Predictors of successful chronic total occlusion percutaneous coronary interventions: a systematic review and meta-analysis

Wang, Nelson; Fulcher, Jordan; Abeysuriya, Nishan; Adams, Mark; Lal, Sean

doi:10.1136/heartjnl-2017-311986

Cited by 28 publications

(10 citation statements)

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“…On the other hand, the presence of calcification tended to be associated with unsuccessful CTO-PCI. Since the strong association between calcification and unsuccessful CTO-PCI has often reported in literatures [5,29,30], it was not surprising that calcification was inversely associated with the true-sub-true phenomenon. Our speculation regarding successful wiring (Fig 4) would not work under the severe calcification, especially calcification near the CTO exit-site.…”

Section: Discussionmentioning

confidence: 96%

Factors associated with antegrade true-sub-true phenomenon in percutaneous coronary intervention for chronic total occlusion

et al. 2020

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Background Recently, the importance of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) has been emphasized with greater success rates. In the antegrade wire based approach, it is generally considered that the guidewire would not advance from the subintimal space to the intimal space without dissection re-entry device. However, it is sometimes observed by intravascular ultrasound (IVUS) that the guidewire within the subintimal space advanced into the distal true lumen. The purpose of this study was to investigate specific conditions or characteristics which were associated with "antegrade true-sub-true" phenomenon in CTO-PCI. Methods We retrospectively reviewed consecutive 320 CTO lesions that underwent CTO-PCI in our institution. Among them, 16 lesions in which the IVUS confirmed the "antegrade true-subtrue" phenomenon were categorized as the true-sub-true group, whereas 27 lesions that resulted in unsuccessful CTO-PCI were categorized as the unsuccessful group. We compared the clinical, lesion, and procedural characteristics between the true-sub-true group and the unsuccessful group. Results The prevalence of bifurcation with abrupt type in CTO exit-sites was significantly higher in the true-sub-true group in comparison to the unsuccessful group (75.0% vs. 25.9%, p = 0.002). The multivariate logistic regression analysis revealed that bifurcation with abrupt type in CTO exit-site (OR 8.017; 95%CI: 1.484-43.304; p = 0.016) was independent predictor of the antegrade true-sub-true phenomenon.

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Section: Discussionmentioning

confidence: 96%

Factors associated with antegrade true-sub-true phenomenon in percutaneous coronary intervention for chronic total occlusion

et al. 2020

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“…En un metanálisis se revisaron los predictores angiográficos y demográficos de éxito clínico y técnico 29 . Entre las variables demográficas se encuentra que el antecedente de infarto, el intervencionismo percutáneo previo, la cirugía de revascularización coronaria, el ictus y la enfermedad vascular periférica previa se asocia con una reducción de al menos un 20% en la probabilidad de éxito.…”

Section: Predictores De éXito Y Fracasounclassified

“…Entre las variables demográficas se encuentra que el antecedente de infarto, el intervencionismo percutáneo previo, la cirugía de revascularización coronaria, el ictus y la enfermedad vascular periférica previa se asocia con una reducción de al menos un 20% en la probabilidad de éxito. Las variables angiográficas asociadas con un menor éxito fueron la presencia de colaterales puente, la calcificación moderada-grave, la angulación del vaso > 45°, la tortuosidad, la presencia de un muñón romo, las lesiones oclusivas ostiales y las OTC en un vaso diferente de la arteria descendente anterior 29 .…”

Section: Predictores De éXito Y Fracasounclassified

Actualizaci�n del intervencionismo percut�neo en la oclusi�n total cr�nica

Cuevas¹,

Elorriaga²,

Sagredo³

2021

RECIC

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Palabras clave: Enfermedad arterial coronaria. Oclusión total crónica. Intervención coronaria percutánea. Cardiopatía isquémica estable. RESUMENEl tratamiento de la oclusión total coronaria (OTC) sigue siendo uno de los grandes retos de la cardiología. La complejidad del procedimiento de angioplastia de una OTC, unida a cierta controversia en cuanto al beneficio clínico, han generado resistencias en la comunidad de cardiólogos para desarrollar programas de intervención coronaria en los laboratorios de hemodinámica. Sin embargo, la evidencia proveniente de estudios observacionales indica que el intervencionismo con éxito puede aumentar de manera significativa la calidad de vida del paciente, mejorar la función ventricular izquierda, reducir la necesidad de una posterior cirugía y, posiblemente, prolongar la supervivencia. Deben tenerse en cuenta varios factores en la selección de los pacientes para el intervencionismo, como la extensión de la isquemia que rodea a la oclusión, la viabilidad miocárdica, la ubicación coronaria de la OTC y la probabilidad de éxito del procedimiento. Esta revisión proporciona una descripción general de la anatomía y de la histopatología de las OTC, la evidencia sobre el beneficio clínico del intervencionismo, el uso de sistemas de puntuación que pueden ser útiles para evaluar de forma más objetiva la probabilidad de éxito, y un resumen de las técnicas actuales para la realización del procedimiento. AbreviaturasEAC: enfermedad arterial coronaria. ICP: intervencionismo coronario percutáneo. IVUS: ecografía intravascular. MACE: evento adverso cardiovascular mayor. MDL: microcatéter de doble luz. OTC: oclusión total coronaria. Update on percutaneous coronary intervention in the management of chronic total occlusions ABSTRACTThe management of chronic total coronary occlusions (CTO) is still today one of the greatest challenges of cardiology. The complexity of the angioplasty procedure of a CTO added to its controversial clinical benefits has generated certain skepticism in the community of cardiologists when developing CTO intervention programs at the catheterization laboratory. However, the evidence from observational studies indicates that if the intervention is successful it can significantly increase the patient's quality of life, improve the left ventricular function, reduce the need for a subsequent coronary artery bypass graft, and possibly improve survival. Several factors must be taken into consideration in the selection of patients elective for an intervention, including the extent of ischemia surrounding the occlusion, the myocardial viability, the coronary location of the CTO, and the chances of being successful with the procedure. This review provides a general description of the anatomy and histopathology of the CTOs, the evidence surrounding the clinical benefit of these procedures, the use of useful scoring systems to assess more objectively the probability of success, and a summary of the latest techniques available today to perform this procedure.

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“…17 Similarly, in a meta-analysis of 61 studies by Wang et al, PAD was associated with lower technical and clinical success. 18 Both studies, however, included procedures performed during earlier years, that is, 2009 to 2013 for the NCDR study and 2000 to 2016 for the Wang meta-analysis; significant advances in CTO PCI have taken place since then. Moreover, PROGRESS-CTO includes experienced centers and operators that can achieve better outcomes when compared to less experienced centers.…”

Section: 99])mentioning

confidence: 99%

The Impact of Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention (Insights From PROGRESS-CTO Registry)

et al. 2019

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The impact of peripheral artery disease (PAD) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 3999 CTO PCIs performed in 3914 patients between 2012 and 2018 at 25 centers, 14% of whom had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with versus without history of PAD. Patients with PAD were older (67 ± 9 vs 64 ± 10 years, P < .001) and had a higher prevalence of cardiovascular risk factors. They also had more complex lesions as illustrated by higher Japanese CTO score (2.7 ± 1.2 vs 2.4 ± 1.3, P < .001). In patients with PAD, the final crossing technique was less often antegrade wire escalation (40% vs 51%, P < .001) and more often the retrograde approach (23 vs 20%, P < .001) and antegrade dissection/reentry (20% vs 16%, P < .001). Technical success was similar between the 2 study groups (84% vs 87%, P = .127), but procedural success was lower for patients with PAD (81% vs 85%, P = .015). The incidence of in-hospital major adverse cardiac events was higher among patients with PAD (3% vs 2%, P = .046). In conclusion, patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions, and lower procedural success.

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Predictors of successful chronic total occlusion percutaneous coronary interventions: a systematic review and meta-analysis

Abstract: The present study has identified strong negative predictors for clinical success for CTO PCI, which will aid in patient selection for this procedure.

Cited by 28 publications

References 28 publications

Factors associated with antegrade true-sub-true phenomenon in percutaneous coronary intervention for chronic total occlusion

Factors associated with antegrade true-sub-true phenomenon in percutaneous coronary intervention for chronic total occlusion

Actualizaci�n del intervencionismo percut�neo en la oclusi�n total cr�nica

The Impact of Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention (Insights From PROGRESS-CTO Registry)

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