The Negative Impact of Incomplete Angiographic Revascularization on Clinical Outcomes and Its Association With Total Occlusions

Farooq, Vasim; Serruys, Patrick W.; García‐García, Héctor M.; Zhang, Yaojun; Bourantas, Christos V.; Holmes, David R.; Mack, Michael J.; Feldman, Ted; Morice, Marie Claude; Ståhle, Elisabeth; James, Stefan; Colombo, Antonio; Diletti, Roberto; Papafaklis, Michail I.; Vries, Ton de; Morel, Marie Angèle; Es, Gerrit Anne van; Mohr, Friedrich W.; Dawkins, Keith D.; Kappetein, Arie Pieter; Sianos, Georgios; Boersma, Eric

doi:10.1016/j.jacc.2012.10.017

Cited by 269 publications

(163 citation statements)

References 42 publications

Supporting

Mentioning

146

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

“…Importantly, the presence of chronic total occlusion (CTO) is the strongest independent predictor of incomplete revascularization in patients undergoing PCI 4. Among hemodialysis patients, the proportion of coronary revascularization of target CTO lesions has been reported to be as high as 20% 5.…”

Section: Introductionmentioning

confidence: 99%

Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry

Nakatani

Kohsaka

Yamane³

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundAmong patients treated with percutaneous coronary intervention for chronic total occlusion (CTO‐PCI), patients on long‐term hemodialysis are at significantly high risk for cardiovascular mortality and morbidity. However, clinical or angiographic predictors that might aid in better patient selection remain unclear. We aimed to assess the acute impact of hemodialysis in patients who underwent CTO‐PCI.Methods and ResultsThe Retrograde Summit registry is a multicenter, prospective registry of patients undergoing CTO‐PCI at 65 Japanese centers. Patient characteristics and procedural outcomes of 4749 patients were analyzed, according to the presence (n=313) or absence (n=4436) of baseline hemodialysis. A prediction model for technical failure among hemodialysis patients was also developed. The technical success rate of CTO‐PCI was significantly lower in hemodialysis than in nonhemodialysis patients (78.0% versus 89.1%, P<0.001). The rates of in‐hospital major adverse cardiac and cerebrovascular events were similar between the 2 groups (1.6% versus 0.9%, P=0.24). Irrespective of clinical/angiographic characteristics or previously developed scoring systems, hemodialysis independently predicted technical failure for CTO‐PCI. Among hemodialysis patients, predictors of technical failure were blunt stump (odds ratio 2.45, 95% confidence interval, 1.15–5.21, P=0.021), severe lesion calcification (odds ratio 2.50, 95% confidence interval, 1.19–5.24, P=0.015), and absence of diabetes mellitus (odds ratio 3.15, 95% confidence interval, 1.49–6.64, P=0.003). In hemodialysis patients without these predictors, the technical success rate was 96.2%.ConclusionsHemodialysis is significantly associated with technical failure. Contemporary CTO‐PCI seems feasible and safe in selected hemodialysis patients.

show abstract

“…18) A recent post-hoc analysis from the 4-year outcomes of the SYNTAX Trial and Registry showed that angiographic complete revascularization was achieved in only 52.8% of the PCI arm and 66.9% of the CABG arm. 32) Patients with incomplete revascularization had a significantly higher risk of death, MI, and repeat revascularization in both the PCI and CABG groups.…”

Section: Considerations On Randomized Controlled Trialsmentioning

confidence: 91%

“…Several studies have demonstrated that incomplete revascularization is an independent predictor of MACE and repeat revascularization. [31][32][33] An important limitation of the reported trials was that they did not evaluate the impact of the degree of revascularization (compared between CABG and PCI) on outcomes. In the CARDia Trial 16) 65% of PCI patients had 3-vessel disease, of whom 88% had complete revascularization.…”

Section: Considerations On Randomized Controlled Trialsmentioning

confidence: 99%

CABG Versus PCI in the Treatment of Diabetic Patients Affected by Coronary Artery Disease

Nicolini

Agostinelli²,

Vezzani³

et al. 2014

Int. Heart J.

View full text Add to dashboard Cite

SummarySurgical coronary revascularization and percutaneous coronary intervention were demonstrated to be effective treatments for coronary artery disease. However, the optimal revascularization strategy remains unclear in certain patient subsets. The recently published Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) trial is a randomized study evaluating the use of CABG versus PCI in diabetic patients with multivessel coronary disease. The purpose of this study was to review the available literature based on randomized trials and observational studies in order to allow clinicians to make evidence-based decisions when treating diabetic patients with multivessel coronary disease. The current evidence suggests that CABG should remain the standard of care for this patient population. (Int Heart J 2014; 55: 469-473)

show abstract

The Negative Impact of Incomplete Angiographic Revascularization on Clinical Outcomes and Its Association With Total Occlusions

Abstract: Within the PCI and CABG arms of the all-comers SYNTAX trial, angiographically determined ICR has a detrimental impact on long-term clinical outcomes, including mortality. This effect remained consistent in patients with and without TOs.

Cited by 269 publications

References 42 publications

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

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

Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry

CABG Versus PCI in the Treatment of Diabetic Patients Affected by Coronary Artery Disease

Contact Info

Product

Resources

About