Prognostic value of the age,creatinine, and ejection fraction score for non‐infarct‐related chronic total occlusion revascularization after primary percutaneous intervention in acute ST‐elevation myocardial infarction patients: A retrospective study

Objective

It is not known if ACEF scores could evaluate the prognosis of recanalization of non‐infarct‐related coronary arteries (non‐IRA) with chronic total occlusions (CTO) in patients who successfully underwent primary PCI. The objective of the current study was to assess the prognostic value of ACEF scores in acute ST‐segment elevation myocardial infarction (STEMI) patients with non‐IRA CTO after successful primary PCI.

Methods

There were 2952 STEMI patients who underwent successful primary PCI from January 2006 to December 2014 in our hospital, among them 377 patients had a non‐IRA CTO lesion. The patients were divided into successful CTO‐PCI group (n = 221) and failed/non‐attempted CTO‐PCI group (n = 156). Patients were stratified based on the ACEF tertiles. Primary end points measured in the current study were major adverse cardiac events (MACE) defined as the composite of all‐cause death, nonfatal myocardial infarction, ischemia‐driven coronary revascularization and hospitalization for heart failure at 1 year.

Results

The incidence of MACE, all‐cause death and cardiac death were higher in the failed/non‐attempted CTO‐PCI group (P < 0.001). In the successful CTO‐PCI group, the cumulative 1‐year incidences of MACE and all‐cause death were decreased compared to those in the failed/non‐attempted CTO‐PCI group (log‐rank P < 0.001). The risk for MACE was reduced in the successful CTO‐PCI group compared to the failed/non‐attempted CTO‐PCI group in patients with low and intermediate ACEF scores (log‐rank P = 0.02).

Conclusions

Successfully staged CTO‐PCI could gain advantageous clinical outcomes in those patients with low or intermediate ACEF scores.     

Ostial right coronary chronic total occlusion: Transesophageal echocardiographic guidance for retrograde aortic re‐entry

As antegrade options are limited, intervention upon the ostial right coronary artery (RCA) chronic total occlusion (CTO) warrants a retrograde approach. Landmarks for an aggressive approach are concerning as passage of stiff guidewires or electrocautery near the RCA ostium may result in wire passage into structures other than the aorta. We report the first use of transesophageal echocardiography (TEE) to assist retrograde passage of a guidewire into the aorta. For the ostial RCA CTO, TEE guidance may be considered to assist retrograde passage of aggressive guidewires into the aorta.     

Value of intravascular ultrasound in the management of coronary chronic total occlusions

Failure of guide wire crossing is the commonest reason for failed procedure in chronic total occlusion (CTO) of the coronary arteries. Intravascular ultrasound can be useful in some cases to achieve. Successful guide wire crossing into the distal true lumen of the coronary artery. We describe two cases demonstrating the role of intravascular ultrasound in successful recannalization of the CTO. © 2009 Wiley‐Liss, Inc.     

The “double stingray technique” for recanalizing chronic total occlusions with bifurcation at the distal cap

Antegrade dissection re‐entry is often discouraged for chronic total occlusions (CTOs) with a bifurcation at the distal cap due to risk of side branch occlusion that can lead to periprocedural myocardial infarction and incomplete revascularization. Antegrade dissection re‐entry, however, is often needed, especially in complex cases. We present the novel “double Stingray technique” for CTOs involving bifurcations, in which the Stingray system is used twice for re‐entry into both vessel branches, followed by two‐stent bifurcation stenting to maintain the patency of both branches.     

In-Hospital Costs and Costs of Complications of Chronic Total Occlusion Angioplasty: Insights From the OPEN-CTO Registry

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).

Simple percutaneous coronary interventions using the modification of complex coronary lesion with excimer laser

Excimer laser coronary atherectomy (ELCA), a unique percutaneous coronary intervention (PCI) device, comprises a monorail-type system and is compatible with any standard 0.014-inch guidewire. ELCA is the only device that vaporizes the atherosclerotic plaques or modifies underlying plaque located underneath to a hard tissue, such as severe calcification or a stent. Therefore, ELCA differs from other coronary atherectomy devices and is useful for patients with acute coronary syndrome, chronic total occlusion or under-expanded stents. This case series reports on patients treated using ELCA to simplify complex PCI procedures. Furthermore, we review and discuss ELCA in several situations.     

Defining Staged Procedures for Percutaneous Coronary Intervention Trials: A Guidance Document

Patients in coronary intervention trials may require more than 1 procedure to complete the intended revascularization strategy. However, these staged interventions are not consistently defined. Standardized definitions are needed to allow meaningful comparisons of this outcome among trials. This document provides guidance on relevant parameters involving staged procedures, including minimum data collection and consistent classification of coronary procedures initially identified as staged; the aim is to achieve consistency among clinical trialists, sponsors, health authorities, and regulators. Definitions were developed jointly among representatives of academic institutions and clinical research organizations based on clinical trial experience and published literature. Reasons for staged procedures were identified and include baseline kidney function, contrast load and radiation exposure, lesion complexity, and patient or operator fatigue. Moreover, nonclinical reasons include procedure scheduling and reimbursement. Management of staged procedures should be a standalone section in clinical trial protocols and clinical events committee charters. These documents should clearly define a time window for staged procedures that allows latitude for local policies, while respecting accepted clinical guidelines, and consistency with study objectives. Investigators should document in the case report form the intent to stage a procedure, the lesions to be treated, and the reasons for staging, preferably before randomization. Ideally, all reinterventions, or at least all procedures performed after the recommended time window, those in which data suggest an anticipated procedure due to a worsening condition and those where a revascularization is attempted in the target vessel, should be reviewed by an independent clinical events committee.     

冠状动脉慢性完全闭塞病变介入治疗并发症的预防及护理

目的探讨冠状动脉慢性完全闭塞病变（chronic total occlusion,CTO）介入治疗（percutaneous coronary intervention,PCI）围术期的护理重点,以降低并发症的发生率和提高患者的长期生存率。方法回顾性总结2003年1月至2010年2月行PCI治疗的824例冠状动脉CTO患者的临床资料及治疗护理措施,重点分析并发症的发生情况及预防、护理对策。结果 824例患者共处理冠状动脉CTO病变875处,成功开通731处,成功率为83.5%（731/875）;并发症发生情况：冠状动脉穿孔8例,心脏压塞5例,急性心肌梗死4例,心力衰竭发生或加重7例,术中严重心律失常53例,术后2d因脑出血死亡1例。结论对冠状动脉CTO患者PCI围术期容易出现的严重并发症进行重点护理和预防,是减少并发症发生率、减轻并发症严重程度的有效措施,是提高PCI治疗效果的重要环节。