Abstract:A total of 210 (8.9% of total PCI (2353) during the study period) CTO patients were followed up. The mean age was 56.54±8.9. In the study sixty nine patients (32.9%) presented with chronic stable angina and rest of the patients had history of acute coronary syndrome of which 22.9% (n=48) had unstable angina (UA) or non ST elevation myocardial infarction (NSTEMI) and 44.2% (n=93) had ST Elevation Myocardial Infarction (STEMI). In those with history of ACS, 64.78% (n=92) had ACS during the previous year and rema… Show more
“…We had low MACE (5.3%) after a successful CTO PCI. The TLR rates were also acceptable in the relatively longer follow-up interval compared with previous studies from India by KsG et al and Goel et al 10, 24. Although opening a CTO of a target vessel was associated with increased average MACE-free time, there was no difference regarding a treated coronary artery which was similar to previously published literature 5, 9, 33, 34…”
Section: Discussionsupporting
confidence: 85%
“…It is one of the most important indication for referral for coronary artery bypass surgery as well 1, 2, 3, 5. Of late, there are growing data, which indicate that successful treatment of CTOs results in improved symptoms, prolonged life, and improved left ventricular function status 6, 7, 8, 9, 10. But the attainment of high-end technical skills, sophisticated hardwares, and dedicated training sessions with experts in this field have made a huge impact on the success rates of CTO in developed nations 10, 11, 12.…”
Background
Chronic total occlusion (CTO) continues to be challenging lesion subset for percutaneous intervention. Last decade has seen tremendous increase in percutaneous coronary intervention (PCI) in this subset owing to improved understanding of the anatomy and enhanced skillset with availability of dedicated hardware. We sought to study the outcomes of CTO PCI in an Indian public hospital.
Methods
This was a single-center non-randomized descriptive follow-up study on CTO PCI. The end-points were procedural success, immediate, and late adverse cardiovascular events [major adverse cardiac event (MACE)] and change in angina and left ventricular function at follow-up.
Results
A total 389 CTO lesions were treated with a success rate of 87% (339/389). The mean Japanese chronic total occlusion (J-CTO) score was 1.78 ± 0.12 (mean ± standard deviation). Multivariate analysis of different angiographic components of J-CTO score identified tortuosity (
p
= 0.001), calcifications (
p
≤ 0.001), and blunt stump (
p
= 0.007) as independent predictors of procedural failure. The periprocedural mortality was less than 1%, and the non-life threatening complications were about 4%. The MACE rate was significantly higher in the procedural failure group (60%) than in the procedural success group (5.3%,
p
< 0.001). An increase in left ventricular ejection fraction (LVEF) was noted following successful CTO PCI after complete revascularization.
Conclusions
The success rates for CTO PCI in this registry were about 87%. Immediate and long-term clinical outcomes were better with lower MACE (5%) after a successful procedure. A key outcome variable included an increase in LVEF among patients after a successful CTO PCI. The overall periprocedural complications were about 5.5%, but majority were non-life threatening.
“…We had low MACE (5.3%) after a successful CTO PCI. The TLR rates were also acceptable in the relatively longer follow-up interval compared with previous studies from India by KsG et al and Goel et al 10, 24. Although opening a CTO of a target vessel was associated with increased average MACE-free time, there was no difference regarding a treated coronary artery which was similar to previously published literature 5, 9, 33, 34…”
Section: Discussionsupporting
confidence: 85%
“…It is one of the most important indication for referral for coronary artery bypass surgery as well 1, 2, 3, 5. Of late, there are growing data, which indicate that successful treatment of CTOs results in improved symptoms, prolonged life, and improved left ventricular function status 6, 7, 8, 9, 10. But the attainment of high-end technical skills, sophisticated hardwares, and dedicated training sessions with experts in this field have made a huge impact on the success rates of CTO in developed nations 10, 11, 12.…”
Background
Chronic total occlusion (CTO) continues to be challenging lesion subset for percutaneous intervention. Last decade has seen tremendous increase in percutaneous coronary intervention (PCI) in this subset owing to improved understanding of the anatomy and enhanced skillset with availability of dedicated hardware. We sought to study the outcomes of CTO PCI in an Indian public hospital.
Methods
This was a single-center non-randomized descriptive follow-up study on CTO PCI. The end-points were procedural success, immediate, and late adverse cardiovascular events [major adverse cardiac event (MACE)] and change in angina and left ventricular function at follow-up.
Results
A total 389 CTO lesions were treated with a success rate of 87% (339/389). The mean Japanese chronic total occlusion (J-CTO) score was 1.78 ± 0.12 (mean ± standard deviation). Multivariate analysis of different angiographic components of J-CTO score identified tortuosity (
p
= 0.001), calcifications (
p
≤ 0.001), and blunt stump (
p
= 0.007) as independent predictors of procedural failure. The periprocedural mortality was less than 1%, and the non-life threatening complications were about 4%. The MACE rate was significantly higher in the procedural failure group (60%) than in the procedural success group (5.3%,
p
< 0.001). An increase in left ventricular ejection fraction (LVEF) was noted following successful CTO PCI after complete revascularization.
Conclusions
The success rates for CTO PCI in this registry were about 87%. Immediate and long-term clinical outcomes were better with lower MACE (5%) after a successful procedure. A key outcome variable included an increase in LVEF among patients after a successful CTO PCI. The overall periprocedural complications were about 5.5%, but majority were non-life threatening.
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“…The overall success rate in our patients was 71.9%, which is comparable to other series. The Indian data by Gopakumar et al showed a success rate of 68% in first attempt which increased to 71.42% in second attempt 9 . The most important factor for success of a CTO is successful wiring of the CTO segment.…”
We performed a retrospective analysis of 146 chronic total occlusion CTO patients to evaluate the antecedents of success and failure in CTO – Percutaneous Coronary Intervention (PCI) in Indian patients. The study aimed to identify the technical success rate, analyse immediate patient outcomes, and understand the factors impacting the successful outcomes. Our results showed that J-CTO (Multicenter CTO Registry of Japan) scores correlate well with the success rates of CTO-PCI and two most important factors deciding failure are lesion length more than 20 mm and lesions with calcification. Most important step to success of CTO is wiring, once wire crosses the segment, success rates of the procedure is around 97%. The wire escalation strategy has to be modified once the initial soft (polymer) wire fails, it’s reasonable to use high tip load wire like conquest pro without the use of intermediate wires (except in presence of tortuosity). At 1 year follow up of these patients, there was a statistically significant drop in angina class and major adverse cardiac event rates in the successful CTO group.
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