Canadian Multicenter Chronic Total Occlusion Registry: Ten-Year Follow-Up Results of Chronic Total Occlusion Revascularization

2021 ◽  
Vol 14 (12) ◽  
Author(s):  
Bradley H. Strauss ◽  
Merril L. Knudtson ◽  
Asim N. Cheema ◽  
P. Diane Galbraith ◽  
Gabby Elbaz-Greener ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chronic Total Occlusion ◽  
Artery Bypass ◽  
Hazard Ratio ◽  
Lower Mortality ◽  
Time Varying ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Coronary Syndrome ◽  
All Cause Mortality

Background: Chronic total occlusions (CTO) occur in nearly 20% of coronary angiograms. CTO revascularization, either by percutaneous coronary intervention (PCI) or coronary artery bypass grafting surgery (CABG), is infrequently performed, approximately one-third of cases. Long-term outcomes are unknown. The objective of the study was to determine whether early CTO revascularization of patients, either by CABG or PCI, was associated with improved clinical outcomes. Methods: One thousand six hundred twenty-four patients from the Canadian CTO registry were followed for at least 9.75 years. Revascularization was performed according to routine clinical practice. Patients were grouped according to CTO revascularization status (PCI or CABG of CTO vessel, CTO revasc) or no CTO revasc (medical therapy only, or PCI/CABG of non-CTO vessels only), within 3 months of initial angiogram. Patients were followed for mortality, revascularization procedures (PCI and CABG), and hospitalizations for acute coronary syndromes and heart failure. Results: Early CTO revasc was performed in 28.2% of patients (17.5% CABG, 10.7% PCI). The CTO revasc group was younger, with more males and generally fewer comorbidities. There was a significantly lower mortality probability at 10 years in the CTO revascularization group (22.7% [95% CI, 19.0%–26.9%]) compared with the no CTO revasc group (36.6% [95% CI, 33.8%–39.5%]). At 10 years, revascularization rates (14.0% versus 22.8%) and acute coronary syndrome hospitalization rates (10.0% versus 16.6%) were significantly lower in the CTO revasc group. Baseline-adjusted analysis showed CTO revasc was associated with significantly lower all-cause mortality (hazard ratio, 0.67 [95% CI, 0.54–0.84]). In both landmark and time varying analyses, association with lower mortality was particularly robust for CTO revascularization by CABG (hazard ratio 0.56 and 0.60, respectively), with a marginally significant result for PCI in the time varying analysis (hazard ratio 0.711 [95% CI, 0.51–0.998]). Conclusions: Early CTO revascularization was associated with significantly lower all-cause mortality, revascularization rates, and hospitalization for acute coronary syndrome at 10 years, and mainly driven by outcomes in patients with CABG.

scholarly journals Ticagrelor Monotherapy Versus Ticagrelor With Aspirin in Acute Coronary Syndrome Patients With a High Risk of Ischemic Events

2021 ◽  
Author(s):  
Seung-Jun Lee ◽  
Yong-Joon Lee ◽  
Byeong-Keuk Kim ◽  
Sung-Jin Hong ◽  
Chul-Min Ahn ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Major Bleeding ◽  
Hazard Ratio ◽  
Unique Identifier ◽  
Total Occlusion ◽  
Target Vessel Revascularization ◽  
Coronary Syndrome ◽  
Stent Length ◽  
The Impact

Background: In patients with acute coronary syndrome (ACS) with a high risk of ischemia, the impact of ticagrelor monotherapy after short-term dual antiplatelet therapy (DAPT) has not been clearly elucidated. Methods: This post hoc analysis of the TICO trial (Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus-Eluting Stent for Acute Coronary Syndrome) compared the impact of ticagrelor monotherapy after 3-month DAPT versus ticagrelor-based 12-month DAPT in patients with high-ischemic risk ACS, defined as any of the following: number of stents implanted ≥3, total stent length >60 mm, complex procedures (chronic total occlusion, left main occlusion, or bifurcation plaques remedied using the 2-stent technique), or a history of diabetes or chronic kidney disease. Ischemic (composite of death, myocardial infarction, stent thrombosis, stroke, and target vessel revascularization) and bleeding outcomes (major bleeding) were evaluated at 12 months. Results: Of the total population (N=3056), 1473 (48.2%) patients were identified as having high-ischemic risk ACS. The rate of the ischemic outcome was significantly higher in high-ischemic risk ACS patients than in nonhigh-ischemic risk ACS patients (3.9% versus 1.9%, hazard ratio, 2.14 [95% CI, 1.37–3.35], P =0.001). Furthermore, the risk of major bleeding (3.2% versus 1.5%, hazard ratio, 2.23 [95% CI, 1.36–3.68], P =0.001) and the composite ischemic and bleeding outcome (6.6% versus 3.3%, hazard ratio, 2.02 [95% CI, 1.44–2.84], P <0.001) were also higher in the high-risk ACS population. In ACS patients with or without high-ischemic risk, the effect of ticagrelor monotherapy after 3-month DAPT, as compared to that of 12-month DAPT, was consistent with ischemic ( P int =0.718), bleeding ( P int =0.092), and composite outcomes ( P int =0.094) without significant interactions. Conclusions: There were no significant heterogeneities in the impact of ticagrelor monotherapy after 3-month DAPT compared with that of ticagrelor-based 12-month DAPT on clinical outcomes according to the presence of high-ischemic risk. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02494895.

scholarly journals Myocardial revascularization in patients with acute coronary syndrome in the context of COVID-19 pandemic: a single-center prospective cohort study

2021 ◽  
Vol 26 (8) ◽  
pp. 4382
Author(s):  
O. V. Kamenskaya ◽  
A. S. Klinkova ◽  
I. Yu. Loginova ◽  
D. V. Habarov ◽  
A. M. Chernyavskiy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Heart Function ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Early Postoperative Period ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Pump Cabg

Aim. To assess the outcomes of myocardial revascularization (MR) and identify risk factors for early postoperative complications in patients with coronary artery disease (CAD) with acute coronary syndrome (ACS) in the context of coronavirus disease 2019 (COVID-19) pandemic.Material and methods. The study included 769 patients aged 67,0±4,4 years with CAD with ACS in the period from April to October 2020. In an expedited manner, percutaneous transluminal coronary angioplasty (n=699) and on pump coronary artery bypass grafting (CABG) (n=70) were performed. All patients underwent a COVID-19 rapid tests. After MR, the following outcomes were recorded: adverse cardiovascular events and other complications; various surgical interventions; bilateral COVID-19 pneumonia; death. The follow-up period lasted 30 days.Results. During the hospitalization, COVID-19 was detected in 5,3% of patients (n=41). Among them, bilateral multisegmental pneumonia developed in 48,8%. Among infected patients, COVID-19-related mortality in the early postoperative period was 9,8%. The all-cause mortality rate was 0,7%. On pump CABG significantly increases the risk of developing COVID-19 pneumonia (odds ratio (OR), 23,2; 95% confidence interval (CI) 14,2-35,4; p<0,001). After MR, COVID-19 pneumonia was associated with respiratory (OR, 7,6; 95% CI, 4,3-11,5; p=0,001) and heart failure (OR, 4,2; 95% CI, 2,9-8,6; p=0,001), atrial fibrillation (OR, 8,3; 95% CI, 4,1-13,9; p=0,001), as well as with all-cause mortality (OR, 10,3; 95% CI, 5,2-16,7; p=0,005). Recurrent transmural myocardial infarction in patients with CAD was associated with heart failure after MR (OR, 7,1; 95% CI, 2,4-12,6; p=0,012).Conclusion. Conducting on pump CABG in patients with CAD with ACS is the leading trigger for developing COVID-19 pneumonia, which, during hospitalization after MR, was associated not only with respiratory complications, but also with impaired heart function, which significantly increases the death risk in this category of patients.

scholarly journals Procedures for chronic total occlusion: when are they recommended and when not

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L114-L116
Author(s):  
Mila Menozzi ◽  
Giancarlo Piovaccari
Keyword(s):  
Chronic Total Occlusion ◽  
Randomized Trials ◽  
Therapeutic Option ◽  
Artery Bypass ◽  
Clinical Problem ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Important Clinical Problem ◽  
Personalized Approach

Abstract Coronary chronic total occlusion (CTO) produces an important clinical problem, often treated with medical therapy or coronary artery bypass grafting. Recent clinical studies, both registries and randomized trials, demonstrated that percutaneous coronary interventions (PCI), could provide a valid therapeutic option. Nonetheless, significant reduction in all-cause mortality, cardiac mortality, myocardial infarction, MACE, and MACCE has not been demonstrated in the subgroups analysis of randomized trials. These analyses suggest that PCI for CTO should be reserved for patients with angina or with large areas of the myocardium with reversible ischaemia. Large randomized studies should search for a personalized approach, considering the risks and complexity of PCI in CTO, which should mainly consider the extension of the ischaemia and the viability of the myocardium.

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