Different scoring systems are used to stratify patients with chronic total coronary artery occlusions (CTO) according to disease complexity to predict the success of the percutaneous coronary ...intervention (PCI). Comparison among different CTO scoring systems and long-term outcome for patients with CTO after PCI has not been well established. The objectives of the study were to assess the ability of different disease severity scoring systems to predict, first, procedural success and, second, overall survival in patients with a successful procedure.
A total of 551 patients who underwent elective CTO PCI in Riga East University hospital from January 2007 to December 2016 were included in the study. Four scoring systems (J CTO, PROGRESS CTO, CL, and CASTLE) were calculated. ROC curves were used to assess the association between scores and procedural success, and the Kaplan-Meier method and Cox regression were used to estimate the association with death from any cause after a successful procedure,
454 of 551cases were successful. With increasing disease complexity, the procedural success rate was significantly reduced in all scoring systems (
< 0.001): Area under the curve was 0.714 for J CTO score, 0.605 for PROGRESS CTO, 0.624 for CL and 0.641 for CASTLE scores. During the median 6.8 years of follow-up time, survival was better in the successful procedure group (
= 0.041). Among patients with procedural success, only PROGRESS and CASTLE scores showed an association with all-cause risk of death. After adjustment for baseline characteristics, patients having high PROGRESS score had almost twice higher risk of death (HR 1.81(95% CI 1.19-2.75)), and those with high and intermediate CASTLE score experienced almost four (HR 3.68(95% CI 1.50-9.05)) and two (HR 2.15, (95% CI 1.42-3.23)) times higher risk of death than the low score patients, respectively.
All four CTO scoring systems had moderate ability to predict procedural success. More complex CTO PCI patients, assessed by PROGRESS and CASTLE scores, has worse all-cause survival in six to seven years after a successful procedure; whereas J CTO and CL scores had no association with survival.
Abstract Background A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs). Objectives The authors describe the European ...experience with and outcomes of retrograde PCI revascularization for coronary CTOs. Methods Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization. Results The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio HR: 2.06; 95% confidence interval CI: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up. Conclusions The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.
A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs).
The authors describe the European experience with and outcomes of ...retrograde PCI revascularization for coronary CTOs.
Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization.
The mean patient age was 62.0 ± 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 ± 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio HR: 2.06; 95% confidence interval CI: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score ≥3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up.
The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes.
Ventricular shunting is a well-recognised and commonly practiced method of reducing increased intracranial pressure in patients with neurologic pathology. There are possible complications related to ...shunt implantation, where the rarest is intracardiac migration of the distal shunt catheter. We present a case where the distal catheter migrated into the right ventricle, causing extrasystoles and was complicated with acute right ventricle failure during the endovascular shunt evacuation procedure.
Background
Gender‐specific data addressing percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in female patients are scarce and based on small sample size studies.
Aims
We ...aimed to analyze gender‐differences regarding in‐hospital clinical outcomes after CTO‐PCI.
Methods
Data from 35,449 patients enrolled in the prospective European Registry of CTOs were analyzed. The primary outcome was the comparison of procedural success rate in the two cohorts (women vs. men), defined as a final residual stenosis less than 20%, with Thrombolysis In Myocardial Infarction grade flow = 3. In‐hospital major adverse cardiac and cerebrovascular events (MACCEs) and procedural complications were deemed secondary outcomes.
Results
Women represented 15.2% of the entire study population. They were older and more likely to have hypertension, diabetes, and renal failure, with an overall lower J‐CTO score. Women showed a higher procedural success rate (adjusted OR aOR = 1.115, confidence interval CI: 1.011–1.230, p = 0.030). Apart from previous myocardial infarction and surgical revascularization, no other significant gender differences were found among predictors of procedural success. Antegrade approach with true‐to‐true lumen techniques was more commonly used than retrograde approach in females. No gender differences were found regarding in‐hospital MACCEs (0.9% vs. 0.9%, p = 0.766), although a higher rate of procedural complications was observed in women, such as coronary perforation (3.7% vs. 2.9%, p < 0.001) and vascular complications (1.0% vs. 0.6%, p < 0.001).
Conclusions
Women are understudied in contemporary CTO‐PCI practice. Female sex is associated with higher procedural success after CTO‐PCI, yet no sex differences were found in terms of in‐hospital MACCEs. Female sex was associated with a higher rate of procedural complications.
Abstract
Coronary artery chronic total occlusions (CTO) are common — approximately one-third of patients with significant coronary artery disease on angiography have at least 1 CTO. Invasive ...treatment of these lesions still remain a major challenge for interventional cardiology due to their complexity. Historically, success rates have improved to about 60–70% by using only the traditional antegrade approach. The results have dramatically improved during the last decade after more widespread application of new retrograde techniques. The aim of our study was to review and analyse single hospital experience in CTO invasive treatment and to evaluate the long-term results. A total of 519 patients undergoing percutaneous coronary interventions (PCI) for CTO at a single tertiary PCI centre (Rīga East University Hospital), were included in the study. The median age was 64 years (38–88), and 80% were male. The retrograde approach (RA) was used for 167 (32.2%) of the CTO PCI patients. The overall patient success rate was 81.3% and it increased from 73.9% in 2007 to 95.2% in 2015 (
p
< 0.001). Mean patient observation time was five years. Overall survival was found significantly better in patients group after successful CTO PCI procedures (Long-rank test,
p
= 0.013).
Introduction. Despite advantages in interventional cardiology during last decade, chronic total occlusions (CTO) still remains one of the biggest problem in percutaneous coronary interventions (PCI) ...(10,14). CTO prevalence is high, but only less than 10% of percutaneous revascularizations are CTO interventions (17). There are no prospective randomized trials, properly powered for hard clinical endpoints, comparing modern optimal medical therapy with contemporary state of the art CTO recanalization (6).
. The aim of our study was to compare CTO PCI procedural parameters and treatment results using anterograde and/or retrograde approach.
The study included all patients undergoing PCI for CTO at single tertiary PCI center between January 2007 and December 2012. 5568 PCI procedures were done in this period in our institution. 486 (8,64%) of them were CTO PCI. Retrograde approach was used in 138 (28,7% of all CTO PCI) cases. Patients were grouped according PCI year performing, approach (anterograde or retrograde) and PCI results (successful or unsuccessful). Demographic and procedural data were collected at the time of intervention.
A total of 405 patients undergoing CTO PCI were included. The median age was 64yrs(38-88) and 79,2% was male. Retrograde approach (RA) was used in 138(28,7%) cases. RA usage has increase from 15.9% in 2007 till 46,8% of cases in 2012(p=0,0000218). The overall patient and procedure success rates were 77,8% (315/90) and 69,9%(340/146) respectively. Overall success rate has increase from 61,4% in 2007 till 87,1% in 2012 (p<0,001). Overall survival was found better in patients group after successful procedure (Long-rank test p=0,019).
Retrograde approach usage significantly increase CTO PCI success rate, but doesn’t increase risk of complications. Long-term outcome and survival after CTO PCI is not depending on approach (anterograde or retrograde), but on procedural success.
The marine metabolite diazonamide A exerts low nanomolar cytotoxicity against a range of tumor cell lines; however, its highly complex molecular architecture undermines the therapeutic potential of ...the natural product. We demonstrate that truncation of heteroaromatic macrocycle in natural diazonamide A, combined with the replacement of the challenging-to-synthesize tetracyclic hemiaminal subunit by oxindole moiety leads to considerably less complex analogues with improved drug-like properties and nanomolar antiproliferative potency. The structurally simplified macrocycles are accessible in 12 steps from readily available indolin-2-one and tert-leucine with excellent diastereoselectivity (99:1 dr) in the key macrocyclization step. The most potent macrocycle acts as a tubulin assembly inhibitor and exerts similar effects on A2058 cell cycle progression and induction of apoptosis as does marketed microtubule-targeting agent vinorelbine.
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