The Impact of Successful Percutaneous Coronary Intervention on the Reduction of Major Cardiovascular Events in Patients with Chronic Total Coronary Occlusion In dr. Saiful Anwar's Malang Hospital

Ratna Pancasari, Mohammad Saifur Rohman, Ardian Rizal, Novi Kurnianingsih, Anna Fuji Rahimah

Abstract


Background: Chronic total coronary occlusion (CTOs) is associated with an increased risk of adverse clinical outcomes. The benefits of percutaneous coronary intervention (PCI) in CTO are still being debated due to the limited data available. This study aims to determine the relationship between the success of PCI in CTOs and the reduction of major cardiovascular events compared to those who failed or did not perform revascularization in patients with chronic coronary total occlusion in RSUD by Dr. Saiful Anwar Malang.

 

Methods:This study is an analytic observational study with a retrospective cohort design. Of a total of 2165 patients who underwent angiography at Saiful Anwar Hospital, Malang, for the period August 2017–September 2020, consecutively, 578 patients with lesions of at least one CTO were found. There were 68 patients who were excluded, so 510 patients were analyzed in this study. They were divided into two groups, the CTO group that was successfully revascularized with PCI (n = 141) and the group that was not revascularized (n = 369). The outcome of this study was major cardiovascular events (MACE), which included cardiac mortality , all cause mortality, and rehospitalization events.

 

Result: Patients with CTO who were not revascularized compared to those with revascularized CTO had a higher history of heart failure, involvement of LM disease, multivessel disease, and three vessel disease (41.2% vs 18.4%, p = 0.041; 16.5% vs 1.8%, p < 0.001; 69.4% vs 22.7%, p < 0.001; 56.5% vs 14.1%, p < 0.001) with a lower mean LVEF (0.49 ± 0.06 vs 0.51 ± 0.07, p=0.045) and older age (60±9 vs 57±8 years ; p=0.007).. At a 12-month follow-up, in the CTO group that was successfully revascularized by PCI, there was a better prognosis than the non-revascularized CTO group in terms of major cardiovascular events (19.9% vs 33.1% Plog-rank = 0.002). These results were consistent for all-cause mortality (5.5% vs 20.6%, Plog-rank =0.027), cardiac mortality (3.7% vs 20.6%, Plog-rank < 0.001) and rehospitalization events. (7.5% vs 32.2%, Plog-rank = 0.001).

 

Conclusion: Successful revascularization of CTO by PCI may provide clinical benefits in patients with CTO in association with major cardiovascular events.


Keywords


Chronic coronary total occlusion (CTO), major cardiovascular events, percutaneous coronary intervention (PCI), revascularization.

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References


Di Mario C, Werner GS, Sianos G, Galassi AR, Büttner J, Dudek D, et al. European perspective in the recanalisation of chronic total occlusions (cto): Consensus document from the eurocto club. EuroInterv. 2007; 3: 30-43

Werner GS. The role of coronary collaterals in chronic total occlusions. Curr Cardiol Rev. 2014;10(1):57-64. doi:10.2174/1573403x10666140311123814

Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S, et al. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol 2012;59(11):991–7.

Ramunddal T, Hoebers LP, Henriques JP, Dworeck C, Angeras O, Odenstedt J, et al. Chronic total occlusions in Sweden—a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). PLoS One 2014;9(8):e103850

Grantham JA, Jones PG, Cannon L, Spertus JA. Quantifying the early health status benefits of successful chronic total occlusion recanalization: results from the FlowCardia’s Approach to Chronic Total Occlusion Recanalization (FACTOR) Trial. Circ Cardiovasc Qual Outcomes 2010;3:284–90

Joyal D, Afilalo J, Rinfret S. Effectiveness of recanalization of chronic total occlusions: a systematic review and meta-analysis. Am Heart J 2010;160:179–87

Lee PH, Lee SW, Park HS, Kang SH, Bae BJ, Chang M, Roh JH, et al. Successful Recanalization of Native Coronary Chronic Total Occlusion Is Not Associated With Improved Long-Term Survival. JACC Cardiovasc Interv. 2016 Mar 28;9(6):530-8. doi: 10.1016/j.jcin.2015.11.016.

Werner GS, Surber R, Kuethe F, et al. Collaterals and the recovery of left ventricular function after recanalization of a chronic total coronary occlusion. Am Heart J 2005;149:129–37.

Tsai TT, Stanislawski MA, Shunk KA, Armstrong EJ, Grunwald GK, Schob AH, Valle JA, Alfonso CE, Nallamothu BK, Ho PM, Rumsfeld JS, Brilakis ES. Contemporary Incidence, Management, and Long-Term Outcomes of Percutaneous Coronary Interventions for Chronic Coronary Artery Total Occlusions: Insights From the VA CART Program. JACC Cardiovasc Interv. 2017 May 8;10(9):866-875. doi: 10.1016/j.jcin.2017.02.044.

Werner GS, Martin-Yuste V, Hildick-Smith D, Boudou N, Sianos G, Gelev V, et al. A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. Eur Heart J. 2018;39:2484–93.

Mashayekhi K, Nührenberg TG, Toma A, Gick M, Ferenc M, Hochholzer W, et al. A randomized trial to assess regional left ventricular function after stent implantation in chronic total occlusion: the REVASC Trial. JACC Cardiovasc Interv. 2018;11:1982–91.

Gong X, Zhou L, Ding X, Chen H, Li H. The impact of successful chronic total occlusion percutaneous coronary intervention on long-term clinical outcomes in real world. BMC Cardiovasc Disord. 2021 Apr 15;21(1):182. doi: 10.1186/s12872-021-01976-w.

de Labriolle A, Bonello L, Roy P, et al. Comparison of safety, efficacy, and outcome of successful versus unsuccessful percutaneous coronary intervention in “true” chronic total occlusions. Am J Cardiol 2008;102:1175–81

Yamamoto E, Natsuaki M, Morimoto T, et al. Long-term outcomes after percutaneous coronary intervention for chronic total occlusion (from the CREDO-Kyoto registry cohort-2). Am J Cardiol 2013;112:767–74.

George S, Cockburn J, Clayton TC, et al. Longterm follow-up of elective chronic total coronary occlusion angioplasty: analysis from the U.K. Central Cardiac Audit Database. J Am Coll Cardiol 2014;64:235–43

Jeroudi OM, Alomar ME, Michael TT, et al. Prevalence and management of coronary chronic total occlusions in a tertiary veterans affairs hospital: CTO Prevalence and Management. Cathet Cardiovasc Intervent. 2014;84(4):637-643. doi:10.1002/ccd.25264

Christofferson RD, Lehmann KG, Martin GV, Every N, Caldwell JH, Kapadia SR. Effect of Chronic Total Coronary Occlusion on Treatment Strategy. The American Journal of Cardiology. 2005;95(9):1088-1091. doi:10.1016/j.amjcard.2004.12.065

Lee SW, Lee PH, Ahn JM, et al. Randomized Trial Evaluating Percutaneous Coronary Intervention for the Treatment of Chronic Total Occlusion: The DECISION-CTO Trial. Circulation. 2019;139(14):1674-1683. doi:10.1161/CIRCULATIONAHA.118.031313

Key Updates in Cardio-Nephrology from 2018: Springboard to a Bright Future. Rev Cardiovasc Med. 2018;19(1). doi:10.31083/j.rcm.2018.01.906

Grantham JA, Marso SP, Spertus J, House J, Holmes DR, Rutherford BD. Chronic Total Occlusion Angioplasty in the United States. JACC: Cardiovascular Interventions. 2009;2(6):479-486. doi:10.1016/j.jcin.2009.02.008

Grantham JA. Survival and Chronic Total Occlusion Percutaneous Coronary Intervention. JACC: Cardiovascular Interventions. 2017;10(9):876-878. doi:10.1016/j.jcin.2017.03.010

Stone GW, Kandzari DE, Mehran R, et al. Percutaneous Recanalization of Chronically Occluded Coronary Arteries: A Consensus Document: Part I. Circulation. 2005;112(15):2364-2372. doi:10.1161/CIRCULATIONAHA.104.481283

Suzuki Y, Tsuchikane E, Katoh O, et al. Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusion Performed by Highly Experienced Japanese Specialists. JACC: Cardiovascular Interventions. 2017;10(21):2144-2154. doi:10.1016/j.jcin.2017.06.024

Mitomo S, Naganuma T, Jabbour RJ, et al. Impact of target vessel on long-term cardiac mortality after successful chronic total occlusion percutaneous coronary intervention: Insights from a Japanese multicenter registry. International Journal of Cardiology. 2017;245:77-82. doi:10.1016/j.ijcard.2017.07.098

Habib RH, Dimitrova KR, Badour SA, et al. CABG Versus PCI. Journal of the American College of Cardiology. 2015;66(13):1417-1427. doi:10.1016/j.jacc.2015.07.060

McEntegart MB, Badar AA, Ahmad FA, et al. The collateral circulation of coronary chronic total occlusions. EuroIntervention. 2016;11(14):e1596-e1603. doi:10.4244/EIJV11I14A310

Jamaiyar A, Juguilon C, Dong F, et al. Cardioprotection during ischemia by coronary collateral growth. American Journal of Physiology-Heart and Circulatory Physiology. 2019;316(1):H1-H9. doi:10.1152/ajpheart.00145.2018

Schaper W. Collateral vessels reduce mortality. European Heart Journal. 2012;33(5):564-566. doi:10.1093/eurheartj/ehr385

Choo GH. Collateral Circulation in Chronic Total Occlusions – an interventional perspective. CCR. 2015;11(4):277-284. doi:10.2174/1573403X11666150909112548

Werner GS, Surber R, Ferrari M, Fritzenwanger M, Figulla HR. The functional reserve of collaterals supplying long-term chronic total coronary occlusions in patients without prior myocardial infarction. European Heart Journal. 2006;27(20):2406-2412. doi:10.1093/eurheartj/ehl270

Sachdeva R, Agrawal M, Flynn SE, Werner GS, Uretsky BF. The myocardium supplied by a chronic total occlusion is a persistently ischemic zone: FFR assessment in CTO. Cathet Cardiovasc Intervent. 2014;83(1):9-16. doi:10.1002/ccd.25001

Jang WJ, Yang JH, Choi SH, et al. Long-Term Survival Benefit of Revascularization Compared With Medical Therapy in Patients With Coronary Chronic Total Occlusion and Well-Developed Collateral Circulation. JACC: Cardiovascular Interventions. 2015;8(2):271-279. doi:10.1016/j.jcin.2014.10.010

Guo L, Zhang X, Lv H, et al. Long-Term Outcomes of Successful Revascularization for Patients With Coronary Chronic Total Occlusions: A Report of 1,655 Patients. Front Cardiovasc Med. 2020;7:116. doi:10.3389/fcvm.2020.00116

Yang JH, Kim BS, Jang WJ, et al. Optimal Medical Therapy vs. Percutaneous Coronary Intervention for Patients With Coronary Chronic Total Occlusion – A Propensity-Matched Analysis –. Circ J. 2016;80(1):211-217. doi:10.1253/circj.CJ-15-0673

Shaw LJ, Berman DS, Maron DJ, et al. Optimal Medical Therapy With or Without Percutaneous Coronary Intervention to Reduce Ischemic Burden: Results From the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial Nuclear Substudy. Circulation. 2008;117(10):1283-1291. doi:10.1161/CIRCULATIONAHA.107.743963

Jones DA, Weerackody R, Rathod K, et al. Successful Recanalization of Chronic Total Occlusions Is Associated With Improved Long-Term Survival. JACC: Cardiovascular Interventions. 2012;5(4):380-388. doi:10.1016/j.jcin.2012.01.012

Joyal D, Afilalo J, Rinfret S. Effectiveness of recanalization of chronic total occlusions: A systematic review and meta-analysis. American Heart Journal. 2010;160(1):179-187. doi:10.1016/j.ahj.2010.04.015

Park TK, Lee SH, Choi KH, et al. Late Survival Benefit of Percutaneous Coronary Intervention Compared With Medical Therapy in Patients With Coronary Chronic Total Occlusion: A 10‐Year Follow‐Up Study. :18.




DOI: https://doi.org/10.21776/ub.hsj.2022.003.03.5

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