Improved cardiac survival, freedom from mace and angina-related quality of life after successful percutaneous recanalization of coronary artery chronic total occlusions

Borgia, Francesco; Viceconte, Nicola; Farouk, Omar; Stuart-Buttle, Claire; Saraswathyamma, Anjana; Parisi, Rosario; Mirabella, Francesca; Dimopoulos, Konstantinos; Mario, Carlo Di

doi:10.1016/j.ijcard.2011.04.023

Cited by 115 publications

(69 citation statements)

References 29 publications

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“…Finally, fewer treated vessels and stents were used in our study than in previous studies. Recently, Mehran et al [30] enrolled 302 patients undergoing attempted CTO-PCI to assess the long-term outcomes of the procedure. They showed no significant differences in CM dose or incidence of CIN between the groups that had Another study on the long-term outcomes of CTO-PCI showed no significant difference in the CM dose between successful and failed CTO-PCI procedures (433±232 vs. 481±222 mL, P=0.46).…”

Section: Discussionmentioning

confidence: 99%

Contrast-induced nephropathy following chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease

Liu

Tan

et al. 2015

Eur Radiol

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Section: Discussionmentioning

confidence: 99%

Contrast-induced nephropathy following chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease

Liu

Tan

et al. 2015

Eur Radiol

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“…According to consensus documents CTO-PCI should be considered in the presence of symptoms (or objective evidence of a large region of ischemia/viability) when the myocardium supplied by the CTO is viable, the likelihood of success is >60 % and the anticipated major complication rate is low [5, 6]. Potential CTO-PCI benefits are ischemia reduction, angina relief, and improved left ventricular ejection function (LVEF) and long-term survival [7–18]. However, these data come from studies enrolling patients with preserved LVEF, where clinical benefits of myocardial revascularization are potentially lower.…”

Section: Introductionmentioning

confidence: 99%

Benefits of chronic total coronary occlusion percutaneous intervention in patients with heart failure and reduced ejection fraction: insights from a cardiovascular magnetic resonance study

Cardona

Martín

Prat‐González

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundChronic total occlusion percutaneous coronary intervention (CTO-PCI) can improve angina and left ventricular ejection fraction (LVEF). These benefits were not assessed in populations with heart failure with reduced ejection fraction (HFrEF). We studied the effect of CTO-PCI on left ventricular function and clinical parameters in patients with HFrEF.MethodsUsing cardiovascular magnetic resonance (CMR), we studied 29 patients with HFrEF and evidence of viability and/or ischemia in the territory supplied by a CTO who were successfully treated with CTO-PCI. In patients with multi-vessel disease, non-CTO PCI was also performed. Imaging parameters, clinical status, and brain natriuretic peptide (BNP) levels were evaluated before and 6 months after CTO-PCI.ResultsA decrease in left ventricular end-systolic volume (160 ± 54 ml vs. 143 ± 58 ml; p = 0.029) and an increase in LVEF (31.3 ± 7.4 % vs. 37.7 ± 8 %; p < 0.001) were observed. There were no differences in LVEF improvement between patients who underwent non-CTO PCI (n = 11) and those without this intervention (n = 18); (p = 0.73). The number of segments showing perfusion defects was significantly reduced (0.5 ± 1 vs. 0.2 ± 0.5; p = 0.043). Angina (p = 0.002) and NYHA functional class (p = 0.004) improved, and BNP levels decreased (p = 0.004) after CTO-PCI.ConclusionsIn this group of patients with HFrEF showing CMR evidence of viability and/or ischemia within the territory supplied by the CTO, an improvement in ejection fraction, left ventricular end-systolic volume and ischemia burden was observed after CTO-PCI. Clinical and laboratory parameters also improved.Trial registrationClinicalTrials.gov NCT02570087. Registered 6 October 2015.

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“…To date, there is only a single study, without a comparison group, demonstrating improved patient-reported health status after successful CTO PCI (1) . In the absence of data documenting the health status benefits of CTO PCI, the Appropriate Use Criteria (AUC) committee of the American College of Cardiology Foundation systematically downgraded the appropriateness of CTO PCI as compared with non CTO PCI in five clinical scenarios (1,2) . Demonstrating comparable symptom relief and quality of life improvement with CTO PCI can support reappraisal of the AUC and underscore the potential of CTO revascularization to improve patients’ health status.…”

Section: Introductionmentioning

confidence: 99%

Quality of life benefits of percutaneous coronary intervention for chronic occlusions

Safley

Grantham

Hatch

et al. 2013

Cathet Cardio Intervent

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Objectives We aimed to compare quality of life benefits of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) with non-CTO PCI. Background Data quantifying the benefits of PCI of CTO are inconsistent. Methods We leveraged a 10-center prospective PCI registry including Seattle Angina Questionnaire (SAQ) assessment at the time of PCI and in follow-up. We propensity matched attempted CTO PCIs with up to 10 non-CTO PCIs. The primary analysis compared changes between baseline and 6 months in SAQ Physical Limitation (PL), Quality of Life (QoL) and Angina Frequency (AF) scores as well as the Rose Dyspnea scores (RDS) and the EQ5D Visual Analogue Scale (VAS). Non-inferiority was assessed for quality of life changes between CTO and non-CTO PCI. Results In 3,303 patients enrolled, 167 single-vessel CTOs were attempted; 147 (88%) were matched with 1,616 non-CTO PCI. Baseline PL (73.0 vs. 77.4, p=0.039) and VAS (66.4 vs. 70.8, p=0.005) scores were lower for CTO. There was no difference in AF, QoL or RDS scores. At 6-month follow-up, all SAQ scores improved (p<0.05 vs. baseline for all) and were equivalent for CTO and Non-CTO (p=NS for all). VAS scores remained lower for CTO, but improved in both groups (p<0.05 vs. baseline for both). Formal non-inferiority testing demonstrated that CTO PCI was not inferior to non-CTO PCI (p≤0.02 for all). Conclusions Symptoms, function, QoL and dyspnea improve to the same degree following CTO PCI as compared with non-CTO PCI. Symptom relief supports CTO PCI to improve patients’ quality of life.

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Improved cardiac survival, freedom from mace and angina-related quality of life after successful percutaneous recanalization of coronary artery chronic total occlusions

Cited by 115 publications

References 29 publications

Contrast-induced nephropathy following chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease

Contrast-induced nephropathy following chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease

Benefits of chronic total coronary occlusion percutaneous intervention in patients with heart failure and reduced ejection fraction: insights from a cardiovascular magnetic resonance study

Quality of life benefits of percutaneous coronary intervention for chronic occlusions

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