Improvement in Survival Following Successful Percutaneous Coronary Intervention of Coronary Chronic Total Occlusions: Variability by Target Vessel

Safley, David M.; House, John A.; Marso, Steven P.; Grantham, J. Aaron; Rutherford, Barry D.

doi:10.1016/j.jcin.2008.05.004

Cited by 140 publications

(85 citation statements)

References 25 publications

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“…240 According to this definition, Ն15% of patients undergoing PCI would be defined as having periprocedural MI. 241,242 Issues in procedure-related MI are discussed in Section 5.10.…”

Section: Pci Complicationsmentioning

confidence: 99%

“…710 However, the impact of successful CTO recanalization on long-term survival remains unsettled. 701,711,712 The decision to try PCI for a CTO (versus continued medical therapy or surgical revascularization) requires an individualized risk-benefit analysis encompassing clinical, angiographic, and technical considerations. Consultation with a cardiothoracic surgeon and use of the Heart Team approach in cases of CTO in which a large territory is subtended and/or multivessel CAD is present are frequently done.…”

Section: Fondaparinux: Recommendationmentioning

confidence: 99%

“…785 Furthermore, a meta-analysis of 15 observational studies found that troponin elevations at any level were linked with worse inhospital and long-term outcomes; elevations Ͼ3 times the upper limit of normal predicted even worse outcomes. 242 Other observational data, however, have raised concerns about whether the relationship is causal. 786,787 A recent study found creatinine kinase-MB to correlate better with MRIdetected MI than troponin level.…”

Section: Class Iib 1 Routine Measurement Of Cardiac Biomarkers (Creamentioning

confidence: 99%

See 2 more Smart Citations

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Levine

Bates²,

Blankenship³

et al. 2011

Circulation

1,885

567

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“…240 According to this definition, Ն15% of patients undergoing PCI would be defined as having periprocedural MI. 241,242 Issues in procedure-related MI are discussed in Section 5.10.…”

Section: Pci Complicationsmentioning

confidence: 99%

Section: Fondaparinux: Recommendationmentioning

confidence: 99%

Section: Class Iib 1 Routine Measurement Of Cardiac Biomarkers (Creamentioning

confidence: 99%

See 1 more Smart Citation

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Levine

Bates²,

Blankenship³

et al. 2011

Circulation

1,885

567

View full text Add to dashboard Cite

“…13,[33][34][35] However, the findings in the current literature regarding the potential relationship between CTO revascularization in patients with very low LVEF and improvement in mortality are inconsistent, as are the criteria for candidacy for ICD implantation. Otherwise, the possibility of LVEF improvement with its beneficial effect on survival provides the rationale for the technically demanding attempt to revascularize a CTO.…”

Section: Impact Of Cto On Mortalitymentioning

confidence: 99%

Ventricular Arrhythmias Among Implantable Cardioverter-Defibrillator Recipients for Primary Prevention

Nombela‐Franco

Mitroi

Fernández‐Lozano

et al. 2012

Circ: Arrhythmia and Electrophysiology

143

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Background-An implantable cardioverter-defibrillator (ICD) is the therapy of choice for primary prevention in patients with ischemia who are at risk for sudden cardiac death (SCD). One third of patients with significant coronary disease have chronic total coronary occlusion (CTO), which is associated with long-term mortality in patients with previous myocardial infarction. However, the impact of CTO on the occurrence of ventricular arrhythmias and long-term mortality in ICD recipients remains unknown. Methods and Results-All consecutive patients with coronary artery disease receiving ICD therapy for the prevention of SCD were included in the study. Among other characteristics, the existence of CTO was assessed. During follow-up, the occurrence of appropriate device delivery because of ventricular arrhythmias as well as mortality were noted. A total of 162 patients (mean age, 62Ϯ9 years; 93% men) with an ICD were included and followed for a median of 26 months (interquartile range, 12-42). At least 1 CTO was present in 71 (44%) patients. Appropriate device therapy was detected in 18% of the patients during the follow-up. The presence of CTO was associated with higher ventricular arrhythmia and mortality rates (log-rank test, Ͻ0.01). Multivariable analysis revealed that CTO was independently associated with appropriate ICD intervention (hazard ratio, 3.5; Pϭ0.003). Conclusions-In patients with ischemic heart disease receiving ICDs for primary prevention of SCD, CTO is an independent predictor for the occurrence of ventricular arrhythmias and has an adverse impact on long-term mortality. (Circ Arrhythm Electrophysiol. 2012;5:147-154.)

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“…One could argue that the survival benefit after successful recanalization of a CTO might be limited to certain subgroups. This was demonstrated by Safley et al 19 who reported a significant benefit in survival after successful PCI of a CTO in the left anterior descending, but not in the left circumflex or RCA. In the context of ULM-PCI, revascularization of CTO-RCA is important to guarantee collateral circulation and provide reserve, if ULM restenosis were to occur.…”

Section: Discussionmentioning

confidence: 80%

Impact of Residual Chronic Total Occlusion of Right Coronary Artery on the Long-term Outcome in Patients Treated for Unprotected Left Main Disease

Takagi

Ielasi

Chieffo

et al. 2013

Circ: Cardiovascular Interventions

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W ith continual improvements in stent technology and adjunctive pharmacotherapy, we have supportive evidence regarding percutaneous coronary intervention (PCI) and drug-eluting stent (DES) implantation in selected unprotected left main (ULM) lesions involving ostium/body or distal bifurcation with low-to-moderate SYNTAX scores. [1][2][3][4][5][6][7][8] Conversely, in patients with SYNTAX score >32, coronary artery bypass grafting (CABG) is recommended. 9 The presence of chronic total occlusion of the right coronary artery (CTO-RCA) contributes to the generation of a high SYNTAX score in patients with ULM stenosis. There is scarcity of data on the impact of residual CTO-RCA in patients undergoing PCI for ULM, and we aim to study this aspect in our cohort of patients. MethodsBetween P=0.014), resulting in the similar major adverse cardiovascular events rates between the 2 groups. When we analyzed patients with concomitant ULM and CTO-RCA, cardiac-death was significantly higher in patients with residual as compared with treated CTO-RCA (log-rank P=0.01) despite no difference in baseline characteristics. Conclusions-Cardiac-death occurred more frequently in patients with residual CTO-RCA as compared with those without residual CTO-RCA. These findings suggest that recanalization of CTO-RCA has significant impact on the longterm cardiac-mortality in patients undergoing ULM-percutaneous interventions probably by offering reserve coronary circulation, if in-stent restenosis were to occur in the treated left main. (Circ Cardiovasc Interv. 2013;6:154-160.)Key Words: chronic total coronary occlusion ◼ drug-eluting stent ◼ left main coronary artery ◼ right coronary artery

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Improvement in Survival Following Successful Percutaneous Coronary Intervention of Coronary Chronic Total Occlusions: Variability by Target Vessel

Abstract: The data suggest that PCI for CTO of the LAD, but not LCX or RCA, is associated with improved long-term survival. This information may assist in selecting patients for attempted CTO PCI.

Cited by 140 publications

References 25 publications

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Ventricular Arrhythmias Among Implantable Cardioverter-Defibrillator Recipients for Primary Prevention

Impact of Residual Chronic Total Occlusion of Right Coronary Artery on the Long-term Outcome in Patients Treated for Unprotected Left Main Disease

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