Improved Propensity-Score Matched Long-Term Clinical Outcomes in Patients with Successful Percutaneous Coronary Interventions of Coronary Chronic Total Occlusion

Stojković, Siniša; Juričić, Stefan; Dobrić, Milan; Nedeljković, Milan; Vukčević, Vladan; Orlić, Dejan; Stanković, Goran; Tomasević, M; Aleksandric, S; Dikic, Miodrag; Tešić, Milorad; Mehmedbegovic, Z; Bošković, Nikola; Zivkovic, M.; Dedovic, V; Ostojić, Miodrag; Beleslin, Branko

doi:10.1536/ihj.17-360

Cited by 18 publications

(20 citation statements)

References 31 publications

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“…The presence of well-developed collaterals was associated with a significantly higher likelihood of procedural success, which has previously been associated with significantly improved prognosis. 37) The most commonly used scoring tool for predicting successful CTO PCI, the J-CTO score, 13) does not include the presence, maturity, or size of the vessel. The more recently described PRO-GRESS CTO score, 38) while it includes the presence or absence of "interventional collaterals" defined as collaterals which are amenable to crossing with a guidewire and microcatheter.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Prognostic Implications of Well-Matured Coronary Collateral Circulation in Patients with a Chronic Total Occlusion (CTO)

et al. 2020

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The predictors and prognostic implications of well-matured collaterals in those with a chronic total occlusion (CTO) are unknown. We sought to identify the determinants of collateral maturation and to determine its effects on procedural outcomes and prognosis. Patients presenting for CTO percutaneous coronary intervention (PCI) between April 2010 and July 2019 were included. Patients with a previous coronary artery bypass (CABG) to the CTO and those with only bridging collaterals were excluded. The degree of collateral maturation was determined by the Rentrop grading classification. Demographic, biochemical, and anatomical factors and procedural and longer-term outcomes were identified. A total of 212 patients were included in the study. Patients with well-matured collaterals were more likely to be females (29.7% versus 15.2% versus 0%, P < 0.005 for Rentrop grade 3, 2, and 0 or 1, respectively), less likely to have chronic kidney disease (CKD) (8.8% versus 4.5% versus 19.2%, P < 0.05) and less likely to have had a prior CABG (15.6% versus 18.7% versus 19.2%). Patients with well-matured collaterals had lower neutrophil-to-leukocyte ratio (NLR) (2.8 versus 4.0 versus 5.7, P < 0.0001). Patients with well-matured collaterals were more likely to have procedural success (90.5% versus 62.5% versus 34.6%, P < 0.0001). The degree of collateral maturation was not associated with longer-term mortality. Improved collateral maturation was associated with female sex and lower rates of CKD and CABG and a lower NLR. Those with well-matured collaterals had a significantly higher rate of procedural success but not improved prognosis.

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Section: Discussionmentioning

confidence: 99%

Predictors and Prognostic Implications of Well-Matured Coronary Collateral Circulation in Patients with a Chronic Total Occlusion (CTO)

et al. 2020

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“…Despite these truly amazing technical improvements in achieving proficiency of CTO recanalization, many aspects of clinical efficacy of this demanding procedure remain controversial. Several non-randomized (observational) trials have shown that successful CTO revascularization could be linked to improved cardiovascular outcomes [15][16][17] and better quality of life (QOL) [18,19] . We have recently published a long term (66 months) follow-up of cohort of 283 patients in whom recanalization of CTO was attempted [20] .…”

Section: Symptomatic and Prognostic Impact Of The Pci For Ctomentioning

confidence: 99%

“…Several non-randomized (observational) trials have shown that successful CTO revascularization could be linked to improved cardiovascular outcomes [15][16][17] and better quality of life (QOL) [18,19] . We have recently published a long term (66 months) follow-up of cohort of 283 patients in whom recanalization of CTO was attempted [20] . Patients with successfully recanalized CTO had lower rate of MACE (defined as composite of cardiac mortality, myocardial infarction, and target vessel revascularization) than patients with failed procedure; the difference that remained statistically significant after adjustment for baseline between-group differences using propensity scores (adjusted HR 0.402; 95%CI: 0.196-0.824; P = 0.013).…”

Section: Symptomatic and Prognostic Impact Of The Pci For Ctomentioning

confidence: 99%

Contemporary indications for percutaneous revascularization of coronary chronic total occlusions

Dobrić¹,

Stojković²

2019

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How to cite this article: Dobric M, Stojkovic S. Contemporary indications for percutaneous revascularization of coronary chronic total occlusions. Vessel Plus 2019;3:26. http://dx. AbstractChronic total occlusions (CTO) are frequently encountered during coronary angiography, and are generally regarded as the most challenging coronary lesions for percutaneous coronary intervention (PCI). Despite great technical advancements and greatly improved reported procedural success rates during previous years, data on clinical benefit of these procedures still remain scarce and controversial. Data from observational trials suggested that PCI for CTO could be linked to improvements both in symptoms and hard cardiovascular outcomes, while randomized controlled trials showed symptomatic improvement only, without improvement in patient's prognosis. This is in parallel with findings for non-CTO PCI in patients with stable angina. Having in mind complexity of these interventions, high costs, greater volume of contrast, and radiation exposure, appropriate patient selection is crucial for optimizing treatment effectiveness. There are few important factors that should be taken into consideration before planning and attempting PCI for CTO. These are: severity of patient's symptoms despite optimal medical therapy, presence of inducible myocardial ischemia and/or viability in the territory of occluded coronary artery.

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“…With the remarkable developments in interventional techniques in the last few years, the procedural success rate and safety of PCI in patients with CTO has improved [3][4][5]. Furthermore, successful PCI for CTO has been shown to reduce the risk of cardiac death, post-operative myocardial infarction (MI), and improves long-term survival compared with failed CTO PCI [6][7][8]. However, even after successful revascularization, the long term clinical outcomes of CTO patients were still unsatisfactory, and it has been identi ed as an independent predictor of the need for targetvessel revascularization (TVR) and subsequent adverse cardiac outcomes after CTO PCI [9,10].…”

Section: Introductionmentioning

confidence: 99%

Impact of Neutrophil-Lymphocyte Ratio on Long-term Outcomes of Patients with Coronary Chronic Total Occlusion After Percutaneous Coronary Intervention

Gao¹,

Li²,

Lei³

et al. 2020

Preprint

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Background: The impact of preprocedural neutrophil-lymphocyte ratio (NLR) level on subsequent adverse cardiovascular events and health status in coronary chronic total occlusion (CTO) patients after stent implantation is unclear. The present study aims to evaluate the impact of NLR level on long-term clinical outcomes and health status of CTO patients after percutaneous coronary intervention (PCI) in the drug eluting stent era.Methods: A total of 311 CTO patients who underwent successful PCI with new-generation drug-eluting stent and with follow-up were enrolled. Patients were classified into 3 groups according to the tertiles of NLR level at baseline. The primary endpoint (major adverse cardiac events, MACE) was a composite of cardiac death, target-vessel myocardial infarction (MI), and ischemia-driven target-vessel revascularization (TVR) on follow-up. Multivariable COX regression analysis was performed to estimate the relationships between the parameters and MACE.Results: Compared with the low and intermediate tertile groups, preprocedural platelet-lymphocyte ratio (PLR) level and age were significantly higher in the high NLR tertile group. After a median follow-up of 32 (interquartile range: 20 to 44) months, MACE was observed in 10 patients (9.7%) in the low tertile, in 21 (20.2%) in the intermediate tertile, and in 31 (29.8%) in the high tertile group (P = 0.001). Kaplan-Meier analysis demonstrated a significantly higher incidence of MACE, mainly driven by TVR, in patients with high tertile than the low and intermediate tertile groups. Multivariable COX regression analysis showed NLR and occluded length as independent predictors of MACE. No statistically differences were observed regarding the five domains of Seattle Angina Questionnaire (SAQ) scores among the 3 groups (all P > 0.05).Conclusions: In conclusion, in patients who underwent PCI for CTO lesions, elevated NLR level was independently associated with MACE (driven by TVR) on follow-up.

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Improved Propensity-Score Matched Long-Term Clinical Outcomes in Patients with Successful Percutaneous Coronary Interventions of Coronary Chronic Total Occlusion

Cited by 18 publications

References 31 publications

Predictors and Prognostic Implications of Well-Matured Coronary Collateral Circulation in Patients with a Chronic Total Occlusion (CTO)

Predictors and Prognostic Implications of Well-Matured Coronary Collateral Circulation in Patients with a Chronic Total Occlusion (CTO)

Contemporary indications for percutaneous revascularization of coronary chronic total occlusions

Impact of Neutrophil-Lymphocyte Ratio on Long-term Outcomes of Patients with Coronary Chronic Total Occlusion After Percutaneous Coronary Intervention

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