Impact of Collateral Circulation on Survival in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention With a Concomitant Chronic Total Occlusion

Elias, Joëlle; Hoebers, Loes P.; Dongen, Ivo M. van; Claessen, Bimmer E.; Henriques, José P.S.

doi:10.1016/j.jcin.2017.01.026

Cited by 36 publications

(48 citation statements)

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“…One registry showed that the presence of well‐developed collaterals to a concomitant CTO in ST‐segment elevation myocardial infarction patients was associated with better long‐term survival 21. In our cohort of stable ICD patients, we found no clear effect of the quality of collateral vessels on survival or on appropriate device therapy, although appropriate device therapy appeared to occur more frequently in patients with well‐developed collaterals.…”

Section: Discussioncontrasting

confidence: 50%

“…One registry showed that the presence of well-developed collaterals to a concomitant CTO in ST-segment elevation myocardial infarction patients was associated with better long-term survival. 21 In our cohort of stable ICD patients, we found no clear effect of the quality of collateral vessels on survival or on appropriate device therapy, although appropriate device therapy appeared to occur more frequently in patients with well-developed collaterals. In the VACTO secondary (impact of chronic total coronary occlusion on recurrence of ventricular arrhythmias in ischemic secondary prevention implantable cardioverter-defibrillator recipients) study, a trend towards more appropriate therapy was observed in patients with Rentrop 3 collaterals.…”

Section: Collateralsmentioning

confidence: 48%

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Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Dongen

Yılmaz

Elias

et al. 2018

JAHA

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BackgroundPrevious studies report conflicting results about a higher incidence of ventricular arrhythmias in patients with a chronic total coronary occlusion (CTO). We aimed to investigate this association in a large cohort of implantable cardioverter defibrillator patients with long‐term follow‐up.Methods and ResultsAll consecutive patients from 1992 onwards who underwent implantable cardioverter defibrillator implantation for ischemic cardiomyopathy at the Leiden University Medical Center were evaluated. Coronary angiograms were reviewed for the presence of a CTO. The occurrence of ventricular arrhythmias and survival status at follow‐up were compared between patients with and patients without a CTO. A total of 722 patients constitute the study cohort (age 66±11 years; 84% males; 74% primary prevention, median left ventricular ejection fraction 30% [first–third quartile: 25–37], 44% received a cardiac resynchronization therapy defibrillator). At baseline, 240 patients (33%) had a CTO, and the CTOs were present for at least 44 (2–127) months. The median follow‐up duration was 4 (2–6) years. On long‐term follow‐up, CTO patients had a higher crude appropriate device therapy rate (37% versus 27%, P=0.010) and a lower crude survival rate (51% versus 67%, P<0.001) compared with patients without a CTO. Corrected for baseline characteristics including left ventricular ejection fraction, the presence of a CTO was an independent predictor for appropriate device therapy.ConclusionsThe presence of a CTO in implantable cardioverter defibrillator patients was associated with more appropriate device therapy and worse prognosis at long‐term follow‐up. Further investigation is warranted regarding a potential beneficial effect of CTO revascularization on the incidence of ventricular arrhythmias.

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Section: Discussioncontrasting

confidence: 50%

Section: Collateralsmentioning

confidence: 48%

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Dongen

Yılmaz

Elias

et al. 2018

JAHA

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“…This stunned myocardium will recover faster than the hibernating myocardium, theoretically leading to earlier functional recovery and probably improved outcomes. In a previous study of STEMI patients with a concurrent CTO survival was better in the patients with well- versus poorly-developed collaterals [26]. However the exact role of collaterals on LV functional recovery and outcome remains controversial and results are conflicting.…”

Section: Discussionmentioning

confidence: 99%

Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial

Elias

Dongen

Hoebers

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundThe Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory.MethodsUsing cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT < 45%. Dysfunctional segments were further analyzed by viability (transmural extent of infarction (TEI) ≤50%.). All outcomes were stratified for randomization treatment.ResultsIn the dysfunctional segments in the CTO territory recovery of SWT was better after CTO PCI compared to no-CTO PCI (ΔSWT 17 ± 27% vs 11 ± 23%, p = 0.03). This recovery was most pronounced in the dysfunctional but viable segments(TEI < 50%) (ΔSWT 17 ± 27% vs 11 ± 22%, p = 0.02). Furthermore in the CTO territory, recovery of SWT was significantly better in the dysfunctional segments in patients with Rentrop grade 2–3 collaterals compared to grade 0–1 collaterals to the CTO (16 ± 26% versus 11 ± 24%, p = 0.04).ConclusionCTO PCI compared with no-CTO PCI is associated with a greater recovery of regional systolic function in the CTO territory, especially in the dysfunctional but viable segments. Further research is needed to evaluate the use of CMR in selecting post-STEMI patients for CTO PCI and the effect of regional LV function recovery on clinical outcome.Trial registrationTrialregister.nl NTR1108, Date registered NTR: 30-okt-2007.

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“…In a recent study Elias et al . showed that in patients presenting with ST-elevation myocardial infarction and concomitant CTO, the Cx was an independent predictor of poorly developed collaterals [ 17 ]. Although in our study the J-CTO score for all arteries was similar, occlusions in the Cx were shorter, which might have influenced our results.…”

Section: Discussionmentioning

confidence: 99%

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

Bryniarski

Klima²,

Surowiec³

et al. 2018

pwki

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IntroductionIn past studies, it has been questioned whether success of recanalization of chronic total occlusion (CTO) depends on the location of the occlusion – the circumflex artery (Cx) was considered as the most difficult to open.AimTo determine whether the effectiveness of recanalization of CTO depends on the location of the obstruction.Material and methodsFrom January 2011 to January 2016, a single operator dedicated to chronic total occlusions performed in our center 357 procedures on 337 patients.ResultsAmong 337 patients included in the study, 83.4% were male. Mean age was 62.8 ±9.3 years. Most of the patients had hypertension (86.4%) and hyperlipidemia (99.4%), and 28.8% of them had diabetes. The most frequently opened artery was the right coronary artery (RCA; 52.4%), followed by the left anterior descending artery (LAD; 29.4%), and last the Cx (18.2%). The mean J-CTO score was comparable between the three groups. The success rate of recanalization of CTO was similar for all arteries: 84.5% in the RCA, 81.9% in the LAD and 89.2% in the Cx (overall p = 0.437). Neither procedural complications nor adverse events depended on the location of the CTO.ConclusionsOur study shows the same efficacy of CTO procedures of all epicardial arteries. We did not observe that effectiveness of recanalization of CTO depends on the location of the obstruction.

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Impact of Collateral Circulation on Survival in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention With a Concomitant Chronic Total Occlusion

Cited by 36 publications

References 36 publications

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial

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

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