Follow-Up Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With and Without Prior Coronary Artery Bypass Graft Surgery: Insights From the Progress-Cto Registry

Nikolakopoulos, Ilias; Karmpaliotis, Dimitrios; Choi, James W.; Khatri, Jaikirshan; Doing, Anthony; Dattilo, Phil; Rafeh, Nidal Abi; Maalouf, Assaad; Jaoudeh, Fadi Abou; Aguilar, Hector Tamez; Shah, Alpesh; Moses, Jeffrey W.; Lembo, Nicholas; Kirtane, Ajay J.; Parikh, Manish; Ali, Ziad A.; Megaly, Michael; Vemmou, Evangelia; Xenogiannis, Iosif; Rangan, Bavana V.; Abdullah, Shuaib; Banerjee, Subhash; García, Santiago; Burke, M. Nicholas; Brilakis, Emmanouil S.

doi:10.1016/s0735-1097(20)31926-4

Cited by 12 publications

(23 citation statements)

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“…They concur in CABG, which is acknowledged as an adverse feature in CTO patients [ 17 , 18 ]. Moreover, a recent study from the PROGRESS database found 5% less recanalization success in CABG patients compared to non-CABG patients [ 19 ]. CTO characteristics such as tortuosity and calcification are more challenging to be consistently evaluated, as they are defined discordantly among scores and might be somewhat subjective to the operator.…”

Section: Discussionmentioning

confidence: 99%

Choice of CTO scores to predict procedural success in clinical practice. A comparison of 4 different CTO PCI scores in a comprehensive national registry including expert and learning CTO operators

et al. 2021

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Background We aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures. Methods Scores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared. Results Mean score values were: CASTLE 1.60±1.10, J-CTO 2.15±1.24, PROGRESS 1.68±0.94 and CL 2.52±1.52 points. The overall percutaneous coronary intervention success rate was 77.8%. Calibration was good for CASTLE and CL, but not for J-CTO or PROGRESS scores. Discrimination: the area under the curve (AUC) of CASTLE (0.633) was significantly higher than PROGRESS (0.557) and similar to J-CTO (0.628) and CL (0.652). Reclassification: CASTLE, as assessed by integrated discrimination improvement, was superior to PROGRESS (integrated discrimination improvement +0.036, p<0.001), similar to J-CTO and slightly inferior to CL score (– 0.011, p = 0.004). Regarding net reclassification improvement, CASTLE reclassified better than PROGRESS (overall continuous net reclassification improvement 0.379, p<0.001) in roughly 20% of cases. Conclusion Procedural percutaneous coronary intervention difficulty is not consistently depicted by available chronic total occlusion scores and is influenced by the characteristics of each chronic total occlusion cohort. In our study population, including expert and learning operators, the CASTLE score had slightly better overall performance along with CL score. However, we found only intermediate performance in the c-statistic predicting chronic total occlusion success among all scores.

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Section: Discussionmentioning

confidence: 99%

Choice of CTO scores to predict procedural success in clinical practice. A comparison of 4 different CTO PCI scores in a comprehensive national registry including expert and learning CTO operators

et al. 2021

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“…Eventually, eight studies comprising a total of 13 439 patients met the inclusion criteria and were included in qualitative synthesis and meta-analysis. [8][9][10][11][12][13][14][15] The baseline clinical characteristics of the patients included in this meta-analysis are summarized in Table 1A.…”

Section: Characteristics Of the Studies And Patients Includedmentioning

confidence: 99%

Lesion characteristics and procedural complications of chronic total occlusion percutaneous coronary intervention in patients with prior bypass surgery: A meta‐analysis

Shi

Luo

et al. 2022

Clinical Cardiology

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Coronary artery bypass graft (CABG) accelerates the prevalence of native coronary chronic total occlusion (CTO), and this kind of CTO shows extensive challenging and complex atherosclerotic pathology. As a result, the procedural success rate of percutaneous coronary intervention (PCI) is inferior to another kind of lesions. The present meta-analysis aims to compare the lesion characteristics and procedural complications of CTO-PCI in patients with or without prior CABG. A total of 8 studies, comprising of 13439 patients, published from inception to August 2021 were included in this meta-analysis. Results were pooled using random effects model and are presented as odds ratio (OR) with 95% confidence intervals (95% CIs). From the 13439 patients enrolled, 3349 (24.9%) patients had previous CABG and 10090 (75.1%) formed the control group in our analysis. For the clinical characteristic, compared to the non-CABG patients, prior CABG patients were older (OR, 3.98; 95% CI,

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“…The low technical success rates of CTO PCI in patients with prior CABG may reflect the enormous difficulty of intervention in this population. We attribute this phenomenon to the following reasons: Firstly, when compared to patients without prior CABG, those with prior CABG who underwent CTO revascularization were older, and exhibited more comorbidities, including hypertension, diabetes, prior MI, previous stroke, chronic kidney insufficiency and left ventricular dysfunction ( 37 , 39 – 41 ), which have previously been shown to be independent predictors of CTO PCI failure ( 11 , 42 ). Secondly, regarding lesion characteristics, patients with prior CABG who underwent CTO intervention often exhibited higher complexity of the CTO lesion and vessel anatomy, mainly because CABG can accelerate development of native coronary artery atherosclerosis due to the competitive flow generated by the grafting process ( 43 ).…”

Section: Characteristics and Cto Pci Success Rates In Patients With P...mentioning

confidence: 99%

“…Notably, previous researchers have frequently performed a retrograde approach in CTO patients with prior CABG ( 38 , 41 , 50 ). For example, a previous meta-analysis reported 34.7 and 21.9% success rates in patients with and without prior CABG ( p < 0.001), respectively ( 51 ).…”

Section: Characteristics and Cto Pci Success Rates In Patients With P...mentioning

confidence: 99%

“…Although numerous studies have investigated in-hospital outcomes of CTO PCI in patients with prior CABG, the results are inconsistent ( 37 , 41 , 50 , 54 ). For example, Megaly et al ( 51 ) performed a meta-analysis, comprising 8,131 patients and found that patients with prior CABG exhibited a higher incidence of in-hospital mortality (0.8 vs. 0.3%; OR: 2.77 [95% CI: 1.43–5.39]; p = 0.003), and MI (1.4 vs. 0.5%; OR: 2.46 [95% CI: 1.46–4.15]; p < 0.001), compared with those without prior CABG.…”

Section: Procedural Complications and In-hospital Outcomes In Patient...mentioning

confidence: 99%

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Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Graft: Current Evidence and Future Perspectives

Guo

Yin

2022

Front. Cardiovasc. Med.

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Coronary chronic total occlusion (CTO), which occurs in 18. 4–52% of all patients referred for coronary angiography, represents one of the last barriers in coronary intervention. Approximately half of all patients with prior coronary artery bypass graft (CABG), who undergo coronary angiography, are diagnosed with coronary CTO. In fact, these patients often develop recurrent symptoms and events, necessitating revascularization. Currently, there is neither a consensus nor developed guidelines for the treatment of CTO patients with prior CABG, and the prognosis of these patients remains unknown. In this review, we discuss current evidence and future perspectives on CTO revascularization in patients with prior CABG, with special emphasis on clinical and lesion characteristics, procedural success rates, periprocedural complications, and long-term outcomes.

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Follow-Up Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With and Without Prior Coronary Artery Bypass Graft Surgery: Insights From the Progress-Cto Registry

Cited by 12 publications

References 0 publications

Choice of CTO scores to predict procedural success in clinical practice. A comparison of 4 different CTO PCI scores in a comprehensive national registry including expert and learning CTO operators

Choice of CTO scores to predict procedural success in clinical practice. A comparison of 4 different CTO PCI scores in a comprehensive national registry including expert and learning CTO operators

Lesion characteristics and procedural complications of chronic total occlusion percutaneous coronary intervention in patients with prior bypass surgery: A meta‐analysis

Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Graft: Current Evidence and Future Perspectives

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