TY - JOUR
T1 - Association of symptom status, myocardial viability, and clinical/anatomic risk on long-term outcomes after chronic total occlusion percutaneous coronary intervention
AU - Song, Lei
AU - Qiao, Shubin
AU - Guan, Changdong
AU - Bai, Yinxiao
AU - Zou, Tongqiang
AU - Wu, Fan
AU - Shi, Yanpu
AU - Xie, Lihua
AU - Sun, Zhongwei
AU - Dou, Kefei
AU - Yang, Weixian
AU - Brilakis, Emmanouil S.
AU - Yang, Yuejin
AU - Yeh, Robert W.
AU - Wu, Yongjian
AU - Kirtane, Ajay J.
AU - Xu, Bo
N1 - Funding Information:
Dr. Brilakis reports the consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support from Regeneron and Siemens. Shareholder: MHI Ventures. Dr. Yeh reports research grants and consulting fees from Abbott Vascular, Boston Scientific, and Medtronic. Dr. Kirtane reports Institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical. In addition to research grants, institutional funding includes fees paid to Columbia University and/or Cardiovascular Research Foundation for speaking engagements and/or consulting. Personal: Travel Expenses/Meals from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. Other authors report no conflicts of interest in regard to this manuscript.
Funding Information:
The authors thank all the non‐author CTO‐PCI operators of the Cardiology Department (Drs. Jilin Chen, Jue Chen, Jun Dai, Zhan Gao, Fenghuan Hu, Chongjian Li, Jianjun Li, Haibo Liu, Yi Mao, Chaowei Mu, Jie Qian, Xuewen Qin, Hong Qiu, Hongbing Yan, Min Yao, Shijie You, Mengyue Yu, Jinqin Yuan, Haitao Zhang, Pei Zhang, and Jinglin Zhao) and other research personnel for their contributions to the study. The study was supported by research funding from the Chinese Academy of Medical Sciences Innovation Project (2018‐12 M‐AI‐007) and the Beijing Municipal Science and Technology Commission Project (Z181100001718113).
Publisher Copyright:
© 2021 Wiley Periodicals LLC.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Objectives: This study aimed to examine the association of less-certain indication of chronic total occlusion percutaneous coronary intervention (CTO-PCI) with subsequent clinical outcomes. Background: The impact of patient symptoms, myocardial viability, and clinical and anatomic risk on long-term outcomes is underdetermined. Methods: Consecutive patients undergoing CTO-PCI at a large-volume single center between 2010 and 2013 were included. Central adjudication was used to assess the appropriateness of three prespecified indications. The primary outcome was the 5-year composite endpoint of death or myocardial infarction (MI). Results: Of 2,659 patients with 2,735 CTO lesions, the 348 (13.1%) asymptomatic patients, 164 (6.2%) patients without viable myocardium in the CTO territory, and 306 (11.5%) patients in whom the Synergy between PCI with Taxus and Cardiac Surgery Score II favored coronary artery bypass grafting (CABG) had higher 5-year death or MI compared with the rest patients in each category (12.0% vs. 8.6%, p =.04; 16.3% vs. 8.5%, p <.0001; 12.2% vs. 8.6%, p =.03), respectively. Multivariable regression analysis demonstrated that without symptom (hazard ratio: 1.51; 95% confidence interval: 1.06–2.15; p =.02), non-viable myocardium in CTO territory (hazard ratio: 1.77; 95% confidence interval: 1.16–2.72; p =.009), and deemed more favorable for CABG (hazard ratio:1.54; 95% confidence interval: 1.04–2.28; p =.03), but not the technical success (hazard ratio:0.85; 95% confidence interval: 0.62–1.18; p =.34), were independent predictors for the primary endpoint. Conclusions: In this large cohort of CTO-PCI, those who were asymptomatic, non-viable myocardium in the CTO territory, or deemed more favorable for CABG were associated with higher risk of long-term mortality or MI.
AB - Objectives: This study aimed to examine the association of less-certain indication of chronic total occlusion percutaneous coronary intervention (CTO-PCI) with subsequent clinical outcomes. Background: The impact of patient symptoms, myocardial viability, and clinical and anatomic risk on long-term outcomes is underdetermined. Methods: Consecutive patients undergoing CTO-PCI at a large-volume single center between 2010 and 2013 were included. Central adjudication was used to assess the appropriateness of three prespecified indications. The primary outcome was the 5-year composite endpoint of death or myocardial infarction (MI). Results: Of 2,659 patients with 2,735 CTO lesions, the 348 (13.1%) asymptomatic patients, 164 (6.2%) patients without viable myocardium in the CTO territory, and 306 (11.5%) patients in whom the Synergy between PCI with Taxus and Cardiac Surgery Score II favored coronary artery bypass grafting (CABG) had higher 5-year death or MI compared with the rest patients in each category (12.0% vs. 8.6%, p =.04; 16.3% vs. 8.5%, p <.0001; 12.2% vs. 8.6%, p =.03), respectively. Multivariable regression analysis demonstrated that without symptom (hazard ratio: 1.51; 95% confidence interval: 1.06–2.15; p =.02), non-viable myocardium in CTO territory (hazard ratio: 1.77; 95% confidence interval: 1.16–2.72; p =.009), and deemed more favorable for CABG (hazard ratio:1.54; 95% confidence interval: 1.04–2.28; p =.03), but not the technical success (hazard ratio:0.85; 95% confidence interval: 0.62–1.18; p =.34), were independent predictors for the primary endpoint. Conclusions: In this large cohort of CTO-PCI, those who were asymptomatic, non-viable myocardium in the CTO territory, or deemed more favorable for CABG were associated with higher risk of long-term mortality or MI.
KW - chronic total occlusion
KW - coronary artery disease
KW - indication
KW - percutaneous coronary intervention
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U2 - 10.1002/ccd.29577
DO - 10.1002/ccd.29577
M3 - Article
C2 - 33650804
AN - SCOPUS:85101876709
VL - 97
SP - 996
EP - 1008
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
SN - 1522-1946
IS - S2
ER -