Survival after percutaneous coronary intervention for chronic total occlusion in elderly patients

Toma, Aurel; Gebhard, Cathérine; Gick, Michael; Ademaj, Fadil; Stähli, Barbara E.; Mashayekhi, Kambis; Ferenc, Mirosław; Neumann, Franz‐Josef; Buettner, Heinz Joachim

doi:10.4244/eij-d-16-00499

Cited by 26 publications

(20 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Traditionally, the ACEF score-the strongest factor associated with cardiac mortality in our study-has been used to stratify risk and predict clinical outcomes in patients who underwent elective PCI on non-occlusive coronary stenoses. 21,22 However, Di Serafino et al 23 showed that the ACEF score could be used as a simple tool to predict clinical outcomes in patients treated with CTO-PCI, as observed in our cohort.…”

Section: Discussionsupporting

confidence: 48%

“…Hoebers et al were also unable to show a significant association between successful CTO‐PCI and mortality (at a median follow‐up of about 30 months), although the number of older CTO patients in their study was small. On the other hand, Toma et al demonstrated that successful CTO‐PCI was significantly associated with improved survival in both older and younger patients. In our patient cohort, regardless of their age, both cardiac and all‐cause mortality were significantly higher in the MT group compared to those who underwent revascularization, but this survival benefit with revascularization was especially notable in older patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients

Flores‐Umanzor

Vázquez

Cepas‐Guillén

et al. 2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

Background Chronic total occlusions (CTOs) are present in more than one third of older patients with myocardial ischemia, but controversy remains about the best therapeutic approach. Aims To compare long‐term survival after CTO revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass graft [CABG]) versus medical treatment (MT) alone in patients aged 75 and older. Methods and results A total of 1,252 consecutive patients with at least one CTO were identified from 2010 to 2014 in our center. Patients were stratified by age (<75 years vs. ≥75 years) in the present analysis. All‐cause and cardiac mortality were assessed at a median follow‐up of 3.5 years. In the older subgroup (26%), patients were more likely to be treated with MT alone (71% vs. 43% of younger patients; p < 0.001). Patients undergoing revascularization were younger and had higher left ventricular ejection fraction (LVEF) and lower age, creatinine, ejection fraction (ACEF) score (age/LVEF +1 if creatinine >2.0 mg/dL), compared to the MT group (p < 0.05). As compared to MT, revascularization predicted lower rates of cardiac mortality and all‐cause mortality in older patients, both in the subgroups treated with CABG (hazard ratio [HR] 0.35, 95% confidence interval [CI] 0.17–0.71; HR 0.39, 95%CI 0.18–0.81) and PCI (HR 0.57, 95%CI 0.33–0.98; HR 0.59, 95%CI 0.28–1.2). No differences in mortality were observed according to type of revascularization procedure. Conclusions Among patients aged at least 75 years with a CTO, revascularization (PCI or CABG) rather than MT alone may portend a better outcome in terms of all‐cause and cardiac mortality.

show abstract

Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients

Flores‐Umanzor

Vázquez

Cepas‐Guillén

et al. 2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…Among the elderly, 61% of patients were males (n = 839) while 39% (n = 549) were females. The BMI reported by only three studies [7,10,14] was higher in younger patients and showed a statistically significant difference (p < 0.01) between the two cohorts in these studies. In terms of past medical history, both the groups had a similar history of prior MI (38% in each group), whereas the higher prevalence of stroke was noted in the older age group [15% (n = 89) vs. 10% (n = 262)].…”

Section: Baseline Characteristicsmentioning

confidence: 69%

“…A total of seven studies were included with 7671 patients [7][8][9][10][11][12]14]. Two studies were prospective and five were retrospective.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Percutaneous coronary intervention for chronic total occlusion in patients aged <75 years versus ≥75 years: a systematic review

Lateef

Ahsan

Fazeel

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

show abstract

“…Более того, успешная реваскуляризация ХОКА приводит к снижению потребности в АКШ и может улучшать отдаленную выживаемость пациентов по сравнению с безуспешной ЧКВ на ХОКА [28,31]. Положительный эффект от успешного открытия ХОКА был также продемонстрирован в более старшей группе пациентов (>75 лет) с высокой коморбидностью [33].…”

Section: роль реканализации хока у пациентов со стабильной ибсunclassified

Modern considerations of myocardial revascularization in coronary chronic total occlusion

Васильев

Руденко

2019

Cardiovasc Ther Prev

View full text Add to dashboard Cite

Мнение по проблемеСовременные аспекты реваскуляризации миокарда при хронических окклюзиях коронарного русла Васильев Д. К., Руденко Б. А.ФГБУ "Национальный медицинский исследовательский центр профилактической медицины" Минздрава России. Москва, Россия Хронические окклюзии коронарного русла встречаются в 16-18,4% случаев согласно результатам наблюдательных исследований и регистров. Традиционно эндоваскулярные реваскуляризации при окклюзиях считаются менее подходящей стратегией. Кардиологи чаще предпочитают медикаментозную терапию. Результаты научных исследований убедительно показали, что неполная реваскуляризация миокарда после безуспешной реканализации окклюзий приводит к более худшему отдаленному прогнозу. Благодаря накопленному опыту и новому техническому оснащению частота успеха реканализации окклюзий коронарного русла достигла 87-95%. Это позволяет в большем количестве случаев добиться полной реваскуляризации миокарда и, безусловно, служит поводом для пересмотра консервативного подхода к окклюзиям в пользу более активного подхода. В связи с этим существует большая потребность в рандомизированных клинических исследованиях для оценки влияния эндоваскулярной реваскуляризации при хронических окклюзиях.Ключевые слова: чрескожное коронарное вмешательство, хронические окклюзии коронарных артерий, ишемическая болезнь сердца, аортокоронарное шунтирование, оптимальная медикаментозная терапия.Конфликт интересов: не заявлен.Для цитирования: Васильев Д. К., Руденко Б. А. Современные аспекты реваскуляризации миокарда при хронических окклюзиях коронарного русла. Кардиоваскулярная терапия и профилактика. инновационных методов профилактики, диагностики и лечения сердечно-сосудистых и других хронических неинфекционных заболеваний, врач рентгенэндоваскулярных методов диагностики и лечения, ORCID: 0000-0003-2602-5006, Руденко Б. А. -д. м.н., врач рентгенэндоваскулярных методов диагностики и лечения, руководитель отдела инновационных методов профилактики, диагностики и лечения сердечно-сосудистых и других хронических неинфекционных заболеваний, ORCID: 0000-0003-0346-9069].Coronary chronic total occlusion (CTO) occurs in 16-18,4% of cases according to observational studies and registers. Traditionally, endovascular revascularization methods are considered a less appropriate strategy then drug therapy. The results of studies have shown that incomplete myocardial revascularization after unsuccessful recanalization leads to a worse long-term prognosis. Due to the accumulated experience and new technical equipment, the success rate of coronary recanalization reached 87-95%. It allows more often achieving complete myocardial revascularization and is as a reason for reconsideration and potential switching from conservative approach to active tactics in CTO. In this regard, there is a great need for randomized clinical trials to assess the efficiency of endovascular revascularization in CTO.For citation: Vasiliev D. K., Rudenko B. A. Modern considerations of myocardial revascularization in coronary chronic total occlusion.

show abstract

Survival after percutaneous coronary intervention for chronic total occlusion in elderly patients

Abstract: In the DES era, elderly patients (≥75 years) derive a similar survival benefit from successful CTO PCI to younger patients. These findings suggest that CTO PCI, when indicated, should not be withheld from the elderly.

Cited by 26 publications

References 22 publications

Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients

Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients

Percutaneous coronary intervention for chronic total occlusion in patients aged <75 years versus ≥75 years: a systematic review

Modern considerations of myocardial revascularization in coronary chronic total occlusion

Contact Info

Product

Resources

About