Mechanical Circulatory Support in High-Risk Percutaneous Coronary Intervention

Kunkel, Katherine; Dabbagh, Mohammed; Zaidan, Mohammad; Alaswad, Khaldoon

doi:10.1016/j.iccl.2020.12.002

Cited by 5 publications

(38 citation statements)

References 53 publications

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“…Coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be more challenging in patients with decreased left ventricular ejection fraction (LVEF), potentially requiring the use of mechanical circulatory support (MCS). 1,2 Patients who have impaired LVEF and have a concomitant CTO have a high risk of sudden death and ventricular arrhythmias as well as poor quality of life. 3 Some pilot studies demonstrated that CTO PCI can be safely performed in patients with low LVEF and can provide good outcomes with improvements in LVEF, global longitudinal strain, and decreased LV end-systolic volume.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of chronic total occlusion percutaneous coronary intervention in patients with reduced left ventricular ejection fraction

Şimşek

Kostantinis

Karácsonyi

et al. 2022

Cathet Cardio Intervent

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Background The relationship between left ventricular ejection fraction (LVEF) and the success and safety of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods We examined the clinical characteristics and outcomes of CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS‐CTO) after stratifying patients by LVEF (≤35%, 36%–49%, and ≥50%). Results A total of 7827 CTO PCI procedures with LVEF data were included. Mean age was 64 ± 10 years, 81% were men, 43% had diabetes mellitus, 61% had prior PCI, 45% had prior myocardial infarction, and 29% had prior coronary artery bypass graft surgery. Technical success was similar in the three LVEF strata: 85%, 86%, and 87%, p = 0.391 for LVEF ≤35%, 36%–49%, and ≥50%, respectively. In‐hospital mortality was higher in lower LVEF patients (1.1%, 0.4%, and 0.3%, respectively, p = 0.001). In‐hospital major adverse cardiovascular events (MACE) were numerically higher in lower EF patients (2.7%, 2.1%, and 1.9%, p = 0.271). At a median follow‐up of 2 months (interquartile range: 19‐350 days), patients with lower LVEF continued to have higher mortality (4.9%, 3.2%, and 1.4%, p < 0.001) while the MACE rates were similar (9.3%, 9.6%, and 7.4%, p = 0.172). Conclusion CTO PCI can be performed with high technical success in patients with reduced LVEF but is associated with higher in‐hospital and post‐discharge mortality.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of chronic total occlusion percutaneous coronary intervention in patients with reduced left ventricular ejection fraction

Şimşek

Kostantinis

Karácsonyi

et al. 2022

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

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“…Ischemic heart disease remains a leading cause of mortality and morbidity, despite recent advancements in medical and heart failure device therapies [1]. Patients requiring revascularization following myocardial infarction, or for symptoms of angina and heart failure, are often deemed higher risk for periprocedural complications due in part to advanced age and significant medical comorbidities [1,2]. Many of these patients have anatomic surgical disease but are prohibitive risk for surgery.…”

Section: Introductionmentioning

confidence: 99%

High-Risk Percutaneous Coronary Intervention: Challenges and Considerations

Gogineni,

Shah

2024

CVIA

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“…The use of mechanical circulatory devices to support high-risk elective PCI has become more common in part due to increasing number of patients considered inoperable or high risk for surgical revascularization. 5 Estimating the need for urgent MCS could facilitate clinical decision-making and procedural planning in CTO PCI. We developed a score to identify patients at increased risk for urgent MCS.…”

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confidence: 99%

Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

Karácsonyi

Stanberry

Şimşek

et al. 2023

Preprint

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Background: Estimating the likelihood of urgent mechanical circulatory support (MCS) can facilitate procedural planning and clinical decision making in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We analyzed 2,784 CTO PCIs performed between 2012 and 2021 at 12 centers. The variable importance was estimated by a bootstrap applying a random forest algorithm to a propensity-matched sample (a ratio of 1:5 matching cases with controls on center). The identified variables were used to predict the risk of urgent MCS. The performance of the risk model was assessed in-sample as well as on 2411 out-of-sample procedures who did not require urgent MCS. Results: Urgent MCS was used in 62 (2.2%) of cases. Patients who required urgent MCS were older (70 [63, 77] vs. 66 [58, 73] years, p=0.003) compared with those who did not require urgent MCS. Technical (68% vs. 87%, p<0.001) and procedural successes (40% vs. 85%, p<0.001) were lower in the urgent MCS group compared with no urgent MCS cases. The risk model for urgent MCS use included retrograde crossing strategy, left ventricular ejection fraction, and lesion length. The resulting model demonstrated good calibration and discriminatory capacity with AUC (95%CI) of 0.79 (0.73, 0.86) and specificity and sensitivity of 86% and 52%, respectively. On the out-of-sample set, the specificity of the model was 87%. Conclusion: The PROGRESS CTO MCS score can help estimate the risk of urgent MCS use during CTO PCI.

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Mechanical Circulatory Support in High-Risk Percutaneous Coronary Intervention

Cited by 5 publications

References 53 publications

Outcomes of chronic total occlusion percutaneous coronary intervention in patients with reduced left ventricular ejection fraction

Outcomes of chronic total occlusion percutaneous coronary intervention in patients with reduced left ventricular ejection fraction

High-Risk Percutaneous Coronary Intervention: Challenges and Considerations

Development of a Novel Score to Predict Urgent Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention

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