Both surgical and percutaneous revascularization improve prognosis in patients with a coronary chronic total occlusion (CTO) irrespective of collateral robustness.
CTO
Chronic total occlusion
Coronary artery bypass grafting
Coronary collaterals
Mortality
Percutaneous coronary intervention
Revascularization
Journal
Heart and vessels
ISSN: 1615-2573
Titre abrégé: Heart Vessels
Pays: Japan
ID NLM: 8511258
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
18
01
2021
accepted:
16
04
2021
pubmed:
30
4
2021
medline:
15
2
2022
entrez:
29
4
2021
Statut:
ppublish
Résumé
The impact of surgical or percutaneous coronary revascularization on prognosis in patients with a chronic total occlusion (CTO) remains uncertain. Particularly, whether revascularization of those with robust coronary collaterals improves prognosis is unknown. The objective of this study was to determine the predictors and prognostic impact of revascularization of a CTO, and to determine the clinical impact of robust coronary collaterals. Patients with a CTO diagnosed on coronary angiography between Jul 2010 and Dec 2019 were included in this study. Management strategy of the CTO was defined as percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or medical management. The degree of collateral robustness was determined by the Rentrop grading classification. Demographic, angiographic and clinical outcomes were recorded. A total of 954 patients were included in the study, of which 186 (19.5%) patients underwent CTO PCI, 296 (31.0%) patients underwent CABG and 472 (49.5%) patients underwent medical management of the CTO. 166 patients (17.4%) had Rentrop grade zero or one collaterals, 577 (60.5%) patients had Rentrop grade two and 211 (22.1%) had Rentrop grade three collaterals. The independent predictors of medical management of the CTO were older age, greater stenosis in the donor vessel, an emergent indication for angiography, a non-LAD CTO and female sex. The degree of collateral robustness was not associated with long-term mortality, while patients who were revascularized either through CABG or PCI had a significantly lower mortality compared to medical management alone (p < 0.0001). In patients with a CTO, the presence of robust collaterals is not associated with prognosis, while both surgical and percutaneous revascularization is associated with improved prognosis. Further research into the optimal revascularization strategy for a CTO is required.
Identifiants
pubmed: 33914092
doi: 10.1007/s00380-021-01859-2
pii: 10.1007/s00380-021-01859-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1653-1660Informations de copyright
© 2021. Springer Japan KK, part of Springer Nature.
Références
Shah PB (2011) Management of coronary chronic total occlusion. Circulation 123(16):1780–1784
doi: 10.1161/CIRCULATIONAHA.110.972802
Christofferson RD, Lehmann KG, Martin GV, Every N, Caldwell JH, Kapadia SR (2005) Effect of chronic total coronary occlusion on treatment strategy. Am J Cardiol 95(9):1088–1091
doi: 10.1016/j.amjcard.2004.12.065
Jeroudi OM, Alomar ME, Michael TT, El Sabbagh A, Patel VG, Mogabgab O, Fuh E, Sherbet D, Lo N, Roesle M, Rangan BV, Abdullah SM, Hastings JL, Grodin J, Banerjee S, Brilakis ES (2014) Prevalence and management of coronary chronic total occlusions in a tertiary Veterans Affairs hospital. Catheter Cardiovasc Interv 84(4):637–643
doi: 10.1002/ccd.25264
Allahwala UK, Jolly SS, Dzavik V, Cairns JA, Kedev S, Balasubramanian K, Stankovic G, Moreno R, Valettas N, Bertrand O, Lavi S, Velianou JL, Sheth T, Meeks B, Brilakis ES, Bhindi R (2018) The presence of a CTO in a non-infarct-related artery during a STEMI treated with contemporary primary pci is associated with increased rates of early and late cardiovascular morbidity and mortality: the CTO-TOTAL substudy. JACC Cardiovasc Interv 11(7):709–711
doi: 10.1016/j.jcin.2017.12.005
Kim BS, Yang JH, Jang WJ, Song YB, Hahn JY, Choi JH, Kim WS, Lee YT, Gwon HC, Lee SH, Choi SH (2015) Clinical outcomes of multiple chronic total occlusions in coronary arteries according to three therapeutic strategies: bypass surgery, percutaneous intervention and medication. Int J Cardiol 197:2–7
doi: 10.1016/j.ijcard.2015.06.017
Wijeysundera HC, Norris C, Fefer P, Galbraith PD, Knudtson ML, Wolff R, Wright GA, Strauss BH, Ko DT (2014) Relationship between initial treatment strategy and quality of life in patients with coronary chronic total occlusions. EuroIntervention 9(10):1165–1172
doi: 10.4244/EIJV9I10A197
Khatri J, Abdallah M, Ellis S (2017) Management of coronary chronic total occlusion. Cleve Clin J Med 84(12 Suppl 3):27–38
doi: 10.3949/ccjm.84.s3.03
Sachdeva R, Agrawal M, Flynn SE, Werner GS, Uretsky BF (2014) The myocardium supplied by a chronic total occlusion is a persistently ischemic zone. Catheter Cardiovasc Interv 83(1):9–16
doi: 10.1002/ccd.25001
Kayaert P, Coeman M, Drieghe B, Bennett J, McCutcheon K, Dens J, Ungureanu C, Zivelonghi C, Agostoni P, Bataille Y, de Hemptinne Q, Gevaert S, De Pauw M, Haine S (2020) iFR uncovers profound but mostly reversible ischemia in CTOs and helps to optimize PCI results. Catheter Cardiovasc Interv. https://doi.org/10.1002/ccd.29072
doi: 10.1002/ccd.29072
pubmed: 32548976
Nombela-Franco L, Iannaccone M, Anguera I, Amat-Santos IJ, Sanchez-Garcia M, Bautista D, Calvelo MN, Di Marco A, Moretti C, Pozzi R, Scaglione M, Canadas V, Sandin-Fuentes M, Arenal A, Bagur R, Perez-Castellano N, Fernandez-Perez C, Gaita F, Macaya C, Escaned J, Fernandez-Lozano I (2017) Impact of chronic total coronary occlusion on recurrence of ventricular arrhythmias in ischemic secondary prevention implantable cardioverter-defibrillator recipients (VACTO secondary study) insights from coronary angiogram and electrogram analysis. JACC Cardiovasc Interv 10(9):879–888
doi: 10.1016/j.jcin.2017.02.008
Allahwala UK, Kott K, Bland A, Ward M, Bhindi R (2020) Predictors and prognostic implications of well-matured coronary collateral circulation in patients with a chronic total occlusion (CTO). Int Heart J 61(2):223–230
doi: 10.1536/ihj.19-456
Allahwala U, Nour D, Bhatia K, Ward M, Lo S, Weaver JC, Bhindi R (2020) Prognostic impact of collaterals in patients with a coronary chronic total occlusion (CTO): a meta-analysis of over 3000 patients. Catheter Cardiovasc Interv. https://doi.org/10.1002/ccd.29348
doi: 10.1002/ccd.29348
pubmed: 33118694
Allahwala UK, Weaver JC, Nelson GI, Nour D, Ray M, Ciofani JL, Ward M, Figtree G, Hansen P, Bhindi R (2020) Effect of Recruitment of acute coronary collaterals on in-hospital mortality and on left ventricular function in patients presenting with ST elevation myocardial infarction. Am J Cardiol 125(10):1455–1460
doi: 10.1016/j.amjcard.2020.02.023
Allahwala UK, Nour D, Alsanjari O, Bhatia K, Nagaraja V, Khatri JJ, Cockburn J, Hildick-Smith D, Sakata Y, Ward M, Weaver JC, Bhindi R (2020) Prognostic implications of the rapid recruitment of coronary collaterals during ST elevation myocardial infarction (STEMI): a meta-analysis of over 14,000 patients. J Thromb Thrombolysis. https://doi.org/10.1007/s11239-020-02282-6
doi: 10.1007/s11239-020-02282-6
pubmed: 32930943
Rentrop KP, Cohen M, Blanke H, Phillips RA (1985) Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 5(3):587–592
doi: 10.1016/S0735-1097(85)80380-6
Werner GS, Ferrari M, Heinke S, Kuethe F, Surber R, Richartz BM, Figulla HR (2003) Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions. Circulation 107(15):1972–1977
doi: 10.1161/01.CIR.0000061953.72662.3A
Guo L, Lv HC, Huang RC (2020) Percutaneous coronary intervention in elderly patients with coronary chronic total occlusions: current evidence and future perspectives. Clin Interv Aging 15:771–781
doi: 10.2147/CIA.S252318
Zhang HP, Ai H, Zhao Y, Li H, Tang GD, Zheng NX, Sun FC, Liu JH (2018) Effect of chronic total occlusion percutaneous coronary intervention on clinical outcomes in elderly patients. Am J Med Sci 355(2):174–182
doi: 10.1016/j.amjms.2017.09.007
Allahwala UK, Brilakis ES, Byrne J, Davies JE, Ward MR, Weaver JC, Bhindi R (2019) Applicability and interpretation of coronary physiology in the setting of a chronic total occlusion. Circ Cardiovasc Interv 12(7):e007813
doi: 10.1161/CIRCINTERVENTIONS.119.007813
Vallabhajosyula S, Prasad A, Gulati R, Barsness GW (2019) Contemporary prevalence, trends, and outcomes of coronary chronic total occlusions in acute myocardial infarction with cardiogenic shock. Int J Cardiol Heart Vasc 24:100414
pubmed: 31517033
pmcid: 6727101
Teng HI, Sung SH, Huang SS, Pan JP, Lin SJ, Chan WL, Lee WL, Lu TM, Wu CH (2018) The impact of successful revascularization of coronary chronic total occlusions on long-term clinical outcomes in patients with non-ST-segment elevation myocardial infarction. J Interv Cardiol 31(3):302–309
doi: 10.1111/joic.12501
Brilakis ES, Banerjee S, Karmpaliotis D, Lombardi WL, Tsai TT, Shunk KA, Kennedy KF, Spertus JA, Holmes DR Jr, Grantham JA (2015) Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv 8(2):245–253
doi: 10.1016/j.jcin.2014.08.014
Safley DM, House JA, Marso SP, Grantham JA, Rutherford BD (2008) Improvement in survival following successful percutaneous coronary intervention of coronary chronic total occlusions: variability by target vessel. JACC Cardiovasc Interv 1(3):295–302
doi: 10.1016/j.jcin.2008.05.004
Yoneda K, Takahashi T, Kishi K (2020) Over ten years follow-up of chronic total coronary occlusion angioplasty. Cardiovasc Revasc Med. https://doi.org/10.1016/j.carrev.2020.10.013
doi: 10.1016/j.carrev.2020.10.013
pubmed: 33183984
Maas AH, Appelman YE (2010) Gender differences in coronary heart disease. Neth Heart J 18(12):598–602
doi: 10.1007/s12471-010-0841-y
Wolff R, Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Sparkes JD, Wright GA, Wijeysundera HC, Strauss BH (2016) Gender differences in the prevalence and treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv 87(6):1063–1070
doi: 10.1002/ccd.26330
Allahwala UK, Weaver JC, Bhindi R (2020) Spontaneous coronary collateral recruitment in patients with recurrent ST elevation myocardial infarction (STEMI). Heart Vessels 35(3):291–296
doi: 10.1007/s00380-019-01493-z
Allahwala UK, Khachigian LM, Nour D, Ridiandres A, Billah M, Ward M, Weaver J, Bhindi R (2020) Recruitment and maturation of the coronary collateral circulation: current understanding and perspectives in arteriogenesis. Microvasc Res 132:104058
doi: 10.1016/j.mvr.2020.104058
Allahwala UK, Weaver J, Bhindi R (2019) Animal chronic total occlusion models: a review of the current literature and future goals. Thromb Res 177:83–90
doi: 10.1016/j.thromres.2019.03.004
Nombela-Franco L, Iannaccone M, Anguera I, Amat-Santos IJ, Sanchez-Garcia M, Bautista D, Calvelo MN, Di Marco A, Moretti C, Pozzi R, Scaglione M, Canadas V, Sandin-Fuentes M, Arenal A, Bagur R, Perez-Castellano N, Fernandez-Perez C, Gaita F, Macaya C, Escaned J, Fernandez-Lozano I (2017) Impact of chronic total coronary occlusion on recurrence of ventricular arrhythmias in ischemic secondary prevention implantable cardioverter-defibrillator recipients (VACTO secondary study): insights from coronary angiogram and electrogram analysis. JACC Cardiovasc Interv 10(9):879–888
doi: 10.1016/j.jcin.2017.02.008
Henriques JP, Hoebers LP, Ramunddal T, Laanmets P, Eriksen E, Bax M, Ioanes D, Suttorp MJ, Strauss BH, Barbato E, Nijveldt R, van Rossum AC, Marques KM, Elias J, van Dongen IM, Claessen BE, Tijssen JG, van der Schaaf RJ, Investigators ET (2016) Percutaneous intervention for concurrent chronic total occlusions in patients with STEMI: the EXPLORE trial. J Am Coll Cardiol 68(15):1622–1632
doi: 10.1016/j.jacc.2016.07.744
Werner GS, Martin-Yuste V, Hildick-Smith D, Boudou N, Sianos G, Gelev V, Rumoroso JR, Erglis A, Christiansen EH, Escaned J, di Mario C, Hovasse T, Teruel L, Bufe A, Lauer B, Bogaerts K, Goicolea J, Spratt JC, Gershlick AH, Galassi AR, Louvard Y, investigators Et (2018) A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. Eur Heart J 39(26):2484–2493
doi: 10.1093/eurheartj/ehy220
Lee S-J, Lee PH, Ahn J-M, Park D-W, Yun S-C, Han S, Kang H, Kang S-J, Kim Y-H, Lee CW, Park S-W, Hur SH, Rha S-W, Her S-H, Choi SW, Lee B-K, Lee N-H, Lee J-Y, Cheong S-S, Kim MH, Ahn Y-K, Lim SW, Lee S-G, Hiremath S, Santosa T, Udayachalerm W, Cheng JJ, Cohen DJ, Muramatsu T, Tsuchikane E, Asakura Y, Park S-J (2019) Randomized trial evaluating percutaneous coronary intervention for the treatment of chronic total occlusion. Circulation 139(14):1674–1683
doi: 10.1161/CIRCULATIONAHA.118.031313
Allahwala UK, Ward MR, Brieger D, Weaver JC, Bhindi R (2019) Indications for percutaneous coronary intervention (pci) in chronic total occlusion (CTO): have we reached a DECISION or do we continue to EXPLORE after EURO-CTO? Heart Lung Circ 28(10):1484–1489
doi: 10.1016/j.hlc.2019.03.014
Khanra D, Mishra V, Jain B, Soni S, Bahurupi Y, Duggal B, Rathore S, Guha S, Agarwal S, Aggarwal P, Sinha S, Himanshu K (2020) Percutaneous coronary intervention provided better long term results than optimal medical therapy alone in patients with chronic total occlusion: a meta-analysis. Indian Heart J 72(4):225–231
doi: 10.1016/j.ihj.2020.07.013
Hori Y, Yoda S, Nakanishi K, Tano A, Suzuki Y, Matsumoto N, Hirayama A (2015) Myocardial ischemic reduction evidenced by gated myocardial perfusion imaging after treatment results in good prognosis in patients with coronary artery disease. J Cardiol 65(4):278–284
doi: 10.1016/j.jjcc.2014.06.015
Holzhey DM, Jacobs S, Walther T, Mohr FW, Falk V (2010) Is chronic total coronary occlusion a risk factor for long-term outcome after minimally invasive bypass grafting of the left anterior descending artery? Ann Thorac Surg 89(5):1496–1501
doi: 10.1016/j.athoracsur.2010.01.063
Widimsky P, Straka Z, Stros P, Jirasek K, Dvorak J, Votava J, Lisa L, Budesinsky T, Kolesar M, Vanek T, Brucek P (2004) One-year coronary bypass graft patency: a randomized comparison between off-pump and on-pump surgery angiographic results of the PRAGUE-4 trial. Circulation 110(22):3418–3423
doi: 10.1161/01.CIR.0000148139.79580.36
Bonow RO, Maurer G, Lee KL, Holly TA, Binkley PF, Desvigne-Nickens P, Drozdz J, Farsky PS, Feldman AM, Doenst T, Michler RE, Berman DS, Nicolau JC, Pellikka PA, Wrobel K, Alotti N, Asch FM, Favaloro LE, She L, Velazquez EJ, Jones RH, Panza JA, Investigators ST (2011) Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med 364(17):1617–1625
doi: 10.1056/NEJMoa1100358
Sun D, Wang J, Tian Y, Narsinh K, Wang H, Li C, Ma X, Wang Y, Wang D, Li C, Wu JC, Tian J, Cao F (2012) Multimodality imaging evaluation of functional and clinical benefits of percutaneous coronary intervention in patients with chronic total occlusion lesion. Theranostics 2(8):788–800
doi: 10.7150/thno.4717
Allahwala UK, Brilakis ES, Kiat H, Ayesa S, Nour D, Ward M, Lo S, Weaver JC, Bhindi R (2020) The indications and utility of adjunctive imaging modalities for chronic total occlusion (CTO) intervention. J Nucl Cardiol. https://doi.org/10.1007/s12350-020-02381-0
doi: 10.1007/s12350-020-02381-0
pubmed: 33025478