occlusion in patients with well‐developed collaterals is not clear.Methods and ResultsA total of 640 chronic total occlusion patients with collateral flow grade ≥2 were divided into 2 groups; chronic total occlusion patients either treated with PCI (the PCI group; n=305) or optimal medical therapy (the optimal medical therapy group; n=335). To adjust for potential confounders, a propensity score matching analysis was performed. Major clinical outcomes were compared between the 2 groups up to 5 years. In the entire population, the PCI group had a lower hazard of myocardial infarction (hazard ratio [HR], 0.177; P=0.039; 95% confidence interval [CI], 0.03–0.91) and the composite of total death or myocardial infarction (HR, 0.298; P=0.017; 95% CI, 0.11–0.80); however, it showed higher hazard of target lesion revascularization (HR, 3.942; P=0.003; 95% CI, 1.58–9.81) and target vessel revascularization (HR, 4.218; P=0.001; 95% CI, 1.85–9.60). After propensity score matching, a total of 158 matched pairs were generated. Although the PCI group showed a higher hazard of target lesion revascularization (HR, 2.868; P=0.027; 95% CI, 1.13–7.31) and target vessel revascularization (HR=2.62; P=0.022; 95% CI, 1.15–5.97), it still exhibited a lower incidence of the composite of total death or myocardial infarction (HR, 0.263; P=0.017; 95% CI, 0.087–0.790). The mean ejection fraction was improved from 47.8% to 51.6% (P<0.001) after PCI.ConclusionsIn our study, successful revascularization by PCI for chronic total occlusion lesions with well‐developed collaterals was associated with lower incidence of death and myocardial infarction, improved left ventricular function, but increased repeat revascularization rate.

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Section: Introductionmentioning

confidence: 95%

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Choi

Rha

et al. 2017

JAHA

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“…In a few older studies the prevalence of CTO in patients undergoing coronary angiography ranged between 10% and 52% depending on the clinical profile of the patient being examined. Among patients who underwent coronary angiography because of suspected coronary artery disease, CTO prevalence was 18%, but in patients with angiographically significant coronary artery disease it was 30% (Christofferson, 2005). CTO prevalence was observed to be higher (54%) among patients with a history of aortocoronary bypass graft (CABG) surgery and lower (10%) among patients with acute coronary syndrome undergoing primary PCI (Fefer, 2012).…”

Section: Discussionmentioning

confidence: 99%

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

Kalniņš

Strēle

Kurcalte

et al. 2018

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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“…At this, the presence of a CTO inluences treatment recommendations and is a strong predictor against PCI as a treatment strategy [5].…”

Section: Introductionmentioning

confidence: 99%

“…The true prevalence of CTOs in the general population is unknown and assumed to be around 15-20% [1][2][3] but varies widely (30-50%) in patients with signiicant coronary artery disease (CAD) [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Chronic Total Occlusions

2005

The American Journal of Cardiology

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The following chapter provides a brief overview on the prevalence, clinical features, and histological indings in chronically occluded coronary arteries. The role of coronary collaterals and myocardial viability as well as left ventricular function for the evaluation of treatment strategies of chronic total occlusions (CTO) will be discussed. Imaging modalities such as computed tomography and intracoronary imaging are discussed for their signiicance in CTO assessment and intervention. Finally, important clinical and procedural aspects, latest interventional strategies and techniques, the armamentarium of dedicated tools for CTO interventions, as well as evidence from published trials and clinical research in the ield will be presented.

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Effect of Chronic Total Coronary Occlusion on Treatment Strategy

Cited by 388 publications

References 13 publications

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

Chronic Total Occlusions

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