Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients With Low Left Ventricular Ejection Fraction

Galassi, Alfredo R.; Boukhris, Marouane; Toma, Aurel; Elhadj, Zied Ibn; Laroussi, Lobna; Gaemperli, Oliver; Behnes, Michael; Akın, İbrahim; Lüscher, Thomas F.; Neumann, Franz Josef; Mashayekhi, Kambis

doi:10.1016/j.jcin.2017.06.058

Cited by 93 publications

(74 citation statements)

References 37 publications

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“…Regarding our baseline demographic characteristics, CTO patients with low LVEF were more diabetic and affected by CKD, when compared to those with preserved and mid‐range LVEF. This was concordant with Galassi et al & Tajstra et al, who revealed that patients with CTO and low LVEF had a higher prevalence of diabetes, peripheral vascular disease (PVD), and CKD besides a higher frequency of previous myocardial infarction (MI), and higher percentage of multivessel coronary artery disease (CAD).…”

Section: Discussionsupporting

confidence: 89%

Echocardiographic assessment of left ventricular function recovery post percutaneous coronary intervention of chronic total occlusions in patients with low and mid‐range left ventricular ejection fractions

et al. 2020

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Objectives Coronary chronic total occlusion (CTO) is a frequent condition encountered in cardiac catheterization laboratory with a prevalence of about 20%. Through literature, data are scarcely reported regarding the left ventricular (LV) function recovery post CTO percutaneous coronary intervention (PCI) in patients with low (<40%) and mid‐range (40%‐49%) LV ejection fraction (LVEF). The aim of this study was to assess the echocardiographic outcomes of CTO patients with low and mid‐range LVEF successfully revascularized at 6‐month follow‐up. Methods This prospective study included 75 patients with at least one CTO of an epicardial coronary artery proved by previous diagnostic coronary angiography with PCI attempt indication, and successfully revascularized. They were equally divided according to LVEF into three groups, and echocardiographic remodeling indices were assessed at baseline and 6 months post PCI. Results Our study showed significant improvement of LVEF, S‐wave velocity by tissue doppler imaging (TDI), LV wall‐motion score (LVWMS), and LV systolic sphericity index (LVSIS) 6 months post CTO PCI in low LVEF group, and a significant improvement in LVEF, S‐wave velocity, and LVWMS in mid‐range LVEF group (P < .05). The delta change in LVEF was significantly more in low LVEF group, compared to the other two groups (F = 4.739, P < .05). Conclusion Successful CTO PCI in patients with low and mid‐range LVEF is associated with significant improvement of LVEF and other indices of myocardial remodeling after 6 months of follow‐up.

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Section: Discussionsupporting

confidence: 89%

Echocardiographic assessment of left ventricular function recovery post percutaneous coronary intervention of chronic total occlusions in patients with low and mid‐range left ventricular ejection fractions

et al. 2020

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“…Fifth, the assessment of angina status was not performed in accordance with standardised measures, such as Seattle Angina Questionnaire, thus making cross-trial comparisons difficult, although the finding of a reduced symptom burden coincides with previous studies,6 including the recent presentation of the preliminary results of the randomised EURO CTO trial i .…”

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confidence: 79%

“…In summary, the EXPLORE trial, although overall neutral, seems to further broaden the evidence base and may, together with other recent CTO studies, which have established the potential of CTO PCI to improve quality of life and reduce symptoms,6 warrant further inquiry by applying the increasingly efficient and safe technique of CTO PCI in different clinical settings, with the ultimate goal of using what seems to be a clinically intuitive benefit of percutaneous complete revascularisation.…”

mentioning

confidence: 94%

“…Therefore, in addition to ongoing randomised studies (eg, SHINE-CTO https://clinicaltrials.gov/ct2/show/NCT02784418), potential novel grounds may be explored to accumulate evidence regarding optimal CTO treatment, such as (1) enlarging the network of peers capable of performing high-quality CTO PCI with success rates >90% through dedicated proctoring programmes, (2) standardising procedural and outcome reporting to facilitate comparisons among trials and creation of large databases8 and (3) investigating the effects of CTO PCI in specific disease subsets, such as low EF, where significant improvements have been shown in an observational setting 6…”

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confidence: 99%

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Chronic total occlusion percutaneous coronary intervention in clinical practice: novel grounds to be EXPLOREd

Stojković

2018

Heart

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“…As evidenced by recent trials, CTO PCI success is improving, but patient selection is key.There has been much interest in CTO PCI in patients with low left ventricular ejection volume (LVEF). Galassi conducted a prospective, multicenter trial of 839 patients undergoing elective CTO PCI comparing three groups: LVEF >50%, LVEF 35-50%, and LVEF <35% 45. All groups had comparable success rates above 90% with low EF not being a predictor of CTO failure.…”

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confidence: 99%

Percutaneous coronary intervention: 2017 in review

Rao

Sheth

Grines

2018

J Interven Cardiology

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In an effort to keep the interventional community up-to-date with the abundant amount of new data, we have selected what we believe to be the most important publications in percutaneous coronary intervention from January 1, 2017 to 2 The overall rate of complete revascularization (CR) was 61.7%.In those patients with CR, there was no difference between CABG or PCI regarding death from any cause as well as composite of death, MI, and stroke at 5 year follow up, even at higher SYNTAX scores.However, compared to CABG with CR, PCI with incomplete revascularization put patients at a significant higher risk for similar endpoints. These studies suggest that the ability to achieve CR should be strongly considered when deciding between CABG and PCI in MVD.As we have learned from contemporary data on revascularization, certain subsets of patients have fared better with one revascularization strategy over another. An observational cohort study of multiple Swedish registries found that in patients with Type 1 diabetes and MVD, first multi-vessel revascularization with PCI was associated with higher risk of cardiac death, MI, and repeat revascularization although with similar all-cause mortality when compared to CABG. 3 This study indicates that CABG may be the preferred strategy in patients with Type 1 diabetes in need of multi-vessel revascularization, and is in agreement with earlier trials showing most of the benefit in patients treated with insulin, but not oral agents.In patients with low or intermediate SYNTAX score, PCI of unprotected left main with everolimus-eluting stents (EES) was shown to be noninferior to CABG with respect to a composite endpoint of death, stroke, and MI at 3 years in the EXCEL trial. 4 Of the 1905 patients randomized during the trial, 1788 patients were also followed for quality of life assessment to fully understand patient's perspective.

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Percutaneous Coronary Intervention of Chronic Total Occlusions in Patients With Low Left Ventricular Ejection Fraction

Abstract: In CTO patients with low LVEF, PCI could represent a safe and effective revascularization strategy achieving good midterm outcome and LVEF improvement.

Cited by 93 publications

References 37 publications

Echocardiographic assessment of left ventricular function recovery post percutaneous coronary intervention of chronic total occlusions in patients with low and mid‐range left ventricular ejection fractions

Echocardiographic assessment of left ventricular function recovery post percutaneous coronary intervention of chronic total occlusions in patients with low and mid‐range left ventricular ejection fractions

Chronic total occlusion percutaneous coronary intervention in clinical practice: novel grounds to be EXPLOREd

Percutaneous coronary intervention: 2017 in review

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