共查询到20条相似文献，搜索用时 15 毫秒
1.
Adam C. Salisbury Dimitri Karmpaliotis J. Aaron Grantham James Sapontis Qingrui Meng Elizabeth A. Magnuson Hemal Gada William Lombardi Jeffrey Moses Haiyan Li Suzanne V. Arnold Suzanne J. Baron John A. Spertus David J. Cohen 《JACC: Cardiovascular Interventions》2019,12(4):323-331
Objectives
The aim of this study was to describe the costs of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and the association of complications during CTO PCI with costs and length of stay (LOS).Background
CTO PCI generally requires more procedural resources and carries higher risk for complications than PCI of non-CTO vessels. The costs of CTO PCI using the hybrid approach have not been described, and no studies have examined the impact of complications on in-hospital costs and LOS in this population.Methods
Costs were calculated for 964 patients in the 12-center OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry using prospectively collected resource utilization and billing data. Multivariate models were developed to estimate the incremental costs and LOS associated with complications. Attributable costs and LOS were calculated by multiplying the independent cost of each event by its frequency in the population.Results
Mean costs for the index hospitalization were $17,048 ± 9,904; 14.5% of patients experienced at least 1 complication. Patients with complications had higher mean hospital costs (by $8,603) and LOS (by 1.5 days) than patients without complications. Seven complications were independently associated with increased costs and 6 with LOS; clinically significant perforation and myocardial infarction had the greatest attributable cost per patient. Overall, complications accounted for $911 per patient in hospital costs (5.3% of the total costs) and 0.2 days of additional LOS.Conclusions
Complications have a significant impact on both LOS and in-hospital costs for patients undergoing CTO PCI. Methods to identify high-risk patients and develop strategies to prevent complications may reduce CTO PCI costs. 相似文献2.
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Zsolt Szijgyarto Rajiv Rampat Gerald S. Werner Claudius Ho Nicolaus Reifart Thierry Lefevre Yves Louvard Alexandre Avran Mashayekhi Kambis Heinz-Joachim Buettner Carlo Di Mario Anthony Gershlick Javier Escaned George Sianos Alfredo Galassi Roberto Garbo Omer Goktekin Marcus Meyer-Gessner David Hildick-Smith 《JACC: Cardiovascular Interventions》2019,12(4):335-342
Objectives
The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty.Background
Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making.Methods
The study analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) datasets were created to develop a risk score for predicting technical failure.Results
There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass graft history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC: 0.66) and validation (AUC: 0.68) datasets.Conclusions
The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome. 相似文献6.
Georg Goliasch Max-Paul Winter Mohamed Ayoub Philipp E. Bartko Catherine Gebhard Kambis Mashayekhi Miroslaw Ferenc Heinz Joachim Buettner Christian Hengstenberg Franz-Josef Neumann Aurel Toma 《JACC: Cardiovascular Interventions》2019,12(19):1915-1923
ObjectivesThe aim of this study was to assess the prognostic impact of post-procedural troponin T increase and mortality in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) to define the threshold at which procedure-related myocardial injury drives mortality.BackgroundCoronary CTO recanalization represents the most technically challenging PCI. The complexity harbors a significant increased risk for complications with CTO PCI with compared with non-CTO PCI. However, there are evidenced biomarker cutoff levels that help identify those patients at risk for unfavorable clinical outcomes.MethodsA total of 3,712 consecutive patients undergoing PCI for at least 1 CTO lesion were enrolled, and comprehensive troponin T measurements were performed 6, 8, and 24 h after the procedure. All-cause mortality was defined as the primary study endpoint.ResultsUsing spline curve analysis, a more than 18-fold increase of troponin above the upper reference limit was significantly associated with mortality. In a Cox regression analysis, the crude hazard ratio was 2.32 (95% confidence interval: 1.83 to 2.93; p < 0.001) for a ≥18-fold increase compared with patients with post-procedural troponin increase <18-fold of the upper reference limit. Results remained virtually unchanged after bootstrap- or clinical confounder–based adjustment.ConclusionsThis large-scale outcome study demonstrates for the first time the prognostic value of post-procedural troponin T elevation after PCI in patients with CTOs. A threshold was defined for procedure-related myocardial injury in patients with CTOs to differentiate them from those without CTOs that may help guide post-procedural clinical care in this high-risk patient population. 相似文献
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Chronic total occlusion (CTO), a fascinating and dynamic niche in the realm of coronary artery
disease, represents a major technical challenge for interventional cardiologists despite evolution of
better guidewires, devices, experience and techniques. Effective wiring technique is the corner stone to
success of percutaneous coronary intervention (PCI) in CTO. As a guide for guidewire crossing in
CTO, coronary angiography is limited. On the other hand, intravascular ultrasound (IVUS) enhances
the ability to identify coronary anatomy, the exact location of the guidewires within an artery, discriminating
a true lumen from the false lumen before guidewire crossing. Some angiographic features
have been suggested to be predictive of procedural failure, including blunt stump with a side branch at the site of occlusion.
Novel use of IVUS can recognize the optimal entry point and evaluate if a guidewire properly penetrates the proximal
cap of CTO. 相似文献
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约1/3接受冠状动脉造影检查的患者可发现慢性完全闭塞（CTO）病变。CTO病变行经皮冠状动脉介入治疗（PCI）的意义在于缓解患者心绞痛症状,改善心功能并减少冠状动脉搭桥的需要。熟悉和掌握CTO病变介入治疗技巧对于提高手术成功率、改善患者的远期预后至关重要。现就CTO病变PCI术的基本和高级技巧,包括器械的选择加以综述。 相似文献
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Peter Tajti Khaldoon Alaswad Dimitri Karmpaliotis Farouc A. Jaffer Robert W. Yeh Mitul Patel Ehtisham Mahmud James W. Choi M. Nicholas Burke Anthony H. Doing Phil Dattilo Catalin Toma A.J. Conrad Smith Barry F. Uretsky Elizabeth Holper Srinivasa Potluri R. Michael Wyman David E. Kandzari Emmanouil S. Brilakis 《JACC: Cardiovascular Interventions》2019,12(4):346-358
Objectives
This study examined the frequency and outcomes of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).Background
Radial access improves the safety of PCI, but its role in CTO PCI remains controversial.Methods
We compared the clinical, angiographic, and procedural characteristics of 3,790 CTO interventions performed between 2012 and 2018 via radial-only access (RA) (n = 747) radial-femoral access (RFA) (n = 844) and femoral-only access (n = 2,199) access at 23 centers in the United States, Europe, and Russia.Results
Patients’ mean age was 65 ± 10 years, and 85% were men. Transradial access (RA and RFA) was used in 42% of CTO interventions and significantly increased over time from 11% in 2012 to 67% in 2018 (p < 0.001). RA patients were younger (age 62 ± 10 years vs. 64 ± 10 years and 65 ± 10 years; p < 0.001), less likely to have undergone prior coronary artery bypass graft surgery (18% vs. 39% and 35%; p < 0.001), and less likely to have undergone prior PCI (60% vs. 63% and 66%; p = 0.005) compared with those who underwent RFA and femoral-only access PCI. RA CTO PCI lesions had lower J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 1.4 vs. 2.6 ± 1.3 and 2.5 ± 1.3; p < 0.001) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) complication (2.3 ± 1.9 vs. 3.2 ± 2.0 and 3.2 ± 1.9; p < 0.001) scores. The mean sheath size was significantly smaller in the RA group (6.6 ± 0.7 vs. 7.0 ± 0.6 and 7.3 ± 0.8; p < 0.0001), although it increased with lesion complexity. Antegrade dissection re-entry (20% vs. 33% and 32%; p < 0.001) was less commonly used with RA, whereas use of retrograde techniques was highest with RFA (47%). The overall rates of technical success (89% vs. 88% vs. 86%; p = 0.061), procedural success (86% vs. 85% vs. 85%; p = 0.528), and in-hospital major complication (2.47% vs. 3.40% vs. 2.18%; p = 0.830) were similar in all 3 groups, whereas major bleeding was lower in the RA group (0.55% vs. 1.94% and 0.88%; p = 0.013).Conclusions
Transradial access is increasingly being used for CTO PCI and is associated with similar technical and procedural success and lower major bleeding rates compared with femoral-only access interventions. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436) 相似文献11.
Yevgeniy Khariton Sophia Airhart Adam C. Salisbury John A. Spertus Kensey L. Gosch J. Aaron Grantham Dimitrios Karmpaliotis Jeffrey W. Moses William J. Nicholson David J. Cohen William Lombardi James Sapontis James M. McCabe 《JACC: Cardiovascular Interventions》2018,11(22):2276-2283
Objectives
This study sought to describe the association between chronic total occlusion (CTO) revascularization (CTO percutaneous coronary intervention [PCI]) and health status in patients with and without cardiomyopathy.Background
Prior PCI trials for cardiomyopathy have excluded CTO patients. Whether patients with reduced left ventricular ejection fraction (LVEF) receive similar health status benefit from CTO-PCI compared with patients with normal LVEF is unclear.Methods
We assessed health status change, using the Seattle Angina Questionnaire (SAQ) Summary, SAQ Angina Frequency, and Rose Dyspnea Scale scores, among patients undergoing successful CTO PCI in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion) Registry. Participants were classified by LVEF (normal, ≥50%; mild-moderate, 30% to 49%; and severe, <30%), with higher SAQ and lower Rose Dyspnea Scale scores indicating better health status. Differences in 1-year outcomes were compared using hierarchical multivariable regression.Results
Of 762 patients, 506 (66.4%), 193 (25.3%), and 63 (8.3%) had normal, mild-moderate, and severely reduced LVEF. SAQ Summary score improvements were observed in each group (27.1 ± 20.4, 26.7 ± 21.2, and 20.3 ± 18.1, respectively). Compared with patients with LVEF ≥50%, those with LVEF <30% had less improvement in SAQ Summary Score (?5.2 points; 95% confidence interval: ?9.0 to ?1.5; p = 0.01) and Rose Dyspnea Scale (+0.5 points; 95% confidence interval: 0.1 to 0.8; p = 0.01), with no difference in odds of angina (odds ratio: 1.3; 95% confidence interval: 0.6 to 3.0; p = 0.48). Health status improvement was similar between patients with LVEF ≥50% and LVEF 30% to 49%.Conclusions
Although health status improvement was less in patients with severely reduced LVEF compared with those with normal LVEF, each group experienced large health status improvements after CTO-PCI. 相似文献12.
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目的:分析慢性完全闭塞(CTO)病变对接受急诊介入治疗的急性心肌梗死(AMI)患者远期预后的影响。方法:分析自2013年1月至2014年9月间纳入中国急性心肌梗死(CAMI)注册登记研究的接受急诊介入治疗的14176例AMI患者,根据冠状动脉造影的结果,将患者分为AMI合并CTO病变组(n=1235)和AMI不合并CTO病变组(n=12941)。随访2年,比较两组的临床预后,主要研究终点为死亡率,次要研究终点为包括心原性死亡、脑卒中、心力衰竭再入院、再次血运重建等的主要不良心血管事件。结果:合并CTO病变的AMI患者占8.7%(1235/14176)。随访2年,AMI合并CTO病变组的患者全因死亡率(9.9%vs.5.4%)和心原性死亡率(5.0%vs.2.6%)明显高于AMI不合并CTO病变组患者(P均<0.01)。单因素分析显示,CTO病变增加AMI患者死亡(HR=1.44,95%CI:1.02~2.03,P=0.04)和再次血运重建(HR=2.14,95%CI:1.55~2.96,P<0.01)风险。多因素回归分析显示,高龄(HR=1.07,95%CI:1.05~1.09)和就诊时存在心力衰竭(HR=2.05,95%CI:1.36~3.09)与患者2年死亡的不良预后明显相关(P均<0.01),而CTO病变不是2年死亡的独立危险因素(HR=1.33,95%CI:0.93~1.90,P=0.11)。结论:合并CTO病变的AMI患者的远期死亡率和心原性死亡率明显高于不合并CTO病变的患者。高龄和就诊时存在心力衰竭是远期死亡的独立危险因素,而CTO病变并不是远期死亡的独立危险因素。 相似文献
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Hui-Ping Zhang Hu Ai Ying Zhao Hui Li Guo-Dong Tang Nai-Xin Zheng Fu-Cheng Sun Jing-Hua Liu 《The American journal of the medical sciences》2018,355(2):174-182
Background
There are little published data reporting the effect of coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on the prognosis of elderly patients with identified CTOs. We sought to evaluate the clinical effect of CTO PCI on the prognosis of elderly patients with CTOs.Methods
A total of 445 consecutive patients diagnosed with a CTO by angiography from January 2011 to December 2013 were enrolled. We compared long-term clinical outcomes between the elderly group (≥75 years; n = 120, 27.0%), and the nonelderly group (<75 years; n = 325, 73.0%) as well as between patients with unopened CTOs and patients with CTOs who were recanalized by PCI either during the index hospitalization or at a staged procedure within 30 days after discharge from the index hospitalization. The primary endpoint was defined as the composite of hospitalization from angina, reinfarction, heart failure or repeat revascularization and cardiac death at the 3-year follow-up.Results
More elderly CTO patients had left main (LM) disease (25.0 versus 15.1%, P = 0.015), 3-vessel disease (96.4% versus 73.8%, P < 0.001) and a Japan-CTO score ≥2 (36.7% versus 23.7%, P = 0.006) than nonelderly CTO patients. Furthermore, elderly patients had a higher syntax score than nonelderly patients (27.0 [25.0, 30.0] versus 26.0 [23.0, 30.0], P = 0.006). PCI was attempted for 33 out of 135 CTO lesions (24.4%) in the elderly group, and 127 out of 378 lesions (33.6%) in the nonelderly group (P = 0.049); however, there were no statistically significant differences in the CTO PCI success rates between the 2 groups (69.7% versus 82.7%, P = 0.097). The 3-year cardiac mortality rate was 15.0% and 4.6% (P < 0.011) for the elderly and nonelderly groups, respectively. Elderly patients with CTOs who were recanalized by PCI and those with unopened CTOs exhibited comparable 3-year cardiac mortality rates (15.0% versus 16.0%, P = 1.000). There was no significant difference in primary endpoint incidence (25.0% versus 33.0%, P = 0.486). Multivariate analysis revealed that after corrections for baseline and procedural differences, right coronary artery CTO (odds ratio = 4.600, 95% CI: 1.320-16.031; P = 0.017) and LM disease combined with 3-vessel disease (odds ratio = 4.296, 95% CI: 1.166-15.831; P = 0.028) were independent predictors of 3-year cardiac mortality among elderly patients with CTOs.Conclusions
Elderly patients with CTOs presented with seriously diseased coronary arteries and poor prognoses. CTO PCI did not seem to significantly improve long-term clinical outcomes among elderly patients with CTOs. Right coronary artery CTO and LM disease combined with 3-vessel disease might be independent predictors of 3-year cardiac mortality in elderly CTO patients. 相似文献15.
控制性正向-逆向内膜下寻径（CART）和反向CART技术是近年来慢性完全闭塞病变介入治疗重要的技术进展,大大提高了慢性完全闭塞病变经皮冠状动脉介入治疗（PCI）成功率。CART和反向CART技术的开展要求术者具有较丰富的正向PCI操作经验,根据自身技术能力、设备条件和患者病变特点合理选择恰当的PCI治疗技术。在血管内超声指导下反向CART技术的应用进一步提高了手术的成功率和安全性。 相似文献
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Ki Hong Choi Young Bin Song Joo Myung Lee Sang Yoon Lee Taek Kyu Park Jeong Hoon Yang Jin-Ho Choi Seung-Hyuk Choi Hyeon-Cheol Gwon Joo-Yong Hahn 《JACC: Cardiovascular Interventions》2019,12(7):607-620
Objectives
This study sought to determine whether intravascular ultrasound (IVUS) guidance compared with angiographic guidance reduces long-term risk of cardiac death in patients undergoing complex percutaneous coronary intervention (PCI).Background
Although IVUS is a useful tool for accurate assessment of lesion profiles and optimal stent implantation, there are limited data on long-term clinical outcomes between IVUS-guided and angiography-guided PCI for patients with complex lesions.Methods
From March 2003 through December 2015, a total of 6,005 patients undergoing PCI for complex lesions with drug-eluting stents were enrolled from a prospective institutional registry. All enrolled subjects had at least 1 complex lesion (defined as bifurcation, chronic total occlusion, left main disease, long lesion, multivessel PCI, multiple stent implantation, in-stent restenosis, or heavily calcified lesion). Patients were classified according to use of IVUS or not. Multiple sensitivity analyses, including multivariable adjustment, propensity-score matching, and inverse-probability-weighted method, were performed to adjust baseline differences.Results
Among the study population, IVUS was used in 1,674 patients (27.9%) during complex PCI. The IVUS-guided PCI group had a significantly larger mean stent diameter (3.2 ± 0.4 vs. 3.0 ± 0.4; p < 0.001), and more frequent use of post-dilatation (49.0% vs. 17.9%; p < 0.001) compared with the angiography-guided PCI group. IVUS-guided PCI was associated with a significantly lower risk of cardiac death during 64 months of median follow-up compared with angiography-guided PCI (10.2% vs. 16.9%; hazard ratio: 0.573; 95% confidence interval: 0.460 to 0.714; p < 0.001). Results were consistent after multivariable regression, propensity-score matching, and inverse-probability-weighted method. The risks of all-cause death, myocardial infarction, stent thrombosis, ischemia-driven target lesion revascularization, and major adverse cardiac events were also significantly lower in the IVUS-guided PCI group.Conclusions
Among patients with complex coronary artery lesion, IVUS-guided PCI was associated with the lower long-term risk of cardiac death and adverse cardiac events compared with angiography-guided PCI. Use of IVUS should be actively considered for complex PCI. 相似文献18.
Takamasa Tanaka Atsunori Okamura Katsuomi Iwakura Mutsumi Iwamoto Hiroyuki Nagai Tomohiro Yamasaki Akinori Sumiyoshi Kota Tanaka Koichi Inoue Yasushi Koyama Tohru Masuyama Masaharu Ishihara Kenshi Fujii 《JACC: Cardiovascular Interventions》2019,12(6):545-555
Objectives
This study sought to compare the procedural outcomes of percutaneous coronary intervention for chronic total occlusion between the periods before and after introduction of 3-dimensional (3D) wiring.Background
Previously, we reported a 3D wiring method by which the operator can construct real-time mental 3D images from 2 perpendicular angles of X-ray system monitor during percutaneous coronary intervention for chronic total occlusion.Methods
A total of 137 chronic total occlusion lesions that could not be passed by tapered soft wires in our hospital between 2012 and 2017 were retrospectively enrolled in the study.Results
Overall success rate was significantly higher in the 3D wiring group (n = 69) than the non-3D wiring group (n = 68) (98% vs. 90%, respectively; p = 0.027). In the primary antegrade cases, the first antegrade approach time was significantly shorter in the 3D wiring group than the non-3D wiring group (42 ± 29 vs. 30 ± 16 min, respectively; p = 0.01). In cases where the antegrade approach was continued throughout the procedure, the success rate was significantly higher in the 3D wiring group than the non-3D wiring group (100% vs. 89.2%, respectively; p = 0.033). Vessel perforation by the antegrade wire tended to be lower in the 3D wiring group than the non-3D wiring group (1% vs. 11%, respectively; p = 0.055).Conclusions
3D wiring enables accurate guidewire control, which improves the success rate of antegrade wiring and reduces the antegrade procedure time, resulting in improvement of the overall success rate. 相似文献19.
Peter Tajti M. Nicholas Burke Dimitri Karmpaliotis Khaldoon Alaswad Gerald S. Werner Lorenzo Azzalini Mauro Carlino Mitul Patel Kambis Mashayekhi Mohaned Egred Oleg Krestyaninov Dmitrii Khelimskii William J. Nicholson Imre Ungi Alfredo R. Galassi Subhash Banerjee Emmanouil S. Brilakis 《JACC: Cardiovascular Interventions》2018,11(7):615-625
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been rapidly evolving during recent years. With improvement in equipment and techniques, high success rates can be achieved at experienced centers, although overall success rates remain low. Prospective, randomized-controlled data regarding optimal use and indications for CTO PCI remain limited. CTO PCI should be performed when the anticipated benefit exceeds the potential risk. New high-quality studies of the clinical outcomes and techniques of CTO PCI are needed, as is the expansion of expert centers and operators that can achieve excellent clinical outcomes in this challenging patient and lesion subgroup. In the current review the authors summarize the latest publications in CTO PCI and provide an overview of the current state of the field. 相似文献
20.
Prevalence,Presentation and Treatment of ‘Balloon Undilatable’ Chronic Total Occlusions: Insights from a Multicenter US Registry 
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下载免费PDF全文 Peter Tajti MD Dimitri Karmpaliotis MD PhD Khaldoon Alaswad MD Catalin Toma MD James W. Choi MD Farouc A. Jaffer MD PhD Anthony H. Doing MD Mitul Patel MD Ehtisham Mahmud MD Barry Uretsky MD Aris Karatasakis MD Judit Karacsonyi MD Barbara A. Danek MD Bavana V. Rangan BDS MPH Subhash Banerjee MD Imre Ungi MD PhD Emmanouil S. Brilakis MD PhD 《Catheterization and cardiovascular interventions》2018,91(4):657-666