Effect of Multivessel Coronary Disease With or Without Concurrent Chronic Total Occlusion on One-Year Mortality in Patients Treated With Primary Percutaneous Coronary Intervention for Cardiogenic Shock

2010 ◽  
Vol 105 (7) ◽  
pp. 955-959 ◽  
Author(s):  
René J. van der Schaaf ◽  
Bimmer E. Claessen ◽  
M. Marije Vis ◽  
Loes P. Hoebers ◽  
Karel T. Koch ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiogenic Shock ◽  
Coronary Disease ◽  
Primary Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
One Year

Abstract 2000: Incomplete ST-Segment Deviation Resolution after Primary Percutaneous Coronary Intervention in Patients with Multivessel Disease is Mainly Due to the Presence of a Non-Infarct-Related Chronic Total Occlusion

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Niels J Verouden ◽  
Bimmer E Claessen ◽  
René J van der Schaaf ◽  
Karel T Koch ◽  
Jan Baan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Multivessel Disease ◽  
Published Data ◽  
Primary Pci ◽  
Total Occlusion ◽  
St Segment ◽  
Percutaneous Coronary

Background Incomplete ST-segment deviation resolution (STR) after epicardial flow restoration may represent microvascular dysfunction and predicts an unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). From recently published data concerning STEMI patients that underwent primary percutaneous coronary intervention (PCI), increased mortality in patients with multivessel disease (MVD) was attributed to the presence of a chronic total occlusion (CTO) in a non-infarct-related artery (IRA). We evaluated whether the presence of MVD with or without a CTO in a non-IRA significantly contributes to incomplete STR in a large cohort of patients undergoing primary PCI for STEMI. Methods In this single-center study, 2127 STEMI patients underwent primary PCI between 2000 and 2006. The IRA and presence of MVD was determined during diagnostic angiography preceding primary PCI. MVD was assessed if ≥ 1 non-IRA showed ≥ 1 coronary stenosis of ≥ 70% and a CTO was defined as a 100% luminal narrowing in a non-IRA. STR was defined as the relative difference (in %) of the summed ST deviation between the pre-PCI and the immediately post-PCI 12-lead ECG. A post-PCI STR of ≥ 70% was considered complete. Results During emergency coronary angiography, singlevessel disease (SVD) was observed in 1474 (69.3 %) patients, MVD without a CTO in 433 (20.4 %) patients, and MVD with a CTO in a non-IRA in 220 (10.3 %) patients. MVD patients less frequently showed complete STR compared to patients with SVD (OR 1.2 95% CI, 1.0 – 1.5 p = 0.046). However, the occurrence of complete STR in SVD patients and MVD patients without a CTO was comparable (OR 1.1, 95% CI, 0.9 – 1.4 p = 0.43). In MVD patients with a CTO, STR was significantly less often complete compared to patients with SVD or with MVD without a CTO (OR 1.6 95% CI, 1.1 – 2.6 p = 0.01). Conclusion STEMI patients with MVD undergoing primary PCI showed complete STR less often compared to SVD patients. This effect is mainly due to a subgroup of MVD patients with a CTO in a non-IRA and not due to mere MVD.

123Effects of scoring or cutting balloon use on severely calcified lesions treated by percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Ikuta ◽  
A Kuwayama ◽  
T Tada ◽  
K Kadota
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Cutting Balloon ◽  
Total Occlusion ◽  
Logistic Regression Models ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
One Year ◽  
Preparation Techniques

Abstract Background Whether preparation techniques during percutaneous coronary intervention (PCI) are associated with restenosis in severely calcified lesions is not well studied. Purpose We aimed to clarify the effects of the preparation techniques during PCI on mid-term outcomes of severely calcified lesions. Methods We examined 2688 consecutive severely calcified lesions (1854 patients) treated by PCI between January 2008 and December 2017, and identified 1789 lesions (66.6%) undergoing routine follow-up angiography within one year postprocedure. The angiographic outcome measure was defined as in-stent restenosis (ISR); ISR was defined as stenosis of ≥50%. We divided the 1789 lesions into two groups on the basis of the presence or absence of ISR: ISR and non-ISR groups. Result ISR was detected in 337 of the 1789 lesions (18.8%). The ISR group, in comparison with the non-ISR group, had more chronic total occlusion lesions (17.9% vs. 12%, p<0.01), less bifurcation lesions (41.9% vs. 48.5%, p=0.03), less reference diameter (2.85±0.64 mm2 vs. 2.96±0.54 mm2, p<0.01), lower use rate of scoring or cutting balloon (13.9% vs. 23.1%, p<0.01), and lower postprocedural percent stenosis (25.9±20.7% vs. 16.9±9.3%, p<0.01). After adjusting chronic total occlusion lesions, target lesions, and other factors in multiple logistic regression models, the use of scoring or cutting balloon was independently associated with ISR (hazard ratio, 0.62; 95% confidence interval, 0.44 to 0.89; p<0.01). Conclusion Using scoring or cutting balloon is associated with good midterm results of severely calcified lesions treated by PCI.

scholarly journals Percutaneous Coronary Intervention to Treat Chronic Total Occlusion: Predictors of Technical Success and One-Year Clinical Outcome

2014 ◽  
Vol 41 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Mojtaba Salarifar ◽  
Mohammad-Reza Mousavi ◽  
Sepideh Saroukhani ◽  
Ebrahim Nematipour ◽  
Seyed Ebrahim Kassaian ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Clinical Outcome ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Technical Failure ◽  
Technical Success ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Procedural Success ◽  
One Year

We investigated the overall success rate of percutaneous coronary intervention (PCI) as a treatment for coronary chronic total occlusion and sought to determine the predictive factors of technical success and of one-year major adverse cardiac events (MACE). These factors have not been conclusively defined. Using data from our single-center PCI registry, we enrolled 269 consecutive patients (mean age, 56.13 ± 10.72 yr; 66.2% men) who underwent first-time PCI for chronic total occlusion (duration, ≥3 mo) from March 2006 through September 2010. We divided them into 2 groups: procedural success and procedural failure. We compared occurrences of in-hospital sequelae and one-year MACE between the groups, using multivariate models to determine predictors of technical failure and one-year clinical outcome. Successful revascularization was achieved in 221 patients (82.2%). One-year MACE occurred in 13 patients (4.8%), with a predominance of target-vessel revascularization (3.7%). The prevalence of MACE was significantly lower in the procedural-success group (1.8% vs 18.8%; P &lt;0.001). In the multivariate model, technical failure was the only predictor of one-year MACE. The predictors of failed procedures were lesion location, multivessel disease, the occurrence of dissection, a Thrombolysis In Myocardial Infarction flow grade of 0 before PCI, the absence of tapered-stump arterial structure, and an increase in serum creatinine level or lesion length. In our retrospective, observational study, PCI was successful in a high percentage of chronic total occlusion patients and had a low prevalence of complications. This suggests its safety and effectiveness as a therapeutic option.

scholarly journals Scoring System for Identification of “Survival Advantage” after Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion

2020 ◽  
Vol 9 (5) ◽  
pp. 1319
Author(s):  
Tatsuya Nakachi ◽  
Shun Kohsaka ◽  
Masahisa Yamane ◽  
Toshiya Muramatsu ◽  
Atsunori Okamura ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Scoring System ◽  
Chronic Total Occlusion ◽  
Clinical Decision Making ◽  
Coronary Intervention ◽  
Survival Advantage ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
One Year

Background: Percutaneous coronary intervention (PCI) is widely used in patients with chronic total occlusion (CTO), but its benefit in improving long-term outcomes is controversial. We aimed to develop a prediction score for grading “survival advantage” conferred by successful results of CTO-PCI and a scoring system for prediction of the influence of CTO-PCI results on major adverse cardiac and cerebrovascular events (MACCEs). Methods: Follow-up data of 2625 patients who underwent CTO-PCI at 65 Japanese centers were analyzed. An integer scoring system was developed by including statistical effect modifiers on the association between successful CTO-PCI and one-year mortality. Results: Follow-up at 12 months was completed in 2034 patients. During follow-up, 76 deaths (3.7%) occurred. Patients with successful CTO-PCI had a better one-year survival than patients with failed CTO-PCI (log rank P = 0.016). Effect modifiers for the association between successful procedure and one-year mortality included diabetes (P interaction = 0.043), multivessel disease (P interaction = 0.175), Canadian Cardiovascular Society class ≥2 (P interaction = 0.088), and prior myocardial infarction (MI) (P interaction = 0.117). Each component was assigned a single point and summed to develop the scoring system. The patients were then categorized to specify the prediction of survival advantage by successful PCI: ≤2 (normal) and ≥3 (distinct). The differences in one-year mortality between patients with successful and failed treatment were −0.7% and 11.3% for normal and distinct score categories, respectively. In the scoring system for MACCE, score components were prior MI (P interaction = 0.19), left anterior descending artery (LAD)-CTO (P interaction = 0.079), and reattempt of CTO-PCI (P interaction = 0.18). The differences in one-year MACCEs between successful and failed patients for each score category (0, 1, and ≥2) were −1.7%, 7.5%, and 15.1%, respectively. Conclusions: The novel scoring system assessing the advantage of successful PCI can be easily applied in patients with CTO. It is a valid instrument for clinical decision-making while assessing the survival advantage of CTO-PCI and the influence of procedural results on MACCEs.

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