Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Wiener klinische Wochenschrift 7-8/2017

01.04.2017 | original article

Long-term major adverse cardiac and cerebrovascular events (MACCE) rate

Comparison of retrograde and antegrade recanalization of chronic total coronary occlusions

verfasst von: MD Klaudija Bijuklic, MD Carsten Schwencke, MD, PhD Prof. Joachim Schofer

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 7-8/2017

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

Background

The recanalization success rate of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be increased by the retrograde approach; however, the long-term outcome of patients undergoing retrograde procedures is unknown.

Aim

We aimed to evaluate the long-term major adverse cardiac and cerebrovascular event (MACCE) rate (e.g. death, myocardial infarction, coronary artery bypass surgery and stroke) in patients after retrograde versus antegrade CTO-PCI.

Methods and results

In a prospective single center study from January 2008 to June 2012, 396 consecutive patients with CTO (≥3 months old) were enrolled. The mean age was 63.4 ± 10.3 years and 86.4% were male. The success rate of the total patient cohort was 88.6%. The retrograde PCI, only attempted after a failed antegrade intervention, was performed in 18% (n = 71) of patients. Long-term MACCE rate (mean follow up 2.3 ± 1.6 years) was significantly higher in the unsuccessful compared to the successful CTO-PCI group (23.1% versus 9.4%, p = 0.01) and this was also the case in the subgroup of antegrade CTO-PCI. In the retrograde subgroup, however, procedural success had no impact on outcome. Patients with unsuccessful retrograde CTO-PCI had a significantly better collateral connection compared to patients with an unsuccessful antegrade approach. Independent predictors for MACCE were peripheral artery disease and an ejection fraction ≤30%.

Conclusion

The long-term MACCE rate after unsuccessful recanalization was significantly higher, which was driven by a higher MACCE rate after unsuccessful versus successful antegrade approaches. In contrast, procedural success in the retrograde group had no impact on outcome.
Literatur
1.
Zurück zum Zitat 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. CrossRefPubMed 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. CrossRefPubMed
2.
Zurück zum Zitat Hoye A, van Domburg RT, Sonnenschein K, Serruys PW. Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992–2002. Eur Heart J. 2005;26:2630–6. CrossRefPubMed Hoye A, van Domburg RT, Sonnenschein K, Serruys PW. Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992–2002. Eur Heart J. 2005;26:2630–6. CrossRefPubMed
3.
Zurück zum Zitat Suero JA, Marso SP, Jones PG, et al. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol. 2001;38:409–14. CrossRefPubMed Suero JA, Marso SP, Jones PG, et al. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol. 2001;38:409–14. CrossRefPubMed
4.
Zurück zum Zitat 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. CrossRefPubMed 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. CrossRefPubMed
5.
Zurück zum Zitat Mehran R, Claessen BE, Godino C, et al. Multinational chronic total occlusion registry. Long-term outcome of percutaneous coronary intervention for chronic total occlusions. JACC Cardiovasc Interv. 2011;4:952–61. CrossRefPubMed Mehran R, Claessen BE, Godino C, et al. Multinational chronic total occlusion registry. Long-term outcome of percutaneous coronary intervention for chronic total occlusions. JACC Cardiovasc Interv. 2011;4:952–61. CrossRefPubMed
6.
Zurück zum Zitat Jones DA, Weerackody R, Rathod K, et al. Successful recanalization of chronic total occlusions is associated with improved long-term survival. JACC Cardiovasc Interv. 2012;5:380–8. CrossRefPubMed Jones DA, Weerackody R, Rathod K, et al. Successful recanalization of chronic total occlusions is associated with improved long-term survival. JACC Cardiovasc Interv. 2012;5:380–8. CrossRefPubMed
7.
Zurück zum Zitat COURAGE Investigators, 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;117:1283–91. CrossRef COURAGE Investigators, 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;117:1283–91. CrossRef
8.
Zurück zum Zitat Nombela-Franco L, Mitroi CD, Fernández-Lozano I, et al. Ventricular arrhythmias among implantable cardioverter-defibrillator recipients for primary prevention: impact of chronic total coronary occlusion (VACTO Primary Study). Circ Arrhythm Electrophysiol. 2012;5:147–54. CrossRefPubMed Nombela-Franco L, Mitroi CD, Fernández-Lozano I, et al. Ventricular arrhythmias among implantable cardioverter-defibrillator recipients for primary prevention: impact of chronic total coronary occlusion (VACTO Primary Study). Circ Arrhythm Electrophysiol. 2012;5:147–54. CrossRefPubMed
9.
Zurück zum Zitat Kirschbaum SW, Baks T, van den Ent M, et al. Evaluation of left ventricular function three years after percutaneous recanalization of chronic total coronary occlusions. Am J Cardiol. 2008;101:179–85. CrossRefPubMed Kirschbaum SW, Baks T, van den Ent M, et al. Evaluation of left ventricular function three years after percutaneous recanalization of chronic total coronary occlusions. Am J Cardiol. 2008;101:179–85. CrossRefPubMed
10.
Zurück zum Zitat Claessen BE, van der Schaaf RJ, Verouden NJ, et al. Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention. JACC Cardiovasc Interv. 2009;2:1128–34. CrossRefPubMed Claessen BE, van der Schaaf RJ, Verouden NJ, et al. Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention. JACC Cardiovasc Interv. 2009;2:1128–34. CrossRefPubMed
11.
Zurück zum Zitat 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. CrossRefPubMed 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. CrossRefPubMed
12.
Zurück zum Zitat Surmely JF, Katoh O, Tsuchikane E, Nasu K, Suzuki T. Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv. 2007;69:826–823. CrossRefPubMed Surmely JF, Katoh O, Tsuchikane E, Nasu K, Suzuki T. Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv. 2007;69:826–823. CrossRefPubMed
13.
Zurück zum Zitat Godino C, Carlino M, Al-Lamee R, Colombo A. Coronary chronic total occlusion. Minerva Cardioangiol. 2010;58:41–60. PubMed Godino C, Carlino M, Al-Lamee R, Colombo A. Coronary chronic total occlusion. Minerva Cardioangiol. 2010;58:41–60. PubMed
14.
Zurück zum Zitat Sumitsuji S, Inoue K, Ochiai M, Tsuchikane E, Ikeno F. Fundamental wire technique and current standard strategy of percutaneous intervention for chronic total occlusion with histopathological insights. JACC Cardiovasc Interv. 2011;4:941–51. CrossRefPubMed Sumitsuji S, Inoue K, Ochiai M, Tsuchikane E, Ikeno F. Fundamental wire technique and current standard strategy of percutaneous intervention for chronic total occlusion with histopathological insights. JACC Cardiovasc Interv. 2011;4:941–51. CrossRefPubMed
15.
Zurück zum Zitat Michael TT, Karmpaliotis D, Brilakis ES, et al. Procedural outcomes of revascularization of chronic total occlusion of native coronary arteries (from a multicenter United States registry). Am J Cardiol. 2013;112:488–92. CrossRefPubMed Michael TT, Karmpaliotis D, Brilakis ES, et al. Procedural outcomes of revascularization of chronic total occlusion of native coronary arteries (from a multicenter United States registry). Am J Cardiol. 2013;112:488–92. CrossRefPubMed
16.
Zurück zum Zitat Morino Y, Kimura T, Hayashi Y, et al. In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J‑CTO Registry (Multicenter CTO Registry in Japan). JACC Cardiovasc Interv. 2010;2:143–51. CrossRef Morino Y, Kimura T, Hayashi Y, et al. In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J‑CTO Registry (Multicenter CTO Registry in Japan). JACC Cardiovasc Interv. 2010;2:143–51. CrossRef
17.
Zurück zum Zitat Werner GS, Ferrari M, Heinke S, et al. Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions. Circulation. 2003;15:1972–7. CrossRef Werner GS, Ferrari M, Heinke S, et al. Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions. Circulation. 2003;15:1972–7. CrossRef
18.
Zurück zum Zitat Joint ESC/ACCF/AHA/WHF Task Force for Universal Definition of Myocardial Infarction, Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, ESC Committee for Practice Guidelines (CPG), Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33:2551–67. CrossRef Joint ESC/ACCF/AHA/WHF Task Force for Universal Definition of Myocardial Infarction, Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, ESC Committee for Practice Guidelines (CPG), Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33:2551–67. CrossRef
19.
Zurück zum Zitat Khan MF, Wendel CS, Thai HM, Movahed MR. Effects of percutaneous revascularization of chronic total occlusions on clinical outcomes: a meta-analysis comparing successful versus failed percutaneous intervention for chronic total occlusion. Catheter Cardiovasc Interv. 2013;82:95–107. CrossRefPubMed Khan MF, Wendel CS, Thai HM, Movahed MR. Effects of percutaneous revascularization of chronic total occlusions on clinical outcomes: a meta-analysis comparing successful versus failed percutaneous intervention for chronic total occlusion. Catheter Cardiovasc Interv. 2013;82:95–107. CrossRefPubMed
20.
Zurück zum Zitat Galassi AR, Tomasello SD, Costanzo L, et al. Long-term clinical and angiographic results of Sirolimus-Eluting Stent in Complex Coronary Chronic Total Occlusion Revascularization: the SECTOR registry. J Interv Cardiol. 2011;24:426–36. CrossRefPubMed Galassi AR, Tomasello SD, Costanzo L, et al. Long-term clinical and angiographic results of Sirolimus-Eluting Stent in Complex Coronary Chronic Total Occlusion Revascularization: the SECTOR registry. J Interv Cardiol. 2011;24:426–36. CrossRefPubMed
Metadaten
Titel
Long-term major adverse cardiac and cerebrovascular events (MACCE) rate
Comparison of retrograde and antegrade recanalization of chronic total coronary occlusions
verfasst von
MD Klaudija Bijuklic
MD Carsten Schwencke
MD, PhD Prof. Joachim Schofer
Publikationsdatum
01.04.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 7-8/2017
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-016-1148-9