Catheter-Based Treatment of Coronary Artery Disease

Holmes, David R.; Williams, David O.

doi:10.1161/circinterventions.108.783134

Cited by 22 publications

(11 citation statements)

References 99 publications

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“…Moreover, reports of stent-thrombosis with DES use has led to concerns of use and timing of dual antiplatelet therapy (14) and the need to focus on cause-specific, rather than overall, mortality (15). Thus, in spite of the marked overall improvement in the field, certain high-risk subsets continue to pose major challenges and warrant closer attention (16). …”

Section: Discussionmentioning

confidence: 99%

Twenty-Year Evolution of Percutaneous Coronary Intervention and Its Impact on Clinical Outcomes

Venkitachalam

Kip

Selzer

et al. 2009

Circ: Cardiovascular Interventions

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101

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Background-Percutaneous coronary intervention (PCI) has undergone rapid progress, both in technology and adjunct therapy. However, documentation of long-term temporal trends in relation to contemporary practice is lacking. Methods and Results-We analyzed PCI use and outcomes in 8976 consecutive patients in the multicenter, National Heart, Lung, and Blood Institute- Patients undergoing PCI in the recent waves were older and more often reported comorbidities than those in the balloon era. PCI was more often performed for acute coronary syndromes and, in spite of the greater disease burden, was more often selective. Procedural success was achieved and maintained more often in the stent era. Significant reductions were observed in in-hospital rates (%) of myocardial infarction (PTCA Registry: 4.9; wave 1, 2.7; wave 2, 2.8; wave 3, 1.9; wave 4, 2.6; wave 5, 2; P trend Ͻ0.001) and emergency coronary artery bypass surgery (PTCA Registry: 3.7; wave 1, 0.4; wave 2, 0.4; wave 3, 0.3; wave 4, 0.4; wave 5, 0; P trend Ͻ0.001). Compared with the PTCA Registry, risk for repeat revascularization (31 to 365 days after index PCI) was significantly lower in the dynamic waves (adjusted hazard ratio: wave 1, 0.72; wave 2, 0.51; wave 3, 0.51; wave 4, 0.30; wave 5, 0.36; PϽ0.05 for all). Conclusions-Percutaneous interventions, in the last 2 decades, have evolved to include more urgent, comorbid cases, despite achieving high success rates with significantly reduced need for repeat revascularization. (Circ Cardiovasc Intervent. 2009;2:6-13.)

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Section: Discussionmentioning

confidence: 99%

Twenty-Year Evolution of Percutaneous Coronary Intervention and Its Impact on Clinical Outcomes

Venkitachalam

Kip

Selzer

et al. 2009

Circ: Cardiovascular Interventions

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101

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“…Axial and oblique MPR images must be used for reading scans as the basic tools for detection and quantification of coronary artery stenosis, b Axial images showing that the distal LAD is occluded and not opacified with contrast just after the origin of the D2 branch. The contrast opacified D2 branch in its normal course, lateral to the interventricular groove, should not be mistaken for the normal LAD, c CAG confirms CTO of distal LAD (arrows) after origin of the D2 branch, and successful PCI was performed, although occlusion site is associated with a side branch Int J Cardiovasc Imaging (2009) 25: 43-54 47 complexity, technical difficulty, long procedure times, and excessive radiation exposure [29]. Once the wire crosses the CTO a low-profile balloon is usually used to follow.…”

Section: Success Rate Of Pci For Ctosmentioning

confidence: 97%

CT coronary angiography of chronic total occlusions of the coronary arteries: how to recognize and evaluate and usefulness for planning percutaneous coronary interventions

Hoe

2009

Int J Cardiovasc Imaging

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Chronic total occlusions (CTO) of the coronary arteries are a common finding. A CTO can be underdiagnosed on CT coronary angiography (CTCA) as a high grade stenosis, because of the presence of retrograde collaterals which allow opacification of the vessel distal to the stenosis, or can be missed completely, especially if another adjacent opacified artery is mistaken for occluded artery. CTOs are considered as Type C or high risk lesions with a higher restenosis rate and increased technical failure rate by percutaneous coronary intervention (PCI). CTCA can help identify features that most influence current success rates of PCI such as marked calcifications at the stump, severe tortuosity of the proximal vessel, long length of the occluded segment as well location of the vessel distal to the occlusion, which often may not be well seen on conventional angiography. Identification of these features and displaying the 3D information as the best angiographic projection that demonstrates the length and orientation of the CTO, either as hard copy images or transmitted direct to the angiographic catheter lab for data fusion, allows strategic preprocedural planning and scheduling of the PCI. Myocardial viability of the affected area of the occluded segment is a major factor that influences whether PCI for CTO is attempted but is not currently readily available by cardiac CT. Contrast enhanced cardiac MR imaging is still the gold standard for this and may need to be performed prior to PCI.

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“…[3][4][5][6] First-generation drugeluting stents (DES) succeeded in further reducing the rate of early TLR, 7,8 but were associated with continued occurrence of late TLR and very late stent thrombosis (ST), which might have been attenuated with newer-generation DES using biocompatible or biodegradable polymer. [9][10][11] Currently, a fully bioresorbable drug-eluting vascular scaffold (BVS) is under clinical evaluation with expectations for better healing responses of the vessel wall and reduction of late adverse events related to the treatment site by eliminating permanent metallic implants.…”

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confidence: 99%

Influence of Sex on Long-Term Outcomes After Implantation of Bare-Metal Stent

et al. 2015

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Background-Female sex was reported to be associated with lower risk for midterm restenosis and repeat revascularization after bare-metal stent implantation. However, the influence of sex on very long-term outcomes after bare-metal stent implantation has not been yet reported. Methods and Results-Among the 9877 patients in the multicenter Coronary Revascularization Demonstrating Outcome study in Kyoto (CREDO-Kyoto) registry cohort-1, bare-metal stent implantation was performed in 5313 patients (men, n=3742 and women, n=1571). Follow-up was completed in 4515 patients (85.0%) at 10 years (duration, 10.3±3.1 [0.0-14.1] years). The cumulative incidence of target-lesion revascularization (TLR) was 27% at 1 year and 34% at 10 years (0.8%/y beyond 1 year). Non-target-lesion revascularization (non-TLR) was the dominant coronary revascularization beyond 1 year (13% at 1 year and 31% at 10 years [2.0%/y beyond 1 year]). Cumulative incidence of stent thrombosis was low (1.2% at 1 year and 1.9% at 10 years). Women were older and had greater prevalence of cardiovascular risk factors than men. The cumulative 10-year incidences of and adjusted risk for TLR were significantly higher in men than in women (36% versus 30%, P<0.001; adjusted hazard ratio, 1.29; 95% confidence interval, 1.15-1.46; P<0.001). The higher risk of men relative to women for TLR was consistent regardless of age (<75 years and ≥75 years). Men in comparison with women were also associated with significantly higher adjusted risks for all-cause death, myocardial infarction, stroke, coronary artery bypass grafting, TLR, and non-TLR. Conclusions-TLR and stent thrombosis continued to occur without attenuation up to 10 years after bare-metal stent implantation. Men in comparison with women were associated with higher adjusted 10-year risks for all-cause death, myocardial infarction, stroke, coronary artery bypass grafting, TLR, and non-TLR.

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Catheter-Based Treatment of Coronary Artery Disease

Cited by 22 publications

References 99 publications

Twenty-Year Evolution of Percutaneous Coronary Intervention and Its Impact on Clinical Outcomes

Twenty-Year Evolution of Percutaneous Coronary Intervention and Its Impact on Clinical Outcomes

CT coronary angiography of chronic total occlusions of the coronary arteries: how to recognize and evaluate and usefulness for planning percutaneous coronary interventions

Influence of Sex on Long-Term Outcomes After Implantation of Bare-Metal Stent

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