Effects of successful percutaneous coronary intervention of chronic total occlusions on myocardial perfusion and left ventricular function

Stuijfzand, Wijnand J.; Biesbroek, P. Stefan; Raijmakers, Pieter; Driessen, Roel; Schumacher, Stefan; Diemen, Pepijn A. van; Berg, Jeffrey van den; Nijveldt, Robin; Lammertsma, Adriaan A.; Walsh, Simon; Hanratty, Colm G.; Spratt, James C.; Rossum, Albert C. van; Royen, Niels van; Knaapen, Paul

doi:10.4244/eij-d-16-01014

Cited by 41 publications

(38 citation statements)

References 21 publications

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“…Thirty‐four observational studies [including two abstracts ] with a total of 2804 patients met our inclusion criteria . Cardiac magnetic resonance imaging (CMR) was used to assess LVEF in nine studies while echocardiography was used in 10 studies . Other studies used left ventriculography or nuclear imaging, or did not specify the method used for assessing LVEF .…”

Section: Resultsmentioning

confidence: 99%

“…Only one randomized-controlled trial (RCT) was identified. 7 Thirty-four observational studies [including two abstracts 13,14 ] with a total of 2804 patients met our inclusion criteria. Cardiac magnetic resonance imaging (CMR) was used to assess LVEF in nine studies [14][15][16][17]29,32,33,40,41 while echocardiography was used in 10 studies.…”

Section: Characteristics Of the Included Studies And Quality Assessmentioning

confidence: 99%

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Meta‐analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling

Megaly

Saad

Tajti

et al. 2018

J Interven Cardiology

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of the Included Studies And Quality Assessmentioning

confidence: 99%

Meta‐analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling

Megaly

Saad

Tajti

et al. 2018

J Interven Cardiology

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“…However, the combined effect of a higher prevalence of CAD risk factors, prior (unrecognized) MI, and prior revascularization in patients with a CTO could hypothetically have led to relatively more microvascular disease in the CTO area, (partially) causing diminished hyperemic MBF and (non‐significantly) lower CFR in these patients . Using [ 15 O]H 2 O PET perfusion, it has previously been shown that MBF during hyperemia is inversely related to the extent of surrounding scar tissue in patients with a CTO …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, next to symptom recognition and viability detection, ischemia detection forms one of the pillars in judicious patient selection for CTO PCI. Major reductions in ischemia can be achieved after CTO PCI, however, it is more conservatively employed compared with PCI of a non‐CTO lesion . [ 15 O]H 2 O positron emission tomography (PET) is the gold standard for non‐invasive myocardial perfusion imaging, reflecting the composite of the epicardial as well as the microvascular bed, and enabling absolute quantification of myocardial perfusion .…”

Section: Introductionmentioning

confidence: 99%

“…Major reductions in ischemia can be achieved after CTO PCI, however, it is more conservatively employed compared with PCI of a non-CTO lesion. [12][13][14] [ 15 O]H 2 O positron emission tomography (PET) is the gold standard for non-invasive myocardial perfusion imaging, reflecting the composite of the epicardial as well as the microvascular bed, and enabling absolute quantification of myocardial perfusion. 15 The aim of this study was to compare the effects of PCI among CTO versus non-CTO lesions on quantitative myocardial blood flow (MBF) and perfusion defect size.…”

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confidence: 99%

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Recovery of myocardial perfusion after percutaneous coronary intervention of chronic total occlusions is comparable to hemodynamically significant non‐occlusive lesions

Schumacher

Driessen

Stuijfzand

et al. 2018

Cathet Cardio Intervent

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Background The benefits of chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) are being questioned. The aim of this study was to assess the effects of CTO PCI on absolute myocardial perfusion, as compared with PCI of hemodynamically significant non‐CTO lesions. Methods Consecutive patients with a preserved left ventricular ejection fraction (≥50%) and a CTO or non‐CTO lesion, in whom [15O]H2O positron emission tomography was performed prior and after successful PCI, were included. Change in quantitative (hyperemic) myocardial blood flow (MBF), coronary flow reserve (CFR) and perfusion defect size (in myocardial segments) were compared between CTOs and non‐CTO lesions. Results In total 92 patients with a CTO and 31 patients with a non‐CTO lesion were included. CTOs induced larger perfusion defect sizes (4.51 ± 1.69 vs. 3.23 ± 2.38 segments, P < 0.01) with lower hyperemic MBF (1.30 ± 0.37 vs. 1.58 ± 0.62 mL·min−1·g−1, P < 0.01) and similarly impaired CFR (1.66 ± 0.75 vs. 1.89 ± 0.77, P = 0.17) compared with non‐CTO lesions. After PCI both hyperemic MBF and CFR increased similarly between groups (P = 0.57 and 0.35) to normal ranges with higher hyperemic MBF values in non‐CTO compared with CTO (2.89 ± 0.94 vs. 2.48 ± 0.73 mL·min−1·g−1, P = 0.03). Perfusion defect sizes decreased similarly after CTO PCI and non‐CTO PCI (P = 0.14), leading to small residual defect sizes in both groups (1.15 ± 1.44 vs. 0.61 ± 1.45 segments, P = 0.054). Conclusions Myocardial perfusion findings are slightly more hampered in patients with a CTO before and after PCI. Percutaneous revascularization of CTOs, however, improves absolute myocardial perfusion similarly to PCI of hemodynamically significant non‐CTO lesions, leading to satisfying results.

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Coronary Angiography After Cardiac Arrest Without ST Segment Elevation

et al. 2020

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IMPORTANCE Ischemic heart disease is a common cause of cardiac arrest. However, randomized data on long-term clinical outcomes of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients successfully resuscitated from cardiac arrest in the absence of ST segment elevation myocardial infarction (STEMI) are lacking.OBJECTIVE To determine whether immediate coronary angiography improves clinical outcomes at 1 year in patients after cardiac arrest without signs of STEMI, compared with a delayed coronary angiography strategy. DESIGN, SETTING, AND PARTICIPANTSA prespecified analysis of a multicenter, open-label, randomized clinical trial evaluated 552 patients who were enrolled in 19 Dutch centers between January 8, 2015, and July 17, 2018. The study included patients who experienced out-of-hospital cardiac arrest with a shockable rhythm who were successfully resuscitated without signs of STEMI. Follow-up was performed at 1 year. Data were analyzed, using the intention-to-treat principle, between August 29 and October 10, 2019.INTERVENTIONS Immediate coronary angiography and PCI if indicated or coronary angiography and PCI if indicated, delayed until after neurologic recovery.MAIN OUTCOMES AND MEASURES Survival, myocardial infarction, revascularization, implantable cardiac defibrillator shock, quality of life, hospitalization for heart failure, and the composite of death or myocardial infarction or revascularization after 1 year.RESULTS At 1 year, data on 522 of 552 patients (94.6%) were available for analysis. Of these patients, 413 were men (79.1%); mean (SD) age was 65.4 (12.3) years. A total of 162 of 264 patients (61.4%) in the immediate angiography group and 165 of 258 patients (64.0%) in the delayed angiography group were alive (odds ratio, 0.90; 95% CI, 0.63-1.28). The composite end point of death, myocardial infarction, or repeated revascularization since the index hospitalization was met in 112 patients (42.9%) in the immediate group and 104 patients (40.6%) in the delayed group (odds ratio, 1.10; 95% CI, 0.77-1.56). No significant differences between the groups were observed for the other outcomes at 1-year follow-up. For example, the rate of ICD shocks was 20.4% in the immediate group and 16.2% in the delayed group (odds ratio, 1.32; 95% CI, 0.66-2.64). CONCLUSIONS AND RELEVANCEIn this trial of patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, a strategy of immediate angiography was not found to be superior to a strategy of delayed angiography with respect to clinical outcomes at 1 year. Coronary angiography in this patient group can therefore be delayed until after neurologic recovery without affecting outcomes. TRIAL REGISTRATION trialregister.nl Identifier: NTR4973

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Effects of successful percutaneous coronary intervention of chronic total occlusions on myocardial perfusion and left ventricular function

Abstract: The vast majority of CTO patients with documented ischaemia and viability showed significant improvement in stress MBF and a reduction of ischaemic burden after successful percutaneous revascularisation with only minimal effect on LVEF.

Cited by 41 publications

References 21 publications

Meta‐analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling

Meta‐analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling

Recovery of myocardial perfusion after percutaneous coronary intervention of chronic total occlusions is comparable to hemodynamically significant non‐occlusive lesions

Coronary Angiography After Cardiac Arrest Without ST Segment Elevation

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