The impact of gender on outcomes in patients with chronic total coronary occlusions undergoing percutaneous coronary intervention: results from a Dutch nationwide registry including 7560 patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Van Veelen ◽  
J Elias ◽  
I.M Van Dongen ◽  
J.P.S Henriques ◽  
P Knaapen
Keyword(s):  
Cardiovascular Disease ◽  
Percutaneous Coronary Intervention ◽  
Survival Curve ◽  
Coronary Intervention ◽  
Chronic Total Occlusions ◽  
Nationwide Registry ◽  
Percutaneous Coronary ◽  
Baseline Characteristics ◽  
Gender Based ◽  
The Impact

Abstract Background Females comprise a minority of patients with chronic total occlusions (CTO). It is known that men have a greater benefit from CTO percutaneous coronary intervention (PCI) than women. We aimed to determine gender-based differences in baseline characteristics and outcomes after PCI in patients with CTO. Methods The Netherlands Heart Registration (NHR) is a nationwide registry that registers outcomes of cardiac interventions. For the purpose of this analysis, the data of all patients undergoing PCI from inception of the NHR to December 2018 were selected, that included PCI with at least one CTO in one of the treated coronary arteries. We compared baseline characteristics and the outcomes 1 year mortality, 30 day myocardial infarction (MI) and target vessel revascularization (TVR) <1 year between men and women. Results A total of 7560 patients were identified that underwent PCI between January 1, 2015 and December 31, 2018 with at least 1 CTO in the treated vessel. A total of 5850 was male (77.4%) and 1710 was female (22.6%). Women were older (68.5±10.6 versus 64.7±10.6 years old, p<0.001), and more frequently had diabetes (29.4% [n=529] versus 25.0% [n=1602], p<0.001) and kidney disease (4.5% [n=529] versus 2.2% [n=142], p<0.001). However, men had more extensive cardiovascular disease, i.e. multi-vessel disease (56.0% [n=3584] versus 50.4% [n=912], p<0.001), previous MI (39.7% [n=2527] versus 31.0% [n=555], p<0.001), previous PCI (48.2% [n=1967] versus 40.2% [n=455], p<0.001) and previous coronary artery bypass grafting (16.8% [n=1085] versus 10.5% [n=191], p<0.001) and more frequently presented with an out-of-hospital cardiac arrest, compared to women (2.1% [n=136] versus 1.1% [n=20], p=0.004). The 1-year mortality was higher in women (10.3% versus 7.5%, p<0.001), as well as the 30-day MI (0.9% versus 0.4%, p=0.043), but men had higher risk for TVR<1 year (11.7% versus 9.5%, p=0.044). Corrected for age and comorbidities, female gender was an independent predictor for mortality (Figure 1; odds ratio 1.83, 95% confidence interval 1.08–3.11, p=0.025). Conclusion In this nationwide registry comprising 7560 CTO patients undergoing PCI, significant gender-based differences were found. Males were found to have more extensive cardiovascular disease. However, females were at higher risk of mortality, possibly due to higher age and higher prevalence of concomitant comorbidities. Figure 1. Survival curve Funding Acknowledgement Type of funding source: None

scholarly journals The Impact of Successful Chronic Total Occlusion Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Real World

2020 ◽  
Author(s):  
Xuhe Gong ◽  
Li Zhou ◽  
Xiaosong Ding ◽  
Hui Chen ◽  
Hongwei Li
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Real World ◽  
Cardiac Death ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
The Impact

Abstract Backgroud: Chronic total occlusions (CTOs) are an important and increasingly recognized subgroup of coronary lesions; the optimal treatment strategy for CTO has not been well established. We sought to examine the impact of CTO percutaneous coronary intervention (PCI) on long-term clinical outcome in the real world.Methods: A total of 592 consecutive patients with CTO in Beijing Friendship Hospital from June 2017 to December 2019 were enrolled. 29 patients were excluded due to Coronary artery bypass grafting (CABG), 301 patients were revascularized by PCI (CTO-R group) and 262 were not revascularized (CTO-NR group). The primary endpoint was cardiac death; Secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, cardiac death, recurrent myocardial infarction, target lesion revascularization, re-hospitalization, heart failure, and stroke. Results: Percent of Diabetes mellitus (53.4% vs 39.5), Chronic kidney disease (8.8% vs 3.7%), CABG history (7.6% vs 1%), three vessel disease(96.2% vs 90%) and LM disease(25.2% vs 13.6%) was significantly higher in the CTO-NR group than in success PCI group (all P<0.05). Moreover, the CTO-NR group has lower EF (0.58±0.11 vs 0.61±0.1, p=0.002) and FS (0.32±0.07 vs 0.33±0.07, p=0.003). At a median follow-up of 12 months, CTO-R was superior to CTO-NR in terms of cardiac death (adjusted hazard ratio [HR]: 0.32, 95% conference interval [CI] 0.11-0.94). The superiority of CTO-R was consistent for MACCE (HR: 0.57, 95% CI 0.37-0.87). At multivariable Cox hazards regression analysis, CTO-R remains one of the independent predictors of lower risk of cardiac death and MACCE.Conclusions: Successful revascularization by PCI offered CTO patients more clinical benefits. The presence of LVEF＜0.5 and LM-disease was associated with an incidence of cardiac death; CTO revascularised was a protected predictor of cardiac death.

scholarly journals Left Main Coronary Artery Disease and Outcomes after Percutaneous Coronary Intervention for Chronic Total Occlusions

2020 ◽  
Vol 9 (4) ◽  
pp. 938 ◽  
Author(s):  
Max-Paul Winter ◽  
Georg Goliasch ◽  
Philipp Bartko ◽  
Jolanta Siller-Matula ◽  
Mohamed Ayoub ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Study Endpoint ◽  
Primary Study ◽  
Left Main ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
The Impact

Background: Concomitant left main coronary artery (LMCA) disease in patients with chronic total occlusions (CTO) commonly results in referral for coronary artery bypass grafting, although the impact of LMCA in CTO patients remains largely unknown. Nevertheless, patient selection for percutaneous coronary intervention of CTOs (CTO-PCI) or alternative revascularization strategies should be based on precise evaluation of the coronary anatomy to anticipate those patients that most likely benefit from a procedure and not on strict adherence to perpetual clinical practice. Therefore, the aim of this study was to assess the impact of LMCA disease on long-term outcomes in patients undergoing percutaneous coronary intervention for CTO. Methods: We enrolled 3860 consecutive patients undergoing PCI for at least one CTO lesion and investigated the predictive value of concomitant LMCA disease. All-cause mortality was defined as the primary study endpoint. Results: We observed that LMCA disease is significantly associated with mortality. In the Cox regression analysis, we observed a crude hazard ratio (HR) 1.59 (95% confidence interval (CI) 1.23–2.04, p < 0.001) for patients with LMCA disease as compared to patients without. Results remained unchanged after bootstrap- or clinical confounder-based adjustment. Conclusion: LMCA disease is associated with excess mortality in CTO patients. Specifically, anatomical features such as CTO of the circumflex artery represent a high risk patient population.

Abstract 18938: Prognostically Important Myocardial Infarctions are Markedly Underreported in Patients Undergoing Percutaneous Coronary Intervention: Insights from CHAMPION PHOENIX

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kenneth W Mahaffey ◽  
Deepak L Bhatt ◽  
Gregg W Stone ◽  
C. Michael Gibson ◽  
P. Gabriel Steg ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Composite Endpoint ◽  
Coronary Intervention ◽  
Myocardial Infarctions ◽  
Clinical Events ◽  
Percutaneous Coronary ◽  
Baseline Characteristics ◽  
Treatment Comparisons ◽  
The Impact ◽  
Clinical Events Committee

Objectives: In the CHAMPION PHOENIX trial, cangrelor was shown to reduce the primary composite endpoint of death, myocardial infarction (MI), ischemia driven revascularization, or stent thrombosis at 48 hours. We explored the effect of cangrelor on MI including different types of MI and the impact of event adjudication. Methods: A central clinical events committee (CEC) systematically identified and adjudicated MI events using pre-defined MI criteria. 30-day death was modeled using baseline characteristics including PCI related MIs. Results: Overall, 10,942 patients were included in the primary analyses; 462 patients had at least one MI at 48 hours reported by the CEC (207 [3.8 %] cangrelor; 255 [4.7 %] clopidogrel; OR 0.80; 95% CI [0.67, 0.97]; P = 0.022), and 143 patients had at least one MI at 48 hours reported by the site investigators (60 [1.1%] cangrelor; 83 [1.5%] clopidogrel; OR 0.72; 95% CI [0.52, 1.01]; P = 0.053). The Table shows the MI types reported by the CEC, the site investigator reported MIs and treatment comparisons. Of the 462 MIs reported by the CEC, 92 (19.9%) were also reported by site investigators, and 370 (80.1%) were not (170 in cangrelor group, 200 in clopidogrel group). Of the 143 MI events reported by the Site Investigators, CEC reported an MI in 92 (64.3%). CEC reported MI events were independently predictive of 30 day mortality OR 3.48; 95% CI (2.00 - 6.03). Conclusions: In patients with ACS undergoing PCI, CEC procedures identified three times as many MIs as the site investigators reported. Site investigators under-report MIs related to percutaneous coronary intervention. MIs reported by the CEC were independently associated with worse 30-day death. The overall efficacy of cangrelor was similar on MIs reported by the site investigators or the CEC.

scholarly journals The Impact of Calcium on Chronic Total Occlusion Management

2021 ◽  
Vol 16 ◽  
Author(s):  
Claudia Cosgrove ◽  
Kalaivani Mahadevan ◽  
James C Spratt ◽  
Margaret McEntegart
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Success Rates ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
Procedural Success ◽  
The Impact

Coronary artery calcification is prevalent in chronic total occlusions (CTO), particularly in those of longer duration and post-coronary artery bypass. The presence of calcium predicts lower procedural success rates and a higher risk of complications of CTO percutaneous coronary intervention. Adjunctive imaging, including pre-procedural computed tomography and intracoronary imaging, are useful to understand the distribution and morphology of the calcium. Specialised guidewires and microcatheters, as well as penetration, subintimal entry and luminal re-entry techniques, are required to cross calcific CTOs. The use of both atherectomy devices and balloon-based calcium modification tools has been reported during CTO percutaneous coronary intervention, although they are limited by concerns regarding safety and efficacy in the subintimal space.

scholarly journals New Aspects in Percutaneous Coronary Intervention of Chronic Total Occlusions

2019 ◽  
Author(s):  
Judit Karácsonyi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Intravascular Imaging ◽  
Complication Rates ◽  
Technical Failure ◽  
Success Rates ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
Procedural Success ◽  
The Impact

Coronary Chronic total occlusions (CTOs) are defined as coronary lesions with Thrombolysis in Myocardial Infarction (TIMI) grade 0 flow of at least 3-month duration. Symptomatic patients with CTOs can be managed in three ways, conservatively with medical therapy, with coronary artery bypass grafting (CABG) or with percutaneous coronary intervention (PCI). CTO PCI can be challenging to perform with variable success rates, depending on operator experience and expertise, but with the development of new techniques and equipment the success rates are getting higher and the complication rates lower. In this dissertation, we focused on three aspects of CTO PCI: (a) the impact of prior failure on the outcomes of CTO PCI, (b) balloon uncrossable lesions and (c) the frequency of use and outcomes of intravascular imaging. We examined the prevalence, clinical and angiographic characteristics, management and procedural outcomes of CTO PCIs in a contemporary, large, multicenter CTO PCI registry. Prior CTO PCI failure has been associated with lower procedural success rates and is part of the Japanese Chronic Total Occlusion (J-CTO) score that was developed to predict the likelihood of successful guidewire crossing within 30 minutes. We sought to examine the impact of prior failure on the subsequent outcomes CTO PCI. The main finding of our study is that a prior failed CTO PCI attempt is associated with higher angiographic complexity, longer procedural duration and fluoroscopy time, but not with lower success and higher complication rates of subsequent CTO PCI attempts. Balloon uncrossable lesions are lesions that cannot be crossed with a balloon after successful advancement of the guidewire distal to the lesion. These lesions can be challenging to treat, requiring specialized techniques and equipment. In our study, we found that balloon uncrossable CTOs are common, are associated with high rates of technical failure, and require specialized techniques for successful treatment. Intravascular imaging can facilitate CTO PCI. Use of intravascular ultrasound (IVUS) for stent optimization during CTO PCI has been shown to improve long-term outcomes, yet its impact on crossing has received limited study. In our study, we found that intravascular imaging is frequently performed during CTO PCI both for crossing and for stent selection/ optimization. Despite its use in more complex lesion subsets, intravascular imaging was associated with similar rates of technical and procedural success for CTO PCI.

Percutaneous Coronary Intervention in Patients with Diabetes and Multivessel or Left Main Disease – a Review

2012 ◽  
Vol 7 (1) ◽  
pp. 37
Author(s):  
Donald E Cutlip ◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Statistical Significance ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Patients With Diabetes ◽  
The Impact

Coronary artery disease in patients with diabetes is frequently a diffuse process with multivessel involvement and is associated with increased risk for myocardial infarction and death. The role of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and multivessel disease who require revascularisation has been debated and remains uncertain. The debate has been continued mainly because of the question to what degree an increased risk for in-stent restenosis among patients with diabetes contributes to other late adverse outcomes. This article reviews outcomes from early trials of balloon angioplasty versus CABG through later trials of bare-metal stents versus CABG and more recent data with drug-eluting stents as the comparator. Although not all studies have been powered to show statistical significance, the results have been generally consistent with a mortality benefit for CABG versus PCI, despite differential risks for restenosis with the various PCI approaches. The review also considers the impact of mammary artery grafting of the left anterior descending artery and individual case selection on these results, and proposes an algorithm for selection of patients in whom PCI remains a reasonable strategy.

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