Ischemic burden reduction after chronic total occlusion percutaneous coronary intervention related to patient prognosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.P Schumacher ◽  
W.J Stuijfzand ◽  
H Everaars ◽  
P.A Van Diemen ◽  
M.J Bom ◽  
...  
Keyword(s):  
Perfusion Defect ◽  
Coronary Intervention ◽  
Defect Size ◽  
Event Free Survival ◽  
Total Occlusion ◽  
Free Survival ◽  
Perfusion Defect Size ◽  
Percutaneous Coronary ◽  
Patient Prognosis

Abstract Background Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) leads to major reductions in ischemic burden. However, to date, studies investigating if more ischemia reduction after CTO PCI translates into an improved patient prognosis, are lacking. Purpose To evaluate if change in absolute myocardial perfusion after CTO PCI is related to patient prognosis. Methods Between 2013–2019, 219 prospectively recruited patients with a CTO underwent quantitative [15O]H2O positron emission tomography perfusion imaging before and 3 months after successful CTO PCI in a single high-volume CTO PCI center (175 procedures/year). Changes in perfusion defect size (in myocardial segments) and hyperemic myocardial blood flow (MBF, in mL min–1 g–1) within the CTO territory after PCI were related to the combined endpoint of death or myocardial infarction (MI). Kaplan-Meier curves (log-rank test) and multivariable Cox regression (including covariates age, gender, prior MI, and left ventricular function) were used to analyze unadjusted and risk-adjusted event-free survivals with HR [95% CI]. Results Out of 213 (97%) patients with a median follow-up of 3.2 [2.1–4.7] years, 22 (10%) patients experienced the composite of death (19, 9%) or MI (5, 2%). Event-free survival was significantly improved in patients with a perfusion defect size reduction of ≥3 segments (N=132, 62%) after CTO PCI compared to <3 segments (p=0.01, risk-adjusted: p=0.02 with HR 0.36 [0.15–0.87]), as well in patients with increase in hyperemic MBF above the median of the population (delta >1.13 mL min–1 g–1) as compared to below the median (p<0.01, risk-adjusted: p=0.01 with HR 0.27 [0.10–0.75]). After PCI, patients with ≥1 segment residual perfusion defect size in the CTO territory at follow-up (N=114, 54%) had a significantly worse event-free survival compared to patients with no residual defect size (p<0.01, risk-adjusted: p=0.01 with HR 4.12 [1.35–12.59]), whereas patients with a residual hyperemic MBF >2.30 mL min–1 g–1 (N=105, 49%) showed a better event-free survival compared to patients with lower residual hyperemic MBF levels (p=0.02, risk-adjusted: p=0.04 with HR 0.33 [0.12–0.95]). Conclusions Patients with more ischemic burden reduction and less residual ischemia following CTO PCI showed a major improved survival free of death or MI. A limitation was the low absolute number of events that prohibited more extensive risk-adjustment of the analyses. Funding Acknowledgement Type of funding source: None

P5748Impact of specific crossing techniques in chronic total occlusion percutaneous coronary intervention on recovery of absolute myocardial perfusion

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S P Schumacher ◽  
W J Stuijfzand ◽  
R S Driessen ◽  
P A Van Diemen ◽  
M J Bom ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Perfusion Defect ◽  
Coronary Intervention ◽  
Defect Size ◽  
Total Occlusion ◽  
Perfusion Defect Size ◽  
Flow Reserve ◽  
Positron Emission ◽  
Positron Emission Tomography Perfusion ◽  
Percutaneous Coronary

Abstract Background Multiple techniques in chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) have been developed to cross CTOs. Purpose To compare recovery of quantitative myocardial blood flow (MBF) after different CTO PCI techniques. Methods Consecutive patients with [15O]H2O positron emission tomography perfusion imaging before and three months after successful CTO PCI were included. Change in quantitative hyperemic MBF, coronary flow reserve (CFR) and perfusion defect size were compared between antegrade wire escalation (AWE), retrograde wire escalation (RWE), antegrade dissection and reentry (ADR) and retrograde dissection and reentry (RDR), and further between specific subintimal crossing and reentry techniques. Results 193 patients were treated with AWE (N=90), RWE (N=24), ADR (N=35) and RDR (N=44). Significant improvements (all p<0.01) in hyperemic MBF (1.19±0.77, 0.94±0.65, 1.09±0.63, and 1.02±0.75 mL min–1 g–1, respectively), CFR (1.34±1.08, 1.14±1.09, 1.31±0.96, and 1.24±0.99, respectively), and perfusion defect size (3.17±2.13, 3.00±2.21, 2.74±2.09, and 2.93±1.92 segments, respectively) were comparable between the four approaches (p=0.40, p=0.84, and p=0.77, respectively). Recovery of hyperemic MBF was less pronounced after subintimal crossing with a knuckle-wire-technique compared to the use of CrossBoss in controlled ADR and RDR (p=0.02), and less after reentry with subintimal tracking and reentry (STAR) in ADR compared with controlled ADR (Stingray) or limited antegrade subintimal tracking (LAST) (p=0.02 and p<0.01). Conclusions Recovery of hyperemic MBF, CFR, and perfusion defect size was significant after CTO PCI and comparable between different crossing techniques. Improvement of hyperemic MBF was inferior after using the knuckle-wire subintimal crossing technique and STAR compared to other subintimal crossing and reentry techniques. Acknowledgement/Funding None

scholarly journals Sex differences in long-term outcomes of patients with percutaneous coronary intervention: the Armenian experience

2013 ◽  
Vol 1 (2) ◽  
pp. 17
Author(s):  
Yeva Sahakyan ◽  
Michael E. Thompson ◽  
Lusine Abrahamyan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Sex Differences ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Event Free Survival ◽  
Free Survival ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary

The present study aimed at assessing sex differences in perioperative characteristics and 3-year event-free survival from major adverse cardiac and cerebrovascular events (MACCE) in patients with percutaneous coronary intervention (PCI) in Armenia. The study utilized an observational, retrospective cohort design enrolling patients who underwent PCI from 2006 to 2008 at a single center in Yerevan, Armenia. Major adverse cardiac and cerebrovascular events included all-cause mortality, myocardial infarction (MI), repeat revascularization, or stroke/transient ischemic attack. Among 485 participants included in the analysis, 419 (86%) were men. Women were older, more hypertensive, more obese, and had significantly higher rates of diabetes. At the end of follow-up, the incidence of MACCE was 37% for men and 33% for women (P=0.9). Based on the results from the adjusted Cox proportional hazards model, the independent predictors of MACCE included acute MI [hazard ratio (HR)=1.43, 95% confidence interval (CI): 1.02-2.00], arrhythmia (HR=1.64, 95% CI: 1.07-2.50), sex (HR=2.46, 95% CI: 1.08- 5.61), diabetes (HR=5.65, 95% CI: 2.14-14.95), and the interaction between sex and diabetes (HR=0.16; 95% CI: 0.05-0.47). Among diabetic patients, men had better event-free survival from MACCE (HR=0.40, 95% CI: 0.19-0.85) than women, whereas in patients without diabetes men had worse outcomes than women (95% CI: 1.08-5.62). In Armenia, the baseline profile of women undergoing PCI differed considerably from that of men. In patients with diabetes, women had worse outcomes at long-term follow-up, while the opposite was noted in patients without diabetes.

P964Relationships between extent of ischemic burden and changes in absolute myocardial perfusion after chronic total occlusion percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S P Schumacher ◽  
M Kockx ◽  
W J Stuijfzand ◽  
R S Driessen ◽  
P A Van Diemen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Myocardial Perfusion ◽  
Perfusion Defect ◽  
Coronary Intervention ◽  
Defect Size ◽  
Large Defect ◽  
Total Occlusion ◽  
Flow Reserve ◽  
Positron Emission ◽  
Percutaneous Coronary

Abstract Background The patient benefits after chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) are being questioned. Purpose The present study explored the relationships between baseline ischemic burden findings and subsequent changes in absolute myocardial perfusion after CTO PCI. Methods Consecutive patients underwent serial [15O]H2O positron emission tomography perfusion imaging prior and 3 months after successful CTO PCI. Change in perfusion defect size (in myocardial segments), quantitative (hyperemic) myocardial blood flow (MBF) and coronary flow reserve (CFR) in the CTO area were compared between patients with a limited (0–1 segment), moderate (2–3 segments) and large perfusion defect (≥4 segments). Results 193 patients were included, with 15, 61 and 117 patients having a limited, moderate and large perfusion defect at baseline. Hyperemic MBF and CFR were lower in a large perfusion defect compared to smaller defects (all comparisons p&lt;0.01). The median decrease in defect size was 1 [0–1] vs 2 [1–3] vs 4 [2–5] in patients with a limited, moderate and large defect (all comparisons p&lt;0.01), whereas hyperemic MBF and CFR improved significantly regardless of baseline defect size (between groups p=0.45 and p=0.55, respectively). Furthermore, when all 193 patients were divided in a low, median and high tertile based on hyperemic MBF and CFR at baseline, changes in hyperemic MBF and CFR after CTO PCI were comparable between patients in different tertiles (between groups p=0.75 and p=0.79, respectively) Conclusions Patients with a CTO and a larger perfusion defect have more severe hyperemic MBF and CFR levels. Major reductions in ischemic burden can be achieved by CTO PCI, with more defect size reduction in patients with a larger perfusion defect, whereas hyperemic MBF and CFR significantly improve irrespective of starting values before PCI. Acknowledgement/Funding None

scholarly journals High Incidence of Cataracts in the Follow-Up of Patients Undergoing Percutaneous Coronary Intervention for Chronic Coronary Total Occlusion

2021 ◽  
Vol 10 (21) ◽  
pp. 5002
Author(s):  
Ricardo Rivera-López ◽  
Celia García-López ◽  
José M. Sánchez-Moreno ◽  
Rafael A. Rivera-López ◽  
Julio Almansa-López ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radiation Dose ◽  
Cox Regression ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Study Objective ◽  
Percutaneous Coronary ◽  
Cataract Development ◽  
Cardiac Catheterizations

Development of cataracts is a well-known adverse effect of ionizing radiation, but little information is available on their incidence in patients after other medical procedures, such as cardiac catheterizations. The study objective was to determine the incidence of cataracts in a cohort of patients undergoing percutaneous coronary intervention (PCI) for chronic coronary total occlusion (CTO) and its association with radiation dose. The study analyzed the incidence of cataracts during the follow-up of 126 patients who underwent chronic total coronary PCI, using Cox regression to identify predictive factors of cataract development. The study included 126 patients, 86.9% male, with a mean age of 60.5 years (range, 55.0–68.0 years). Twenty-three (18.2% n = 23) developed cataracts during a mean follow-up of 49.5 months (range 37.3–64.5 months). A higher incidence was observed in patients who received more than 5 Gy (29.0% vs. 14.7%, Hazard ratio (HR = 2.84 [1.19–6.77]). Multivariate analysis revealed a relationship between cataract development during the follow-up and a receipt of radiation dose >5 Gy (HR = 2.60, 95% confidence interval [CI 1.03–6.61]; p = 0.03), presence or history of predisposing eye disease (HR = 4.42, CI:1.57–12.40), diabetes (HR = 3.33 [1.22–9.24]), and older age, as in >57 (HR, 6.40 [1.81–22.61]). An elevated incidence of cataracts was observed in patients after PCI for CTO. The onset of cataracts is related to the radiation dose during catheterization, which is a potentially avoidable effect of which operators should be aware.

scholarly journals Long-term prognosis of chronic total occlusion treated by successful percutaneous coronary intervention in patients with or without diabetes mellitus: a systematic review and meta-analysis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yong Zhu ◽  
Shuai Meng ◽  
Maolin Chen ◽  
Kesen Liu ◽  
Ruofei Jia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Long Term Prognosis

Abstract Background Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Therefore, the purpose of our study was to investigate the clinical outcomes of CTO-PCI in patients with or without DM. Methods All relevant articles published in electronic databases (PubMed, Embase, and the Cochrane Library) from inception to August 7, 2020 were identified with a comprehensive literature search. Additionally, we defined major adverse cardiac events (MACEs) as the primary endpoint and used risk ratios (RRs) with 95% confidence intervals (CIs) to express the pooled effects in this meta-analysis. Results Eleven studies consisting of 4238 DM patients and 5609 non-DM patients were included in our meta-analysis. For DM patients, successful CTO-PCI was associated with a significantly lower risk of MACEs (RR = 0.67, 95% CI 0.55–0.82, p = 0.0001), all-cause death (RR = 0.46, 95% CI 0.38–0.56, p < 0.00001), and cardiac death (RR = 0.35, 95% CI 0.26–0.48, p < 0.00001) than CTO-medical treatment (MT) alone; however, this does not apply to non-DM patients. Subsequently, the subgroup analysis also obtained consistent conclusions. In addition, our study also revealed that non-DM patients may suffer less risk from MACEs (RR = 1.26, 95% CI 1.02–1.56, p = 0.03) than DM patients after successful CTO-PCI, especially in the subgroup with a follow-up period of less than 3 years (RR = 1.43, 95% CI 1.22–1.67, p < 0.0001). Conclusions Compared with CTO-MT alone, successful CTO-PCI was found to be related to a better long-term prognosis in DM patients but not in non-DM patients. However, compared with non-DM patients, the risk of MACEs may be higher in DM patients after successful CTO-PCI in the drug-eluting stent era, especially during a follow-up period shorter than 3 years.

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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