In-hospital outcome of re-attempted percutaneous coronary interventions for chronic total occlusion

Guelker, Jan‐Erik; Blockhaus, Christian; Kroeger, Knut; Kürvers, Julian; Ilousis, Dimitrios; Mashayekhi, Kambis

doi:10.5603/cj.a2021.0012

Cited by 6 publications

(2 citation statements)

References 33 publications

(40 reference statements)

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“…Sachdeva et al [21] further reported that all patients with occluded coronary arteries showed an ischemic fractional flow reserve, even with severe regional dysfunction or well-developed collaterals. 9 Nowadays, PCI is becoming the preferred revascularization method due to the rapid advancement in equipment and techniques as well as a growing expertise among dedicated operators [22][23][24][25][26][27]. The rate of successful CTO PCI has increased to 90% in experienced institutions [28].…”

Section: Discussionmentioning

confidence: 99%

Comparison of successful versus failed percutaneous coronary intervention in patients with chronic total occlusion: A systematic review and meta-analysis

et al. 2024

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Background:The optimal treatment strategy of chronic total occlusion (CTO) is currently debated. This meta-analysis aimed to evaluate the long-term clinical outcomes of successful percutaneous coronary intervention (PCI) of CTO.Methods: Electronic databases were searched for studies comparing long-term outcomes between successful PCI in patients with CTO using drug-eluting stents and failed procedures. Meta-analysis was conducted with major adverse cardiac events (MACE) and all-cause mortality during the longest follow-up as endpoints. The combined hazard ratios (HRs) were applied to assess the correlation between successful CTO PCI and MACE/all-cause mortality.Results: Eight studies consisting of 6,211 patients published between 2012 and 2020 met our inclusion criteria, and the CTO PCI success rate was 81.2%. Patients in the failed group were much older, and more likely to have morbidities (hypertension and 2 prior myocardial infarction), reduced left ventricular ejection fraction, and severe lesion characteristics (multivessel disease and moderate/severe calcification). Pooled results indicated that successful CTO PCI was significantly associated with prognosis.Compared to failed recanalization, patients receiving successful procedures had an improved MACE (HR: 0.50, 95% CI: 0.40-0.61, p < 0.001). Subgroup analyses further revealed the prognostic value of successful CTO PCI. However, no difference was observed regarding all-cause mortality (HR: 0.79, 95% CI: 0.61-1.02, p = 0.074). Conclusions:The present study showed that CTO recanalization was associated with improved long-term outcomes. However, randomized trials are needed to confirm the results due to the mismatch of baseline characteristics.

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Section: Discussionmentioning

confidence: 99%

Comparison of successful versus failed percutaneous coronary intervention in patients with chronic total occlusion: A systematic review and meta-analysis

et al. 2024

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“…A composite endpoint was evaluated including acute cardiac death, vascular and bleeding complications, coronary perforation, which necessitated treatment by pericardial puncture, peri-interventional myocardial infarction (MI) which was defined as an increase in cardiac troponin blood levels in a patient who also exhibits signs or symptoms of MI, stroke and emergency coronary artery bypass grafting surgery (CABG) [ 19 , 20 ].…”

Section: Methodsmentioning

confidence: 99%

Influence of the Single Coronary Vessel on Acute Outcomes of In-Stent CTO Recanalization

Guelker¹,

Blockhaus²,

Kemala³

et al. 2022

Rev. Cardiovasc. Med.

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Objective: Recanalization of in-stent chronic total occlusion (IS-CTO) is challenging and has resulted in inconsistent results. The aim of our study was to analyze the influence of the individual coronary vessels on the acute outcomes following IS-CTO PCI. Methods: This was an observational retrospective study, including 66 patients undergoing recanalization of a CTO. The CTO interventions were performed bi-femoral using 7-French guiding catheters. A composite endpoint summarizing severe complications was evaluated, including emergency coronary artery bypass grafting surgery (CABG) and cardiac death. Results: We subdivided our cohort into three groups (LAD group, LCX group, RCA group). The retrograde technique and the utilization of an extension catheter were used more frequently in patients with a RCA IS-CTO. There was no significant difference between the composite safety endpoints amongst the three groups. Technical success was independent of the involved vessel. Conclusions: Success and complication rates are independent of the occluded vessel. This challenging and complex coronary intervention is feasible and can be carried out in complete safety.

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Effects of a prior failed attempt on the outcomes of subsequent chronic total occlusion‐percutaneous coronary intervention

Zheng,

Ai,

Zhao

et al. 2024

Aging Medicine

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ObjectivesPatients undergoing a prior failed attempt of chronic total occlusion‐percutaneous coronary intervention (CTO‐PCI) represent a challenging subgroup across all patients undergoing CTO‐PCI. There are limited data on the effects of a prior failed attempt on the outcomes of subsequent CTO‐PCI. We aimed to compare the procedural results and 24‐month outcomes of prior‐failed‐attempt CTO‐PCI with those of initial‐attempt CTO‐PCI.MethodsPatients who underwent attempted CTO‐PCI between January 2017 and December 2019 were prospectively enrolled. We analyzed the procedural results and 24‐month major adverse cardiac events (MACE) between patients who underwent prior‐failed‐attempt and initial‐attempt CTO‐PCI. MACE was defined as a composite of cardiac death, target vessel‐related myocardial infarction, and ischemia‐driven target vessel revascularization (TVR) during follow‐up.ResultsIn total, 484 patients who underwent CTO‐PCI (prior‐failed‐attempt, n = 49; initial‐attempt, n = 435) were enrolled during the study period. After propensity score matching (1:3), 147 patients were included in the initial‐attempt group. The proportion of the Japanese‐CTO (J‐CTO) score ≥2 was higher in the patients who underwent prior failed attempt than in those who underwent initial attempt (77.5% vs. 38.8%, p < 0.001). The retrograde approach was more often adopted in the prior‐failed‐attempt group than in the initial‐attempt group (32.7% vs. 3.4%, [P< 0.001). Successful CTO revascularization rates were significantly lower in the prior‐failed attempt‐group than in the initial attempt group (53.1% vs. 83.3%, P < 0.001). The multivariate analysis revealed that J‐CTO score ≥2 [odds ratio (OR), 0.359; 95% confidence interval (CI), 0.159–0.812; P = 0.014], intravascular ultrasound procedure (OR, 4.640; 95% CI, 1.380–15.603; P = 0.013), and prior failed attempt (OR, 0.285; 95% CI, 0.125–0.648; P = 0.003) were the independent predictors for successful CTO revascularization. There were no significant differences in major procedural complications (2.0% vs. 0.7%, p = 0.438) and MACE rates (4.1% vs. 8.8%, p = 0.438) between the groups, mainly due to the TVR rate (4.1% vs. 8.2%, P = 0.522).ConclusionsCompared with initial‐attempt CTO‐PCI, prior‐failed‐attempt CTO‐PCI deserves more attention, since it is associated with a lower successful CTO revascularization rate. Prior failed attempt, J‐CTO score ≥2, and IVUS procedure are the determining factors for predicting successful CTO revascularization. There are no significantly different unfavorable outcomes between patients who undergo prior‐failed‐attempt and initial‐attempt CTO‐PCI.

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In-hospital outcome of re-attempted percutaneous coronary interventions for chronic total occlusion

Cited by 6 publications

References 33 publications

Comparison of successful versus failed percutaneous coronary intervention in patients with chronic total occlusion: A systematic review and meta-analysis

Comparison of successful versus failed percutaneous coronary intervention in patients with chronic total occlusion: A systematic review and meta-analysis

Influence of the Single Coronary Vessel on Acute Outcomes of In-Stent CTO Recanalization

Effects of a prior failed attempt on the outcomes of subsequent chronic total occlusion‐percutaneous coronary intervention

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