Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI

Henriques, José P.S.; Hoebers, Loes P.; Råmunddal, Truls; Laanmets, Peep; Eriksen, Erlend; Bax, Matthijs; Ioanes, Dan; Suttorp, Maarten J.; Strauss, Bradley H.; Barbato, Emanuele; Nijveldt, Robin; Rossum, Albert C. van; Marques, Koen M.; Elias, Joëlle; Dongen, Ivo M. van; Claessen, Bimmer E.; Tijssen, Jan G.P.; Schaaf, René J. van der

doi:10.1016/j.jacc.2016.07.744

Cited by 323 publications

(187 citation statements)

References 27 publications

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“…CTO PCI success was 73%. Cardiac magnetic resonance imaging performed after 4 months showed similar left ventricular ejection fraction and left ventricular end‐diastolic volume in the 2 study groups 5. Despite its limitations (enrollment of patients regardless of symptoms and regardless of viability and ischemia of the myocardium supplied by the CTO; potential selection bias given slow enrollment over 7 years at 14 sites; low CTO PCI success rate; and use of a surrogate rather than a clinical primary end point), the EXPLORE trial findings do not support routine PCI of nonculprit CTOs for improving the ejection fraction of patients with recent ST‐segment‐–elevation acute MI.…”

Section: Clinical Benefitsmentioning

confidence: 72%

“…Only one randomized controlled trial comparing CTO PCI with medical therapy alone has been published to date, the EXPLORE (Evaluating Xience and Left Ventricular Function in Percutaneous Coronary Intervention on Occlusions After ST‐Elevation Myocardial Infarction) trial 5. The EXPLORE trial randomized 304 patients who underwent primary PCI for ST‐segment–elevation myocardial infarction (MI) and had a coexisting non–infarct‐related artery CTO to CTO PCI versus medical therapy alone.…”

Section: Clinical Benefitsmentioning

confidence: 99%

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Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Tajti

Brilakis

2018

JAHA

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Section: Clinical Benefitsmentioning

confidence: 72%

Section: Clinical Benefitsmentioning

confidence: 99%

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Tajti

Brilakis

2018

JAHA

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“…The EXPLORE (Evaluating Xience and Left Ventricular Function in Percutaneous Coronary Intervention on Occlusions After ST‐Segment–Elevation Myocardial Infarction) trial randomized patients presenting with acute STEMI and concurrent CTO in an nIRA to receive either early revascularization (within 1 week) or conservative (non‐PCI) therapy 10. They reported a relatively high level of successful CTO PCI (77%).…”

Section: Discussionmentioning

confidence: 99%

“…Of these, 16 were selected for further review. Ultimately, 5 observational studies and 1 RCT satisfied all inclusion criteria 10, 14, 15, 16, 17, 18. All selected studies were published in journals as full English articles.…”

Section: Methodsmentioning

confidence: 99%

“…The current literature includes several small studies which suggest that successful revascularization of CTO lesions is associated with a lower risk of death, stroke, and coronary artery bypass grafting; less recurrent angina; and improvement of left ventricular ejection fraction (LVEF) 8, 9. However, a recent randomized prospective trial did not find benefit for patients with STEMI who had PCI of an nIRA CTO 10. We therefore performed a meta‐analysis to compare outcomes between patients presenting with STEMI who underwent PCI revascularization of nIRA CTO versus those who did not.…”

mentioning

confidence: 99%

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Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Villablanca

Olmedo

Weinreich

et al. 2018

JAHA

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BackgroundStudies have shown that chronic total occlusion (CTO) in a noninfarct‐related artery in patients with ST‐segment–elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct‐related artery CTO in patients with ST‐segment–elevation myocardial infarction translates to improved outcomes. We performed a meta‐analysis to compare outcomes between patients presenting with ST‐segment–elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct‐related artery CTO versus those who did not.Method and ResultsWe conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all‐cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Random effects model was used and heterogeneity was considered if I 2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32–0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20–0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36–0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all‐cause mortality (OR, 0.47; 95% CI, 0.22–1.00), myocardial infarction (OR, 0.78; 95% CI, 0.41–1.46), repeat revascularization (OR, 1.13; 95% CI, 0.56–2.27), and stroke (OR, 0.51; 95% CI, 0.20–1.33).ConclusionsIn this meta‐analysis, CTO percutaneous coronary intervention of the noninfarct‐related artery in patients presenting with ST‐segment–elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.

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Association of Successful Percutaneous Revascularization of Chronic Total Occlusions With Quality of Life

et al. 2023

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ImportanceChronic total occlusion percutaneous coronary intervention (CTO-PCI) is not usually offered because of skepticism about long-term clinical benefits.ObjectiveTo assess the association of successful CTO-PCI with quality of life by analyzing the relevant domains of the Seattle Angina Questionnaire (SAQ).Data SourcesPubMed, EMBASE, Web of Science, Google Scholar, and Cochrane databases were searched to identify randomized trials and observational studies specifically addressing quality of life domains of SAQ from January 2010 to June 2022.Study SelectionStudies included reporting SAQ metrics such as angina frequency, physical limitation, and quality of life, before and after CTO-PCI.Data Extraction and SynthesisThe present study was performed according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements, in which fixed-effect or random-effect models with generic inverse-variance weighting depending on statistical homogeneity were applied. Data were extracted by 3 independent reviewers.Outcomes and MeasuresThe primary outcome was angina frequency; physical limitation and quality of life were assessed as secondary outcomes.ResultsSeven prospective randomized or observational studies (2500 patients) were included, with a mean (SD) participant age of 61.2 (2.1) years. CTO-PCI was associated with significantly improved quality-of-life metrics during a mean (SD) follow-up of 14.8 (16.3) months. In patients with successful procedures, angina episodes became less frequent (mean [SD] difference for SAQ angina frequency of 12.9 [3.1] survey points [95% CI, 7.1-19.8 survey points]; standardized mean difference was 0.54 [95% CI, 0.21-0.92]; P = .002; I2 = 86.4%) and they experienced less physical activity limitation (mean [SD] difference for SAQ physical limitation of 9.7 [6.2] survey points [95% CI, 3.5-16.2 survey points]; standardized mean difference was 0.42 [95% CI, 0.24-0.55]; P &lt; .001; I2 = 20.9%), and greater quality-of-life domain (mean [SD] difference for SAQ quality of life of 14.9 [3.5] survey points [95% CI, 7.7-22.5 survey points]; standardized mean difference was 0.41 [95% CI, 0.25-0.61]; P &lt; .001; I2 = 58.8%) compared with patients with optimal medical therapy or failed procedure. Furthermore, follow-up duration (point estimate, 0.03; 95% CI, 0.01-0.04; P = .01) was associated with a significant decrease in angina frequency in meta-regression analysis.Conclusions and RelevanceIn this systematic review and meta-analysis examining quality of life following CTO-PCI, successful procedures were associated with improved quality-of-life parameters compared with patients on optimal medical therapy or after failed CTO-PCI. These findings suggest support for using PCI to treat CTOs in symptomatic patients unresponsive to medical treatment.

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Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI

Cited by 323 publications

References 27 publications

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Association of Successful Percutaneous Revascularization of Chronic Total Occlusions With Quality of Life

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