Successful versus unsuccessful antegrade recanalization of single chronic coronary occlusion: Eight‐year experience and outcomes by a propensity score ascertainment

Jaguszewski, Miłosz; Ciećwierz, Dariusz; Gilis‐Malinowska, Natasza; Fijałkowski, Marcin; Targoński, Radosław; Masiewicz, Emilia; Stróżyk, Aneta; Duda, Maciej; Chmielecki, Michal; Lewicki, Łukasz; Dubaniewicz, Witold; Burakowski, Sławomir; Drewla, Piotr; Skarżyński, Paweł; Rynkiewicz, Andrzej; Alibegovic, Jasmina; Landmesser, Ulf; Gruchała, Marcin

doi:10.1002/ccd.25841

Cited by 6 publications

(7 citation statements)

References 38 publications

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“…Interestingly, in a post hoc analysis of the SYNTAX trial (n = 1800), nested PCI (n = 198), and nested CABG registries (n = 649), complete revascularization to patients with !1 CTO (PCI: 26.3%, CABG: 36.4%) was achieved more frequently in the CABG versus PCI group (68.1% versus 49.4%, p < 0.001); in the same report, incomplete revascularization was associated with higher 4year mortality in the whole cohort, as well as in the subgroup with CTO [57]. On the other hand, in patients with a single-vessel CTO, successful, versus failed, CTO-PCI was not associated with a longterm survival benefit [37,41]. Individually, survival benefit associated with successful, versus failed, CTO-PCI was consistent in the left anterior descending artery, but not in the left circumflex territory; lack of benefit was consistent in the right coronary artery [14,33].…”

Section: Reappraisal Of the Quality Of Evidencementioning

confidence: 85%

“…On the other hand, studies that demonstrated comparable cardiovascular outcome with successful, versus failed, CTO-PCI are summarized in Table 4. All showed comparable mortality and other MACE between the two comparison groups, at long-term follow-up, either in adjusted, or in both adjusted and unadjusted analysis [3,18,20,[39][40][41][42][43]. However, as an inherent limitation to all registries and observational studies, the retrospective analysis of data could have introduced selection bias, added to the absence of information on the exact medical treatment received in the comparison groups.…”

Section: Impact On the Cardiovascular Outcomementioning

confidence: 99%

“…Second, the baseline characteristics of such group are often unmatched with (often worse than) the successful group [16]; worse baseline risk profile could have determined procedural failure as well as worse long-term outcome, alike. Interestingly, in many studies, no difference in clinical outcome was observed between the two groups (successful versus failed CTO-PCI) after adjusted analysis [3,18,20,[39][40][41][42][43]. Third, failed procedures were associated with a high complication rate; indeed, the repeated attempt at passing wires and balloons across occluded segments is accompanied by substantial trauma; this could translate into higher procedural and in-hospital complications.…”

Section: Reappraisal Of the Quality Of Evidencementioning

confidence: 99%

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Percutaneous revascularization of coronary chronic total occlusion: Toward a reappraisal of the available evidence

Karjalainen

Nammas

2017

Journal of Cardiology

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Chronic total occlusion (CTO) is a challenging subset of coronary artery disease that is commonly encountered in real-world practice; it is associated with worse long-term prognosis. Observational studies suggest that percutaneous coronary intervention (PCI) for CTO is associated with reduction in myocardial ischemia and improvement in quality of life and left ventricular function. Some observational studies suggested that CTO-PCI is associated with improvement of the 'hard' clinical endpoints; others did not. Nearly all these studies compared the clinical outcome of successful versus failed PCI, rather than comparing the outcome of a whole CTO-PCI cohort versus a 'true' control group. Interestingly, in observational studies that compared the outcome of CTO-PCI versus optimal medical treatment, long-term mortality was comparable between the two strategies. In patients with multi-vessel disease and CTO, complete revascularization is more often achieved by coronary artery bypass grafting than by PCI; the SYNTAX score of these patients often favors surgical revascularization according to the current guidelines. The current guidelines reflect the divergence of opinion on the usefulness/benefit of CTO-PCI, mainly due to the lack of randomized trials. Evidence is awaited from three ongoing randomized controlled trials comparing PCI versus optimal medical treatment in the setting of CTO.

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Section: Reappraisal Of the Quality Of Evidencementioning

confidence: 85%

Section: Impact On the Cardiovascular Outcomementioning

confidence: 99%

Section: Reappraisal Of the Quality Of Evidencementioning

confidence: 99%

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Percutaneous revascularization of coronary chronic total occlusion: Toward a reappraisal of the available evidence

Karjalainen

Nammas

2017

Journal of Cardiology

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“…Several observational studies have suggested that successful CTO PCI improves mortality rates [12,25] and MACE [12,25,26] when compared to failed CTO PCI, whereas one propensity score matched retrospective study revealed no difference in all-cause mortality [26]. Any possible improvement in outcome could be attributed to changes in cardiac function and positive remodeling [27,28].…”

Section: Clinical Outcomes Following Cto Pcimentioning

confidence: 99%

Long-term improvement of symptoms of angina pectoris after successful revascularization of coronary artery chronic total occlusions

Miyashita

Mansikkaniemi

Sinisalo

et al. 2023

Scandinavian Cardiovascular Journal

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Objectives. To compare long-term angina pectoris relief of successful versus failed percutaneous coronary intervention of chronic total occlusions (CTO PCI). Background. Previous studies demonstrate better short-term angina pectoris relief of CTO PCI than with optimal medical treatment (OMT), however, data on the long-term effects are lacking. Methods. 295 patients undergoing CTO PCI were analyzed retrospectively, with a follow-up evaluation of symptoms of angina pectoris and all-cause death one to four years after the intervention. The primary outcome was long-term relief of symptoms of angina pectoris. Secondary outcomes included a composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and later target vessel revascularization (TVR). At follow-up, patients were interviewed for symptoms of angina pectoris at 1, 6, 12, and 22 to 48 months after the intervention. Results. CTO PCI was successful in 225 (76%) patients and failed in 70 (24%) patients. Short-term (six months) relief of angina pectoris was observed in both groups, but only the successful CTO PCI group showed long-term relief. The Kaplan-Meier curves of all-cause death did not differ between the groups (p ¼ .715). The final follow-up was a mean (range) of 37 (25 to 44) months after the intervention in the successful CTO PCI group, and 33 (28 to 48) months in the failed CTO PCI group. Conclusions. Successful CTO PCI is associated with better long-term relief of symptoms of angina pectoris compared to failed CTO PCI.

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“…Polish data regarding usage of TRA in CTO are limited. Jaguszewski et al [5] in a series of 1110 CTO treated by antegrade approach from 2003 to 2010 reported no differences in success rate depending on the chosen access site. As described in the first Polish publication concerning recanalization of coronary chronic total occlusion by retrograde approach, in this special sub-set of procedures we used only femoral access [6].…”

Section: Introductionmentioning

confidence: 95%

Treatment of coronary chronic total occlusion by transradial approach: Current trends and expert recommendations

Bryniarski

Zabojszcz²,

Bryniarski

2017

Cardiol J.

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The aim of this review is to highlight the technical details and the scientific data on percutaneous coronary interventions (PCIs) in chronic total occlusion (CTO) performed by transradial approach (TRA). Transfemoral approach (TFA) is commonly regarded as the standard for CTO PCI, but there is a growing number of CTO recanalization procedures performed by TRA. We discuss the relevant technical details to approach a CTO by transradial access, especially the compatibility of various CTO recanalization techniques with specific guiding catheter sizes. Randomized prospective trials in this field are lacking and only data from observational studies are available. We can conclude that transradial access for CTO PCI is feasible and could be very useful in selected patients. In our opinion, transradial access in CTO PCIs should be limited to operators and centers highly experienced in CTO recanaliza¬tion and in TRA.

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Successful versus unsuccessful antegrade recanalization of single chronic coronary occlusion: Eight‐year experience and outcomes by a propensity score ascertainment

Abstract: Successful PCI for single CTO does not improve long-term survival, nonetheless, is associated with reduced overall MACE and the need for surgical revascularization.

Cited by 6 publications

References 38 publications

Percutaneous revascularization of coronary chronic total occlusion: Toward a reappraisal of the available evidence

Percutaneous revascularization of coronary chronic total occlusion: Toward a reappraisal of the available evidence

Long-term improvement of symptoms of angina pectoris after successful revascularization of coronary artery chronic total occlusions

Treatment of coronary chronic total occlusion by transradial approach: Current trends and expert recommendations

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