In-Hospital Outcomes of Contemporary Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion

Morino, Yoshihiro; Kimura, Takeshi; Hayashi, Yasuhiko; Muramatsu, Toshiya; Ochiai, Masahiko; Noguchi, Yuichi; Kato, Kenichi; Shibata, Yoshisato; Hiasa, Yoshikazu; Doi, Osamu; Yamashita, Takehiro; Abe, Mitsuru; Hinohara, Tomoaki; Mitsudo, Kazuaki; Investigators, J-Cto Registry

doi:10.1016/j.jcin.2009.10.029

Cited by 260 publications

(121 citation statements)

References 18 publications

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“…The success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions have been increased by the advancement of operator's skill, experience with intervention techniques (anterograde and retrograde approaches, wire manipulations techniques, and so on), and device technology (improved dedicated CTO guidewires, microcatheters, CTO balloons, and coronary stents) 1, 2, 3, 4. 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.…”

Section: Introductionmentioning

confidence: 99%

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: 99%

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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“…Angiographic CTO lesion characteristics are predictive of success rate and procedure time. [9][10][11] The multicenter Japanese CTO Registry 12 investigators developed the J-CTO score as a scoring system to grade the difficulty in crossing a CTO within 30 minutes and overall success rate. 13 Thus, it might be a valuable tool for some operators dealing with the challenge of patient selection for CTO PCI and for schedule management.…”

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confidence: 99%

Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort

Nombela‐Franco

Ureña

Jerez-Valero

et al. 2013

Circ: Cardiovascular Interventions

102

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Background-Chronic total occlusion (CTO) recanalization is a complex and technically challenging procedure. The J-CTO score has been proposed to stratify case complexity and procedural success rates. However, the score has never been tested outside the setting of the original study. Moreover, its predictive value when using a hybrid antegrade or retrograde approach is unknown. We investigated the performance of the J-CTO score for predicting procedure complexity and success in an independent contemporary cohort. Methods and Results-A total of 209 consecutive patients who underwent CTO recanalization by a high-volume operator were included. Clinical and angiographic data were prospectively collected. The J-CTO score was applied for each patient, and discrimination and calibration were evaluated in the whole cohort, and according to the approach (antegrade 47% and retrograde 53%). Clinical and angiographic differences were noted between the original and studied cohort. The mean J-CTO score was 2.18±1.26, and successful guidewire crossing within 30 minutes and final angiographic success were 44.5% and 90.4%, respectively. The J-CTO score demonstrated good discrimination (c statistic, >0.70) and calibration (Hosmer-Lemeshow P>0.1) in the whole cohort and for antegrade and retrograde approaches. However, the final success rate was not associated with the J-CTO score. Conclusions-In this independent cohort, the J-CTO score showed good discriminatory and calibration capacity for guidewire CTO crossing within 30 minutes but it does not for final success rate. The J-CTO score helps to predict complexity of CTO recanalization, and the simplicity of the score supports the widespread use as a clinical tool. Methods Study Population and CTO ProceduresBetween January 2010 and December 2012, a total of 245 consecutive CTO PCI were performed by a single operator (S.R.). Of these, 36 (14.7%) patients were performed outside our institution and were not available for angiographic analysis. Hence, the final study population consisted of 209 patients, all patients referred for CTO PCI, without angiographic exclusion criteria. Baseline, procedural and hospitalization data were prospectively collected and entered in a dedicated database. Our institutional review committee approved prospective data collection as part of the Recherche Évaluative en Cardiologie InTervenionnelle (RÉCIT) registry, and subjects provided signed informed consent. A CTO was defined as an obstruction of a coronary artery with anterograde thrombolysis in myocardial infarction flow grade 0 that was confirmed or presumed to be ≥3 months old. 11 The duration of the CTO was estimated by clinical information or the results of previous angiography. Successful angiographic recanalization was defined as a restoration of thrombolysis in myocardial infarction flow grade 3 and residual stenosis <30% in the occluded artery. Successful procedure was defined as successful angiographic recanalization and no in-hospital major adverse cardiovascular event including death, strok...

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“…Moderate proximal vessel tortuosity was defined as the presence of at least 2 bends >70°or 1 bend >90°and severe tortuosity as 2 bends >90°or 1 bend >120°in the CTO vessel. The Japanese Chronic Total Occlusion score was calculated as described by Morino et al 26 The Progress CTO score was calculated as described by Christopoulos et al 22 Technical success was defined as successful CTO revascularization with achievement of <30% residual diameter stenosis within the treated segment and restoration of Thrombolysis In Myocardial Infarction grade 3 antegrade flow. Procedural success was defined as achievement of technical success with no inhospital major adverse cardiac events (MACE).…”

Section: Definitionsmentioning

confidence: 99%

Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

Karácsonyi

Alaswad

Jaffer

et al. 2016

JAHA

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In-Hospital Outcomes of Contemporary Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion

Cited by 260 publications

References 18 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

Validation of the J-Chronic Total Occlusion Score for Chronic Total Occlusion Percutaneous Coronary Intervention in an Independent Contemporary Cohort

Use of Intravascular Imaging During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

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