Long-Term Outcomes of Chronic Total Occlusion Recanalization Versus Percutaneous Coronary Intervention for Complex Non-Occlusive Coronary Artery Disease

Azzalini, Lorenzo; Carlino, Mauro; Bellini, Barbara; Marini, Claudia; Pazzanese, Vittorio; Toscano, Evelina; Gramegna, Mario; Moscardelli, Silvia; Bognoni, Ludovica; Montorfano, Matteo

doi:10.1016/j.amjcard.2019.10.034

Cited by 45 publications

(37 citation statements)

References 18 publications

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“…Categorical variables were expressed as absolute numbers and percentages. The Student t statistic was used to compare quantitative variables between two groups and χ 2 All analyses were performed using the statistical package of SPSS 19 and the p value of < 0.05 was considered statistically significant.…”

Section: Discussionmentioning

confidence: 99%

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J-chronic total occlusion score predictive capacity for percutaneous coronary intervention success of chronic total occlusion: Results from a European single center cohort with progressive experience over time

et al. 2023

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Background: Several scoring systems have been described to assess the level of difficulty and to predict the probability of success of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). The J-CTO score was initially developed to correlate CTO complexity with guidewire time crossing through the lesion within 30 min. Moreover, almost all scoring systems represent procedures performed by seasoned operators. Herein, this study sought to evaluate the predictive capacity of J-CTO for PCI success in a European single-center cohort with growing experience in the approach of CTO.Methods: 526 procedures were performed between 2007 and 2020 mainly by a single operator. The predictive power of J-CTO score was assessed by area under the receiveroperator characteristic curve (ROC) in the entire cohort and additionally in two separate periods. The goodness-of-fit of the model was evaluated by the Hosmer and Lemeshow statistic.Results: Successful procedure in first-attempt PCI was 79.5% and the overall success including 47 repeated procedures was achieved in 85.8%. The retrograde approach was attempted in 14.4%. The score was inversely associated with procedural success and lower success rate in more difficult CTOs (p < 0.001). ROC curve for the entire cohort, and first block (case 1-200) and second block (case 201-526) was 0.696, 0.661 and 0.748, respectively. The model showed good calibration for the entire cohort (X2 = 1.7; p = 0.43).Conclusions: J-CTO score showed an acceptable predictive power for procedural success in this cohort although its discriminatory power is better as the level of experience is improved.

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Section: Discussionmentioning

confidence: 99%

“…Although the incorporation of new and specific devices has dramatically increased procedural success [1], it is still lower than that of PCI of other complex non-occluded arteries [2].…”

Section: Introductionmentioning

confidence: 99%

J-chronic total occlusion score predictive capacity for percutaneous coronary intervention success of chronic total occlusion: Results from a European single center cohort with progressive experience over time

et al. 2023

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“…Prior to the advancement of technique and devices for CTO PCI, CTO lesion is still a challenging subset for successful CTO revascularization. PCI for CTO patients was associated with lower procedural success rates and higher risk of operative complications than those with less complex lesions [19]. With the improvement of technique and equipment for CTO revascularization, such as the retrograde approach,…”

Section: Discussionmentioning

confidence: 97%

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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“…Complex PCI was defined using a modified version of the Giustino et al criteria 5‐7 as any PCI with at least one of the following characteristics: three vessels treated, total stent length >60 mm, chronic total occlusion intervention, bifurcation intervention, PCI for in‐stent restenosis, saphenous vein graft intervention, left main PCI, Impella‐supported PCI (Abiomed, Danvers, MA), or use of rotational or orbital atherectomy.…”

Section: Methodsmentioning

confidence: 99%

One‐year outcomes of patients undergoing complex percutaneous coronary intervention with three contemporary drug‐eluting stents

Azzalini

Baber

Johal

et al. 2020

Cathet Cardio Intervent

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Objectives We aimed to evaluate the 1‐year outcomes of three everolimus‐eluting stents (EES) for complex percutaneous coronary intervention (PCI). Background It is controversial whether contemporary bioresorbable‐polymer drug‐eluting stents (BP‐DES) are associated with better outcomes compared with durable‐polymer DES (DP‐DES). Methods Patients undergoing PCI with cobalt‐chromium (CoCr)‐DP‐EES (Xience), platinum‐chromium (PtCr)‐DP‐EES (Promus), or PtCr‐BP‐EES (Synergy) at one high‐volume institution between 2015 and 2017 were included. The primary endpoint was 1‐year major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target‐vessel revascularization. Associations were also examined in patients undergoing complex PCI. Multivariable analysis was conducted to adjust for baseline differences across groups. Results We included n = 5,446 patients (CoCr‐DP‐EES, n = 3,177; PtCr‐DP‐EES, n = 1,555; PtCr‐BP‐EES, n = 714). Patients treated with PtCr‐BP‐EES had higher comorbidity burden and procedural complexity. At 1 year, MACE rates were 8.9% for CoCr‐DP‐EES versus 8.9% for PtCr‐DP‐EES versus 8.6% for PtCr‐BP‐EES (p = .97). The incidence of definite/probable stent thrombosis (ST) was also similar (0.6 vs. 0.4 vs. 0.3%, p = .69). Complex PCI was performed in n = 2,894/5,446 (53.1%). At 1 year, MACE rates were 11.5 versus 10.7 versus 10.3%, respectively (p = .83). The incidence of definite/probable ST was also similar (0.9 vs. 0.3 vs. 0.3%, p = .22). On multivariable analysis, stent type was not an independent predictor of MACE either in the overall or in the complex PCI population. Conclusions We observed comparable 1‐year rates of MACE and definite/probable ST in patients undergoing PCI with CoCr‐DP‐EES, PtCr‐DP‐EES, and PtCr‐BP‐EES. Results were unchanged among patients undergoing complex PCI. Future multicenter randomized studies should confirm and extend our findings.

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Long-Term Outcomes of Chronic Total Occlusion Recanalization Versus Percutaneous Coronary Intervention for Complex Non-Occlusive Coronary Artery Disease

Cited by 45 publications

References 18 publications

J-chronic total occlusion score predictive capacity for percutaneous coronary intervention success of chronic total occlusion: Results from a European single center cohort with progressive experience over time

J-chronic total occlusion score predictive capacity for percutaneous coronary intervention success of chronic total occlusion: Results from a European single center cohort with progressive experience over time

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

One‐year outcomes of patients undergoing complex percutaneous coronary intervention with three contemporary drug‐eluting stents

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