Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion (original) (raw)
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Medicina, 2019
Background and objectives: Different scoring systems are used to stratify patients with chronic total coronary artery occlusions (CTO) according to disease complexity to predict the success of the percutaneous coronary intervention (PCI). Comparison among different CTO scoring systems and long-term outcome for patients with CTO after PCI has not been well established. The objectives of the study were to assess the ability of different disease severity scoring systems to predict, first, procedural success and, second, overall survival in patients with a successful procedure. Materials and Methods: A total of 551 patients who underwent elective CTO PCI in Riga East University hospital from January 2007 to December 2016 were included in the study. Four scoring systems (J CTO, PROGRESS CTO, CL, and CASTLE) were calculated. ROC curves were used to assess the association between scores and procedural success, and the Kaplan–Meier method and Cox regression were used to estimate the associa...
JACC. Cardiovascular interventions, 2015
This study sought to develop a scoring model predicting percutaneous coronary intervention (PCI) success in chronic total occlusions. Coronary chronic total occlusion is the lesion subtype in which angioplasty is most likely to fail. Chronic total occlusion for PCI (CTO-PCI) failure is associated with higher 1-year mortality and major adverse cardiac events compared with successful CTO-PCI. Although several independent predictors of final procedural success have been identified, no study has yet produced a model predicting final procedural outcome. Data from 1,657 consecutive patients who underwent a first-attempt CTO-PCI were prospectively collected. The scoring model was developed in a derivation cohort of 1,143 patients (70%) using a multivariable stepwise analysis to identify independent predictors of CTO-PCI failure. The model was then validated in the remaining 514 (30%). The overall procedural success rate was 72.5%. Independent predictors of CTO-PCI failure were identified a...
REC: interventional cardiology (English Edition), 2020
Introduction and objectives: Chronic total coronary occlusion (CTO) is often a complex entity to deal with through a percutaneous coronary intervention, and the clinical benefits of successful recanalization still remain uncertain. Most registries feature data in limited time periods and do not reflect the impact that specific dedicated programs have on recanalization. Our study evaluates the results of a CTO program on a long-term period of time. Methods:All patients' CTOs treated with percutaneous coronary interventions at our center from 2002 through 2017 were prospectively included in the registry. The clinical, angiographic and procedural data were collected, and clinical follow-up was conducted. Three consecutive periods of time were considered for the analysis of temporal trends. Results: Atotal of 424 CTOs (408 patients) were included. In 339 patients (80%) the procedure was successful. The rate of success increased over time, from 57% in 2002-2006 to 87% in 2012-2017 (P = .001). The most important independent predictor of procedural failure was lesion tortuosity. After a median follow-up of 39.7 months, the rates of major adverse cardiovascular events and cardiovascular mortality in success vs failed groups were 13.9% vs 24.7% (P = .015) and 3.6% vs 14.1% (P = .001), respectively. These were the independent predictors of cardiovascular mortality: chronic kidney disease, left anterior descending artery occlusion, and procedural failure. Conclusions: Our series shows a high rate of success in CTO recanalization, which has increased over the last few years due to greater expertise and improved program-specific technical advances. Several angiographic and procedural variables have been identified as predictors of failure. Successful procedures, especially on the left anterior descendent coronary artery, were associated with lower rates of cardiovascular mortality.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2011
interventions by radial and femoral routes-can we decrease the fluoroscopy time with increased experience? An observational study Radiyal ve femoral yollardan gerçekleştirilen koroner anjiyografi ve girişimler sırasında geçen sürenin kıyaslanması -Deneyimin artması ile floroskopi süresini kısaltabilir miyiz ? Gözlemsel bir çalışma Original Investigation Özgün Araşt›rma ÖZET Amaç: Radiyal yol erişimi koroner anjiyografiler ve girişimler için giderek daha fazla kullanılmaktadır. Bununla beraber, girişimcilerin, transfemoral ya da transradiyal işlemler sırasında maruz kaldıkları radyasyon bilinmemektedir. Çalışmanın amacı, floroskopi zamanını değerlendirerek işlemi yapanların periferik arter yolu ile ilgili maruz kaldıkları radyasyonu karşılaştırmaktı. İkinci amaç, foloroskopi süresi ile operatör deneyimi arasındaki ilişkiyi belirlemekti. Yöntemler: Bu gözlemsel çalışma 1 Temmuz 2009 ile 30 Eylül 2009 periyodu arasında, Karaçi (Pakistan)'de bir üçüncü basamak tedavi Kardiyovasküler Enstitüsünde yapıldı. Koroner anjiyografi (KA) veya perkütan koroner müdahale (PKM) için gelen 1016 ardışık hastada çalışma yaptık. Sağ kalp kateterizasyonu veya valvüloplasti hastaları çalışma dışı bırakıldı. Bu 1016 hastanın 928'i tanısal KA'lar (734 femoral yolla [f-KA] ve 194 radiyal yolla[r-KA]) ve 88 hasta PKM (64 femoral yolla[f-PKM] ve 24 radiyal yolla [r-PKM]) idi. Floroskopi zamanı radyasyona maruz kalma yerine kayıtlara geçti. İstatistiksel analiz eşleştirilmemiş t, Mann-Whitney U, Ki-kare ve ANOVA tesleri ile yapıldı.
JACC. Cardiovascular interventions, 2016
The purpose of this study was to evaluate long-term clinical impact of routine follow-up coronary angiography (FUCAG) after percutaneous coronary intervention (PCI) in daily clinical practice in Japan. The long-term clinical impact of routine FUCAG after PCI in real-world clinical practice has not been evaluated adequately. In this prospective, multicenter, open-label, randomized trial, patients who underwent successful PCI were randomly assigned to routine angiographic follow-up (AF) group, in which patients were to receive FUCAG at 8 to 12 months after PCI, or clinical follow-up alone (CF) group. The primary endpoint was defined as a composite of death, myocardial infarction, stroke, emergency hospitalization for acute coronary syndrome, or hospitalization for heart failure over a minimum of 1.5 years follow-up. Between May 2010 and July 2014, 700 patients were enrolled in the trial among 22 participating centers and were randomly assigned to the AF group (n = 349) or the CF group...
Background: The percutaneous coronary intervention of chronic total occlusions (CTOs) is considered the most challenging technical procedure in the current interventional cardiology. Japanese Multicenter CTO Registry (J-CTO Score) was established to predict the probability of successful guidewire crossing through a half-hour. Aim: To assess the correlation of J score with percutaneous revascularization success in chronic coronary total occlusion patients. Method: This is a retrospective study that was included CTO patients who underwent coronary angiography at Cardiac Catheterization Laboratory at King Abdul-Aziz Cardiac Center between January 2010 - December 2017 will be extracted from an electronic database ( Apollo Lx, Best Care, Xcelera, Muse). Data collected from patients included demographics, cardiovascular risk factors, comorbidities, angiographic parameters, Haemodynamic Measurements, and laboratory tests. SPSS was used to analyze data. Results: There were 173 patients included in the study, the mean±SD of CTOs number was1.4±0.8, the mean±SD of J-CTO score was1.8±0.9, the mean ±SD of fluro time was 29.3±14. There was no significant association between J-CTO score and outcome of patients (P=0.6), the amount of contrast used also had no significant association with patients‘outcome (P=0.4), whereas the mean of fluro time was significantly associated with outcome of patients (P=0.01). Conclusion: J score showed no association with the success rate, however lower fluro time was a predictor of success
Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions
Journal of the American College of Cardiology, 2007
The aim of our study was to examine the trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over the last 25 years from a single PCI registry and to examine the impact of drug-eluting stents. Background The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and there are limited data available from contemporary practice. Methods We evaluated the outcomes of 1,262 patients from the Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to the time of their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era). Results Procedural success rates were 51%, 72%, 73%, and 70% (p Ͻ 0.001), respectively, in the 4 groups. In-hospital mortality (2%, 1%, 0.4%, and 0%, p ϭ 0.009), emergency coronary artery bypass grafting (15%, 3%, 2%, and 0.7%, p Ͻ 0.001), and rates of major adverse cardiac events (8%, 5%, 3%, and 4%, p ϭ 0.052) decreased over time. During follow-up, the combined end point of death, myocardial infarction, or target lesion revascularization, was significantly lower in the 2 most recent cohorts compared with those patients treated before (p ϭ 0.001 for trend). Technical failure to treat the CTO was not an independent predictor of long-term mortality (hazard ratio 1.16 [95% confidence interval 0.90 to 1.5], p ϭ 0.25). Conclusions Procedural success rates for CTO have not improved over time in the stent era, highlighting the need to develop new techniques and devices. Compared with the prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50%.
Revista espanola de cardiologia (English ed.), 2018
There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting. Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers. A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59.2%). Previous recanalization attempts had been made in 15%. The mean SYNTAX score was 19.5 ± 10.6 and J-score was > 2 in 17.3%. A retrograde procedure was performed in 92 patients (9.2%). The success rate was 74.9% and was higher in patients without previous attempts (82.2% vs 75.2%; P = .001), those with a J-score ≤ 2 (80.5% vs 69.5%; P = .002), and in intravascular ultrasound-guided PCI (89.9% vs 76.2%, P = .001), which was an independent predictor of success. In contrast, severe calcification, length > 20mm, and blunt proximal cap were independent predictor...