Long-Term Follow-Up of Elective Chronic Total Coronary Occlusion Angioplasty

George, Sudhakar; Cockburn, James; Clayton, Tim; Ludman, Peter; Cotton, James; Spratt, James C.; Redwood, Simon; Belder, Mark de; Belder, Adam de; Hill, Jonathan; Hoye, Angela; Palmer, Nick; Rathore, Sudhir; Gershlick, Anthony; Mario, Carlo Di; Hildick‐Smith, David

doi:10.1016/j.jacc.2014.04.040

Cited by 234 publications

(130 citation statements)

References 11 publications

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…I am not truly surprised for the benefit in mortality, because it confirms somehow the data reported in previous observational or post-hoc studies [1][2][3][4][5][6]. I find also clinically unacceptable stating that a treatment is non-inferior to another one, based on a composite endpoint, when its different components move clearly in different directions for each therapeutic option.…”

supporting

confidence: 74%

DECISION-CTO: A “negative” clinical trial? Really?

Gutiérrez‐Chico

Louvard

2017

Cardiol J.

View full text Add to dashboard Cite

supporting

confidence: 74%

DECISION-CTO: A “negative” clinical trial? Really?

Gutiérrez‐Chico

Louvard

2017

Cardiol J.

View full text Add to dashboard Cite

“…[28][29][30] Recently, George and colleagues reported that successful CTO intervention was associated with a decrease in mortality as compared to unsuccessful CTO intervention using large registry data (n = 13,443). 31) Furthermore, Jang and colleagues reported the long-term survival benefit of CTO revascularization as compared to medical therapy using a propensity score-matched population. 32) However, the association between improvement of LV systolic function and revascularization of coronary CTO has not been investigated in patients with heart failure.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

et al. 2016

View full text Add to dashboard Cite

SummaryRevascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered for heart failure with reduced ejection fraction (HFrEF). However, revascularization therapy does not always improve left ventricular ejection fraction (LVEF). The purpose of this study was to investigate the determinants of LVEF improvement following revascularization in HFrEF patients. From 2,229 consecutive decompensated heart failure patients, a total of 47 HFrEF patients who underwent revascularization were included in the analysis. Improvement of LVEF was defined as [(LVEF during chronic phase) -(LVEF during acute phase)] ≥ 10%. Univariate and multivariate logistic regression analyses were applied to investigate the determinants of LVEF improvement. The prevalence of revascularization by PCIs including chronic total occlusion (CTO) was significantly greater in the improved EF group (45.0%) as compared to the non-improved EF group (11.1%) (P = 0.02). Multivariate logistic regression analysis revealed that revascularization by PCIs including CTO was the significant determinant of the LVEF improvement after adjusting for confounding factors (OR 5.43, 95% CI 1.06-27.74, P = 0.04). Optimal medical therapy (angiotensin-converting enzyme (ACE) inhibitor and/or angiotensin II receptor blocker (ARB) and beta-blockers) was less frequently prescribed in patients with CABG (50.0% for ACE inhibitor and/or ARB and 41.7% for beta-blocker) than in patients without CABG (94.3% for both) (P < 0.01 and P < 0.001, respectively). In conclusion, revascularization by PCIs including CTO was the significant determinant of LVEF improvement in HFrEF patients. Our results underscore the importance of optimal medical therapy even if patients receive complete revascularization such as CABG. (Int Heart J 2016; 57: 565-572) Key words: Percutaneous coronary intervention, Coronary artery bypass grafting, Chronic total occlusion H eart failure is a common disease with a prevalence of 1-2% in the adult population, 1) and still has high mortality in developed countries. One-year mortality rates in population-based studies have been reported to be 25% to 45%.2-5) The mortality rate was higher in heart failure with reduced ejection fraction (HFrEF) than heart failure with preserved ejection fraction (HFpEF). 6) Mortality rates of HFrEF (ejection fraction < 50%) patients were reported to be 32% at one year and 68% at 5 years.6) The most common cause of HFrEF is coronary artery disease, which accounts for approximately two-thirds of HFrEF. 7)Revascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered in heart failure with coronary artery disease, and sometimes improves clinical outcomes including left ventricular function. [8][9][10][11][12] However, revascularization therapy is not always effective in heart failure with coronary artery disease.13) It is unknown which types of patients receive the benefits such as improvement o...

show abstract

“…Contemporary research from George et al23 also demonstrated a mortality benefit for CTO revascularization in a registry investigation of >13 000 patients in the United Kingdom. Possible explanations for the underlying mechanism of the clinical benefit of opening CTO lesions include the improvement in blood flow in the peri‐infarct area and recovery of contractile function of the hibernated areas perfused by in the CTO territory.…”

Section: Discussionmentioning

confidence: 90%

Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Villablanca

Olmedo

Weinreich

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundStudies have shown that chronic total occlusion (CTO) in a noninfarct‐related artery in patients with ST‐segment–elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct‐related artery CTO in patients with ST‐segment–elevation myocardial infarction translates to improved outcomes. We performed a meta‐analysis to compare outcomes between patients presenting with ST‐segment–elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct‐related artery CTO versus those who did not.Method and ResultsWe conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all‐cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Random effects model was used and heterogeneity was considered if I 2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32–0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20–0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36–0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all‐cause mortality (OR, 0.47; 95% CI, 0.22–1.00), myocardial infarction (OR, 0.78; 95% CI, 0.41–1.46), repeat revascularization (OR, 1.13; 95% CI, 0.56–2.27), and stroke (OR, 0.51; 95% CI, 0.20–1.33).ConclusionsIn this meta‐analysis, CTO percutaneous coronary intervention of the noninfarct‐related artery in patients presenting with ST‐segment–elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.

show abstract

Long-Term Follow-Up of Elective Chronic Total Coronary Occlusion Angioplasty

Abstract: Successful CTO PCI was associated with improved long-term survival. The improvement was greatest in patients when complete revascularization was achieved. The identity of the successfully treated occluded vessel was not associated with differences in outcome.

Cited by 234 publications

References 11 publications

DECISION-CTO: A “negative” clinical trial? Really?

DECISION-CTO: A “negative” clinical trial? Really?

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Contact Info

Product

Resources

About