Effectiveness of recanalization of chronic total occlusions: A systematic review and meta-analysis

Joyal, Dominique; Afilalo, Jonathan; Rinfret, Stéphane

doi:10.1016/j.ahj.2010.04.015

Cited by 374 publications

(243 citation statements)

References 32 publications

Supporting

Mentioning

218

Contrasting

Unclassified

Order By: Relevance

“…Several previous observational studies and meta‐analysis regarding clinical outcomes in patients with successful CTO PCI have demonstrated its beneficial effect, such as improved survival rates and LV function, compared with failed PCI 1, 4, 5, 6, 8, 15. In contrast, some observational studies suggest that successful CTO PCI is not associated with improvement of survival rates and cardiovascular events 16, 17.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies demonstrated that successful CTO intervention was associated with improved survival rates and angina symptom relief when compared with the failed CTO intervention 1, 4, 5, 6. Despite previous study results, the proportion of patients who underwent PCI for CTO lesions was still lower,7, 8 and current guidelines recommend that the physicians should consider the clinical benefits regarding clinical, angiographic, and technical parameters when determining whether or not to perform PCI in patients with CTO lesions 9, 10…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Choi

Rha

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundThe impact of percutaneous coronary intervention (PCI) on chronic total occlusion in patients with well‐developed collaterals is not clear.Methods and ResultsA total of 640 chronic total occlusion patients with collateral flow grade ≥2 were divided into 2 groups; chronic total occlusion patients either treated with PCI (the PCI group; n=305) or optimal medical therapy (the optimal medical therapy group; n=335). To adjust for potential confounders, a propensity score matching analysis was performed. Major clinical outcomes were compared between the 2 groups up to 5 years. In the entire population, the PCI group had a lower hazard of myocardial infarction (hazard ratio [HR], 0.177; P=0.039; 95% confidence interval [CI], 0.03–0.91) and the composite of total death or myocardial infarction (HR, 0.298; P=0.017; 95% CI, 0.11–0.80); however, it showed higher hazard of target lesion revascularization (HR, 3.942; P=0.003; 95% CI, 1.58–9.81) and target vessel revascularization (HR, 4.218; P=0.001; 95% CI, 1.85–9.60). After propensity score matching, a total of 158 matched pairs were generated. Although the PCI group showed a higher hazard of target lesion revascularization (HR, 2.868; P=0.027; 95% CI, 1.13–7.31) and target vessel revascularization (HR=2.62; P=0.022; 95% CI, 1.15–5.97), it still exhibited a lower incidence of the composite of total death or myocardial infarction (HR, 0.263; P=0.017; 95% CI, 0.087–0.790). The mean ejection fraction was improved from 47.8% to 51.6% (P<0.001) after PCI.ConclusionsIn our study, successful revascularization by PCI for chronic total occlusion lesions with well‐developed collaterals was associated with lower incidence of death and myocardial infarction, improved left ventricular function, but increased repeat revascularization rate.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Choi

Rha

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…While the success rate of PCI to coronary CTO was not sufficient (51-74%) until 2009, 37,38) the introduction of new devices such as guidewires or microcatheters and bidirectional approaches (antegrade and retrograde) has significantly increased the initial success rate of CTO. [39][40][41] Furthermore, the long-term patency of revascularized CTO was low in patients treated using bare-metal stents, 42) however, the long-term patency of revascularized CTO is comparable to non-CTO lesions in patients treated by drug-elution stents.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

et al. 2016

View full text Add to dashboard Cite

SummaryRevascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered for heart failure with reduced ejection fraction (HFrEF). However, revascularization therapy does not always improve left ventricular ejection fraction (LVEF). The purpose of this study was to investigate the determinants of LVEF improvement following revascularization in HFrEF patients. From 2,229 consecutive decompensated heart failure patients, a total of 47 HFrEF patients who underwent revascularization were included in the analysis. Improvement of LVEF was defined as [(LVEF during chronic phase) -(LVEF during acute phase)] ≥ 10%. Univariate and multivariate logistic regression analyses were applied to investigate the determinants of LVEF improvement. The prevalence of revascularization by PCIs including chronic total occlusion (CTO) was significantly greater in the improved EF group (45.0%) as compared to the non-improved EF group (11.1%) (P = 0.02). Multivariate logistic regression analysis revealed that revascularization by PCIs including CTO was the significant determinant of the LVEF improvement after adjusting for confounding factors (OR 5.43, 95% CI 1.06-27.74, P = 0.04). Optimal medical therapy (angiotensin-converting enzyme (ACE) inhibitor and/or angiotensin II receptor blocker (ARB) and beta-blockers) was less frequently prescribed in patients with CABG (50.0% for ACE inhibitor and/or ARB and 41.7% for beta-blocker) than in patients without CABG (94.3% for both) (P < 0.01 and P < 0.001, respectively). In conclusion, revascularization by PCIs including CTO was the significant determinant of LVEF improvement in HFrEF patients. Our results underscore the importance of optimal medical therapy even if patients receive complete revascularization such as CABG. (Int Heart J 2016; 57: 565-572) Key words: Percutaneous coronary intervention, Coronary artery bypass grafting, Chronic total occlusion H eart failure is a common disease with a prevalence of 1-2% in the adult population, 1) and still has high mortality in developed countries. One-year mortality rates in population-based studies have been reported to be 25% to 45%.2-5) The mortality rate was higher in heart failure with reduced ejection fraction (HFrEF) than heart failure with preserved ejection fraction (HFpEF). 6) Mortality rates of HFrEF (ejection fraction < 50%) patients were reported to be 32% at one year and 68% at 5 years.6) The most common cause of HFrEF is coronary artery disease, which accounts for approximately two-thirds of HFrEF. 7)Revascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered in heart failure with coronary artery disease, and sometimes improves clinical outcomes including left ventricular function. [8][9][10][11][12] However, revascularization therapy is not always effective in heart failure with coronary artery disease.13) It is unknown which types of patients receive the benefits such as improvement o...

show abstract

“…Patients benefit from revascularization with a reduction of symptoms or need for bypass surgery, improvement of left ventricular function and prolonged survival like previous studies showed [8 -11]. Also long-term mortality is reduced after successfully performed PCI procedures [12]. Moreover, completeness of revascularization was identified as a strong predictor of survival in simultaneous CTOs [13].…”

mentioning

confidence: 50%

Development and Suggestion of a Cardiac CTA Scoring System for the Prediction of Revascularization Success in Chronic Total Occlusions (CTO) of the Coronary Arteries

Roller

Harth

Rixe

et al. 2015

Fortschr Röntgenstr

View full text Add to dashboard Cite

Heart 172Roller FC et al. Development Objective: Analyzing occluded segments with computed tomography angiography (CTA) prior to percutaneous coronary intervention (PCI) increased revascularization success in chronic total occlusions (CTO). The aim of our study was to develop a scoring system for the prediction of PCI success in CTO. Materials and Methods: 41 consecutive CTO patients (30 male; 63.1 years +/-8.3 standard deviation) underwent CTA prior to PCI. All CTOs were categorized by two radiologists in consensus regarding the presence of special features and without knowledge of PCI outcome. All outcome criteria were evaluated. Afterwards one point was assigned for each unequally distributed outcome criteria per CTO and all points were added up to a single score. Results: Severe calcifications (failure group 68.8 % vs. success group 28.0 %; p < 0.02) and intraluminal calcifications (68.8 %; 40.0 %), tortuosity (25.0 %; 0 %; p < 0.02), linear intrathrombus enhancement (37.5 %; 60.0 %) and distal vessel disease (68.8 %; 44.0 %) were unequally distributed. By adopting a threshold of 4 points or higher (maximum 5 points), the results were: sensitivity 31.3 %, specificity 100 %, negative predictive value (NPV) 69.4 % and positive predictive value (PPV) 100 %. The PCI complication rate was 9.8 % and the mean contrast media amount was 234.4 ml. Conclusion: With the suggested scoring system, based on five CTA criteria, PCI failure could be predicted with high PPV and specificity in our group of patients, but the NPV and sensitivity are low. However, 5 unsuccessful PCIs (13.2 %) could have been avoided and none would have been wrongly omitted. Regarding the complication rate during PCI and the high amounts of contrast media needed, a prediction system appears to be desirable and should be the object of large-scale trials.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

show abstract

Effectiveness of recanalization of chronic total occlusions: A systematic review and meta-analysis

Cited by 374 publications

References 32 publications

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well‐Developed Collaterals

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

Development and Suggestion of a Cardiac CTA Scoring System for the Prediction of Revascularization Success in Chronic Total Occlusions (CTO) of the Coronary Arteries

Contact Info

Product

Resources

About