Predictors of poor clinical outcomes after successful chronic total occlusion intervention with drug-eluting stents

Kim, Gwang-Sil; Kim, Byeong Keuk; Shin, Dong Ho; Kim, Jung-Sun; Hong, Myeong Ki; Gwon, Hyeon‐Cheol; Kim, Hyo–Soo; Yu, Cheol Woong; Park, Hun Sik; Chae, In‐Ho; Rha, Seung Woon; Jang, Yangsoo; Registry, K-Cto

doi:10.1097/mca.0000000000000498

Cited by 13 publications

(8 citation statements)

References 28 publications

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“…Besides, CKD was not routinely evaluated among CTO patients in previous studies. 26 , 33 , 36 In present study, only 51 (7%) patients were with CKD in successful CTO PCI group in our study, and the mean contrast volume was 227mL. Hydration, before and after the CTO procedure, was effective to reduce the occurrence of CIN.…”

Section: Discussionmentioning

confidence: 50%

“… 24 Herein, diabetes mellitus was associated with MACE, consistent with previous reports. 25 , 26 Diabetic patients have more comorbidities, significant atherosclerotic burden, longer and more complex coronary lesions, and more adverse cardiovascular events, probably due to frequent hyperplasia, platelet hyperreactivity, increased fibrinogen levels, thromboxane, proinflammatory states, systemic endothelial dysfunction, and metabolic disorders. 27 , 28 Notably, collateral circulation development is less common in diabetic patients than in non-diabetic patients when coronary arteries become occluded.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Adverse Events Among Chronic Total Occlusion Patients Undergoing Successful Percutaneous Coronary Intervention and Medical Therapy

Yang¹,

Guo²,

Lv³

et al. 2021

CIA

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Objective Limited data are available on the predictors of major adverse cardiac events (MACE) after a successful coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and medical therapy. This study aimed to identify predictors of MACE in CTO patients undergoing successful recanalization and medical therapy. Methods A total of 2015 patients with CTOs were enrolled. About 718 patients underwent successful CTO recanalization, and 1297 patients received medical therapy. The primary outcome was the frequency of MACE, defined as a composite of cardiac death, myocardial infarction, and target-vessel revascularization. Multivariate models were used to determine predictors of MACE. Results In successful CTO recanalization group, MACE occurred in 123 (17.1%) patients. In multivariate analysis, heart failure (hazard ratio [HR] 1.77, 95% confidence interval [CI]: 1.04–3.04, p = 0.036) was identified as independent predictors for MACE in successful CTO recanalization. Additionally, in medical therapy group, the significant predictors of MACE were male gender (HR 1.53, 95% CI: 1.13–2.05, p = 0.005), diabetes mellitus (HR 1.39, 95% CI: 1.11–1.74, p = 0.003), heart failure (HR 1.44, 95% CI: 1.10–1.87, p = 0.007), J-CTO score (HR 1.17, 95% CI: 1.07–1.28, p = 0.001) and multivessel disease (HR 2.20, 95% CI: 1.42–3.39, p < 0.001). Conclusion Heart failure was predictor for composite cardiovascular events in patients with CTO after successful recanalization. Male gender, diabetes mellitus, heart failure, J-CTO score and multivessel disease were predictors of MACE in CTO patients with medical therapy.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Predictors of Adverse Events Among Chronic Total Occlusion Patients Undergoing Successful Percutaneous Coronary Intervention and Medical Therapy

Yang¹,

Guo²,

Lv³

et al. 2021

CIA

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“…IVUS-XPL (lesion length > 28 mm) and CTO-IVUS clinical trials have both shown significant reductions in MACE with IVUS. [31][32][33] In IVUS-XPL trial, major adverse cardiac events at 5 years occurred in 36 patients (5.6%) receiving IVUS guided PCI and in 70 patients (10.7%) receiving angiographic guidance (hazard ratio: 0.50; 95% confidence interval: 0.34 to 0.75; p = 0.001). 33 Further, in a randomized control clinical trial of 402 CTO procedures, MACE was significantly lower in IVUS guided PCI group compared with angiographic guided group (2.6% vs. 7.1%, p = 0.035; HR: 0.35, CI: 0.13-0.97).…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length

Shoaib

Spratt

Curzen

et al. 2021

Cathet Cardio Intervent

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Background: Long lesions are known to have worse outcomes following percutaneous coronary intervention (PCI), but there are limited data assessing the association between lesion length and clinical outcomes in PCI procedures undertaken in chronic total occlusions (CTO). Methods and results:We formed a longitudinal cohort (2006-2018, n = 27,205) of stable angina patients who underwent PCI to CTO in the British Cardiovascular Intervention Society (BCIS) database. Clinical, demographical, procedural, and outcome data were analyzed in three groups by treated segment length, < 30 mm (n = 11,782), 30-59 mm (n = 10,415), ≥ 60 mm (n = 5008). Prevalence of previous myocardial infarction and PCI were higher in patients in 30-59 mm group or ≥ 60 mm group compared with < 30 mm group. Following multivariable analysis, no significant difference was observed in in-patient death (OR = 30-59 mm

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“…Чем длиннее поражение, тем ниже частота успеха. Представленные данные согласуются с результатами других авторов и показывают, что длина ХОКА >30 мм служит предиктором безуспешного ЧКВ ХОКА [30,31]. В случае длинных ХОКА чаще приходится прибегать к ретроградной реканализации через систему коллатеральных ветвей.…”

Section: Discussionunclassified

Predictors of unsuccessful endovascular recanalization of coronary chronic total occlusion

Васильев¹,

Руденко²,

Шаноян³

et al. 2021

Cardiovasc Ther Prev

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The prevalence of endovascular interventions for coronary chronic total occlusion (CTO) remains small worldwide. This is due to the complexity of procedure and the risk of intraoperative complications. In this regard, the search for predictors of unsuccessful endovascular intervention in CTO plays a special role. This will allow for a careful selection of patients with the most favorable expectation effect of the operation. Aim. To identify predictors of unsuccessful endovascular recanalization of CTO.Material and methods. This retrospective study included 180 patients with chronic coronary artery disease (CAD) in the period from November 2017 to June 2019, who had multivessel lesion in combination with CTO. In all patients, an attempt was made to achieve complete myocardial revascularization. Depending on the success of procedure, the patients were divided into two groups: complete and incomplete myocardial revascularization. The follow-up period was 12 months.Results. All baseline characteristics of patients in the compared groups were similar. The successful recanalization rate of occlusion was 79,5%. Multivariate regression analysis showed that calcified CTO (p<0,001), baseline SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score >32 (p=0,006), CTO length >30 mm (p=0,046) and CTO of circumflex artery (p<0,01) are significant predictors of unsuccessful endovascular recanalization of CTO. To assess the predictive value of the model, a ROC analysis was carried out, and the area under the curve (AUC) was calculated. The AUC was 0,87, which indicates a high predictive quality of the model. The sensitivity and specificity of the model were 78 and 81%, respectively.Conclusion. The study showed that the presence of calcified CTO, SYNTAX score >32 points, CTO length >30 mm, and CTO of circumflex artery are significant predictors of unsuccessful CTO recanalization.

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Predictors of poor clinical outcomes after successful chronic total occlusion intervention with drug-eluting stents

Cited by 13 publications

References 28 publications

Predictors of Adverse Events Among Chronic Total Occlusion Patients Undergoing Successful Percutaneous Coronary Intervention and Medical Therapy

Predictors of Adverse Events Among Chronic Total Occlusion Patients Undergoing Successful Percutaneous Coronary Intervention and Medical Therapy

Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length

Predictors of unsuccessful endovascular recanalization of coronary chronic total occlusion

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