Successful treatment of complex coronary chronic total occlusions improves midterm outcomes

Wu, Kaize; Huang, Zehan; Zhong, Zhian; Liao, Hongtao; Zhou, Yi; Luo, Bingzheng; Narayanan, Mahesh Anantha; Khouzam, Rami N.; Garg, Aakash; Vukčević, Vladan; Kounis, Nicholas G.; Zhou, Bin

doi:10.21037/atm.2019.05.09

Cited by 9 publications

(3 citation statements)

References 23 publications

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“…A literature search identified seven prospective trials and one retrospective trial published between 2012 and 2020 [10][11][12][13][14][15][16][17] which provided the HRs and 95% CIs in multivariate analysis for at least one of the endpoints, including 7 studies for MACE and 3 studies for all-cause mortality. If a study considered patients with failed CTO PCI as the reference, then the data was converted to HR estimations considering cases with successful CTO PCI as a reference group to reflect the impact of successful CTO PCI on CTO patients.…”

Section: Search Resultsmentioning

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: Search Resultsmentioning

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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“…The average J-CTO score was 1.5 in this study, which was lower than that in randomized clinical trials [ 10 , 24 ] ranging from 1.8 to 2.1, indicating less complex CTO lesions were enrolled in the study and this kind of lesion might be suitable for DCB treatment. J-CTO score is an independent predictor of MACEs [ 25 ]. Although the long-term MACEs were not significantly different between DCB only and hybrid groups in this study, the MACEs rate might be higher in hybrid group due to higher J-CTO score after longer follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions

Qin,

Chen,

et al. 2023

Coronary Artery Disease

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Objectives This study aims to compare the clinical outcomes of patients with de novo chronic total occlusion (CTO) lesions treated by hybrid strategy and drug-coated balloons (DCB)-only strategy. Backgrounds DCBs have been used as an alternative to or in combination with drug-eluting stents in CTO lesions. However, the clinical impact of DCB treatment on CTO lesion remains uncertain. Methods We retrospectively enrolled 154 patients with de novo CTO lesions treated by DCB, including 57 cases in hybrid group and 97 cases in DCB-only group. Results The lesions in hybrid group were more complicated than those in DCB-only group as shown by higher J-CTO score, and therefore higher percentage of retrograde approach, more IVUS guidance, more CTO guidewires, and longer procedural time were demonstrated. Although the percentage of non-flow-limiting dissection and residual stenosis of more than 30% were lower in hybrid group, TIMI flow grade, satisfactory and acceptable recanalization rate were not significantly different between two groups. During a median follow-up was 470 days, the incidence of target lesion revascularization (TLR), myocardial infarction and cardiac death was 11.0%, 1.3% and 1.9%, respectively. The long-term TLR-free survival was comparable between hybrid and DCB-only groups. By multivariate analysis, DCB length and age were predictors of TLR. Conclusion DCB treatment appears effective and safe in selected de novo CTO lesions during long-term follow up. The recanalization results and long-term outcomes are comparable between hybrid and DCB-only group despite more complicated lesions in hybrid group.

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“…Крупные регистры и РКИ убедительно показали, что у пациентов с полной реваскуляризацией миокарда отмечается значительное снижение уровня смертности [14][15][16]. В РКИ SYNTAX остаточный SYNTAX score >8 баллов был связан c более высокой смертностью от всех причин в течение 5 лет.…”

Section: Discussionunclassified

Endovascular myocardial revascularization in patients with multivessel coronary artery disease with chronic total occlusion and high surgical risk

Васильев

Руденко

Шаноян

et al. 2020

Cardiovasc Ther Prev

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The main reason for incomplete myocardial revascularization is the presence of chronic coronary total occlusion (CTO), which is detected in every fourth patient during coronary angiography. At the same time, a generally accepted approach to the treatment of CTO has not yet been developed.Aim. To assess the rationale of complete myocardial revascularization in patients with multivessel coronary artery disease (CAD) with chronic total occlusion and high surgical risk.Material and methods. This retrospective, open-label, non-randomized clinical trial was carried out included 180 patients multivessel CAD and CTO. The patients underwent endovascular surgery for complete myocardial revascularization. Depending on the success of surgery, the patients were divided into groups of complete and incomplete myocardial revascularization. Endpoints were death, acute coronary syndrome, re-revascularization after 1-year follow-up. Left ventricular (LV) contractility and clinical status of patients in the study groups after 1 year of observation was assessed.Results. The median follow-up was 12,1 months. The successful rate of revascularization was 79,4%. The incidence of main composite endpoint in the group of complete myocardial revascularization was 5,59%, while in the group of incomplete revascularizations — 21,6% (p=0,005).Conclusion. The study showed that low incidence of intraoperative complications and a high successful rate of revascularization are characteristic of complete myocardial revascularization in patients at high surgical risk with multivessel CAD and CTO. Complete myocardial revascularization leads to a significant decrease in the incidence of major coronary events.

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Successful treatment of complex coronary chronic total occlusions improves midterm outcomes

Cited by 9 publications

References 23 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

Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions

Endovascular myocardial revascularization in patients with multivessel coronary artery disease with chronic total occlusion and high surgical risk

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