Prognostic Impact of Percutaneous Coronary Intervention of Chronic Total Occlusion in Acute and Periprocedural Myocardial Infarction

Kim, Seung Hyun; Behnes, Michael; Mashayekhi, Kambis; Meyer‐Geßner, Markus; El‐Battrawy, Ibrahim; Akın, İbrahim

doi:10.3390/jcm10020258

Cited by 11 publications

(12 citation statements)

References 102 publications

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“…In patients with AMI, the presence of concurrent CTO is associated with increased mortality 3,6 . The pathological mechanisms involved include aggravated ischemia caused by occlusion of IRA and subsequent interruption of collateral supply to non‐IRA CTO, microvascular ischemia, reperfusion injury, and electrical instability, which may lead to poorer outcomes in these patients compared with patients who suffered from CTO and stable CAD 25 . Theoretically, revascularization of non‐IRA CTO after IRA PCI might yield more clinical benefits, as the recovery of blood supply in both the CTO territory and overlapping border of the infarct zone may reduce left ventricular remodeling and improve contractile function.…”

Section: Discussionmentioning

confidence: 99%

A comparison of long‐term clinical outcomes between percutaneous coronary intervention (PCI) and medical therapy in patients with chronic total occlusion in noninfarct‐related artery after PCI of acute myocardial infarction

Qin

Chen

et al. 2022

Clinical Cardiology

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Background: Chronic total occlusion (CTO) in a noninfarct-related artery (IRA) is one of the risk factors for mortality after acute myocardial infarction (AMI). However, there are limited data comparing the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with patients having medical therapy (MT) in CTO lesion after AMI PCI.Methods: We retrospectively enrolled 330 patients (successful CTO PCI in 166 patients, failed CTO PCI in 32 patients, MT in 132 patients) with non-IRA CTO from a total of 4372 patients who underwent PCI after AMI in our center. Propensity score matching (PSM) was used to adjust for baseline differences.Results: The primary analysis is based on the intention-to-treat population. During a median follow-up period of 946 days, patients in the PCI group (n = 198) had significantly higher cardiac death-free survival (96.6% vs. 82.8%, p = .004) compared with patients in MT group (n = 132). However, no significant difference in the occurrence of cardiac death was observed after PSM. The analysis based on the perprotocol population demonstrated significantly higher cardiac death-free survival in the successful CTO PCI group (n = 166) compared with the occluded CTO group (n = 164) both before and after PSM. In subgroup analysis, successful CTO PCI was associated with less cardiac death in patients over 65 years old, with LVEF < 50%, left anterior descending (LAD) IRA, and non-LAD CTO lesion compared with occluded CTO group.Conclusions: Patients undergoing successful revascularization of non-IRA CTO after AMI might have a better long-term prognosis. Moreover, patients with LVEF < 50% may benefit from successful non-IRA CTO PCI after AMI.

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Section: Discussionmentioning

confidence: 99%

A comparison of long‐term clinical outcomes between percutaneous coronary intervention (PCI) and medical therapy in patients with chronic total occlusion in noninfarct‐related artery after PCI of acute myocardial infarction

Qin

Chen

et al. 2022

Clinical Cardiology

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“…The decrease of HSP70 from day 1 to day 7 after the acute insult of MI may result from circulating HSP70 shifting into the dying cells at the ischemic site, imposing intracellular protective effects, which remains to be validated. The formation of CTO lesion is with concomitant coronary collateral circulation development ( 23 ), which to some extent offers benefits for sustaining the oxygen supply in ischemic sites of the myocardium. Besides, the complex mechanisms underlying CTO formation also underscore the long-term ischemia-related myocardial stunning ( 23 ), which is characterized by the altered expression of metabolic and prosurvival proteins ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…The formation of CTO lesion is with concomitant coronary collateral circulation development ( 23 ), which to some extent offers benefits for sustaining the oxygen supply in ischemic sites of the myocardium. Besides, the complex mechanisms underlying CTO formation also underscore the long-term ischemia-related myocardial stunning ( 23 ), which is characterized by the altered expression of metabolic and prosurvival proteins ( 24 ). Thus, the increased level of HSP70 from the acute phase of infarction to CTO may implicate the possible “prosurvival” role of HSP70 in the development of collateral connections and myocardial hibernation, which needs to be proven in experimental models.…”

Section: Discussionmentioning

confidence: 99%

Plasma Heat Shock Protein 70 Is Associated With the Onset of Acute Myocardial Infarction and Total Occlusion in Target Vessels

Gao

Dong

et al. 2021

Front. Cardiovasc. Med.

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Background: Whether the role of plasma heat shock protein 70 (HSP70) in acute myocardial infarction (AMI) is protective or detrimental remains debated, and the relationship between HSP70 and total occlusion remains elusive.Methods: A total of 112 patients with primary diagnosis of AMI and 52 patients with chronic coronary syndrome (CCS) were enrolled into the study. Plasma HSP70 level was determined by ELISA on day 1 and day 7 after the onset of AMI and was examined before angiography in patients with CCS. Peak NT-proBNP, high-sensitivity C-reactive protein (CRP), troponin T (cTnT), and left ventricular ejection fraction were measured.Results: Plasma HSP70 was significantly higher in CCS than AMI (P < 0.0001), and it showed a significant decrease from day 1 to day 7 after AMI (P < 0.01). Elevated HSP70 was associated with decreased levels of LDL-C (P < 0.05), peak cTnT (R = −0.3578, P < 0.0001), peak NT-proBNP (R = −0.3583, P < 0.0001), and peak CRP (R = −0.3539, P < 0.0001) and a lower diagnosis of AMI (R = −0.4016, P < 0.0001) and STEMI (R = −0.3675, P < 0.0001), but a higher diagnosis of total occlusion in target vessels (R = 0.1702, P < 0.05). HSP70 may provide certain predictive value for the diagnosis of AMI, STEMI, and total occlusion in target vessels, and the area under the receiver operating characteristic curves were 0.7660, 0.7152, and 0.5984, respectively. HSP70 was also negatively associated with in-hospital stay (P < 0.001) and positively correlated with left ventricular ejection fraction (LVEF) at 1-year follow-up (P < 0.05), despite no association with in-hospital major adverse cardiovascular events (MACE).Conclusion: Plasma HSP70 level was found to decrease from day 1 to day 7 post-AMI, but the overall level of patients with AMI was lower than that of patients with CCS. However, the ability of HSP70 to identify clinically significant AMI and STEMI was moderate, and the predictive value to total occlusion was slight.

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“…Although there is no clear evidence about the clinical benefit of revascularization of concurrent CTO in AMI patients, the available data are in favor of a complete coronary revascularization[ 40 , 41 ]. A possible explanation for the conflicting results in this setting, could be that the timing of the revascularization procedure following primary PCI must be individualized on the basis of the clinical characteristics of each patient; the application of a standardized timing in this complex clinical and procedural setting cannot be generalized.…”

Section: Acute Myocardial Infarction With Concomitant Chronic Occlusionmentioning

confidence: 99%

Chronic total occlusion revascularization: A complex piece to "complete" the puzzle

Muraca¹,

Carrabba²,

Virgili³

et al. 2022

WJC

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Treatment of coronary chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) has rapidly increased during the past decades. Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success. The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently, has led to an exponential increase in the number of CTO-PCI procedures, even if are still underutilized. It has been widely demonstrated that complete coronary revascularization, achieved by either coronary artery bypass graft or PCI, is associated with prognostic improvement, in terms of increased survival and reduction of major adverse cardiovascular events. The application of “contemporary” strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit, even in high-risk patients or complex coronary anatomy with CTO. The increasing success of CTO-PCI, allowing a complete or reasonable incomplete coronary revascularization, is enabling to overcome the last great challenge of interventional cardiology, adding a “complex” piece to “complete” the puzzle.

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Prognostic Impact of Percutaneous Coronary Intervention of Chronic Total Occlusion in Acute and Periprocedural Myocardial Infarction

Cited by 11 publications

References 102 publications

A comparison of long‐term clinical outcomes between percutaneous coronary intervention (PCI) and medical therapy in patients with chronic total occlusion in noninfarct‐related artery after PCI of acute myocardial infarction

A comparison of long‐term clinical outcomes between percutaneous coronary intervention (PCI) and medical therapy in patients with chronic total occlusion in noninfarct‐related artery after PCI of acute myocardial infarction

Plasma Heat Shock Protein 70 Is Associated With the Onset of Acute Myocardial Infarction and Total Occlusion in Target Vessels

Chronic total occlusion revascularization: A complex piece to "complete" the puzzle

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