scholarly journals High Incidence of Cataracts in the Follow-Up of Patients Undergoing Percutaneous Coronary Intervention for Chronic Coronary Total Occlusion

2021 ◽  
Vol 10 (21) ◽  
pp. 5002
Author(s):  
Ricardo Rivera-López ◽  
Celia García-López ◽  
José M. Sánchez-Moreno ◽  
Rafael A. Rivera-López ◽  
Julio Almansa-López ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radiation Dose ◽  
Cox Regression ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Study Objective ◽  
Percutaneous Coronary ◽  
Cataract Development ◽  
Cardiac Catheterizations

Development of cataracts is a well-known adverse effect of ionizing radiation, but little information is available on their incidence in patients after other medical procedures, such as cardiac catheterizations. The study objective was to determine the incidence of cataracts in a cohort of patients undergoing percutaneous coronary intervention (PCI) for chronic coronary total occlusion (CTO) and its association with radiation dose. The study analyzed the incidence of cataracts during the follow-up of 126 patients who underwent chronic total coronary PCI, using Cox regression to identify predictive factors of cataract development. The study included 126 patients, 86.9% male, with a mean age of 60.5 years (range, 55.0–68.0 years). Twenty-three (18.2% n = 23) developed cataracts during a mean follow-up of 49.5 months (range 37.3–64.5 months). A higher incidence was observed in patients who received more than 5 Gy (29.0% vs. 14.7%, Hazard ratio (HR = 2.84 [1.19–6.77]). Multivariate analysis revealed a relationship between cataract development during the follow-up and a receipt of radiation dose >5 Gy (HR = 2.60, 95% confidence interval [CI 1.03–6.61]; p = 0.03), presence or history of predisposing eye disease (HR = 4.42, CI:1.57–12.40), diabetes (HR = 3.33 [1.22–9.24]), and older age, as in >57 (HR, 6.40 [1.81–22.61]). An elevated incidence of cataracts was observed in patients after PCI for CTO. The onset of cataracts is related to the radiation dose during catheterization, which is a potentially avoidable effect of which operators should be aware.

scholarly journals Percutaneous Coronary Intervention in Chronic Total Occlusion - In Hospital Outcome

1970 ◽  
Vol 1 (2) ◽  
pp. 156-160
Author(s):  
N Kar ◽  
M Ullah ◽  
PK Karmakar ◽  
AEM Mazharul Islam ◽  
AQM Reza ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Chronic Stable Angina ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Hospital Outcome ◽  
Number Of Patients ◽  
Percutaneous Coronary ◽  
Cardiac Catheterizations

Background- Although a total coronary occlusion is identified approximately in one third of the diagnostic cardiac catheterizations, still an attempted revascularization of total occlusion accounts for less than 8% of all percutaneous coronary interventions (PCI). Percutaneous Coronary Intervention (PCI) of chronic total occlusion (CTO) is one of the major challenges in interventional cardiology. It is now an well-accepted revascularization procedure.  Methods: It was a prospective observational study conducted in National Institute of Cardiovascular Diseases, Dhaka, from July 2004 to June 2005. 50 consecutive patients with chronic total occlusion undergoing PCI were included in the study. Patients were observed during procedure and during the hospital stay. Result: The mean age of the patients was 46.7 ± 9.3 and 48.0% were in the age range of 45-54 years. 24 patients had post MI angina, 20 patients had chronic stable angina and 6 patients had unstable angina. Technical success was in 98% cases and procedural success was in 94% cases. One patient developed vessel perforation and was treated by prolonged balloon inflation. There was no death or STEMI and only 2 patients developed NSTEMI. Conclusion: In our study with the use of available facilities PCI in CTOs was possible with a high success rate. But dealing of more complicated lesion will require more improved technology and hardware. A study with larger number of patients and longer duration of follow up to determine the efficacy of the procedure in improving morbidity and mortality is needed. Keywords : Chronic total occlusion; Percutaneous Coronary Intervention; In hospital outcome DOI: http://dx.doi.org/10.3329/cardio.v1i2.8122 Cardiovasc. j. 2009; 1(2) : 156-160

scholarly journals Long-term prognosis of chronic total occlusion treated by successful percutaneous coronary intervention in patients with or without diabetes mellitus: a systematic review and meta-analysis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yong Zhu ◽  
Shuai Meng ◽  
Maolin Chen ◽  
Kesen Liu ◽  
Ruofei Jia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Long Term Prognosis

Abstract Background Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Therefore, the purpose of our study was to investigate the clinical outcomes of CTO-PCI in patients with or without DM. Methods All relevant articles published in electronic databases (PubMed, Embase, and the Cochrane Library) from inception to August 7, 2020 were identified with a comprehensive literature search. Additionally, we defined major adverse cardiac events (MACEs) as the primary endpoint and used risk ratios (RRs) with 95% confidence intervals (CIs) to express the pooled effects in this meta-analysis. Results Eleven studies consisting of 4238 DM patients and 5609 non-DM patients were included in our meta-analysis. For DM patients, successful CTO-PCI was associated with a significantly lower risk of MACEs (RR = 0.67, 95% CI 0.55–0.82, p = 0.0001), all-cause death (RR = 0.46, 95% CI 0.38–0.56, p < 0.00001), and cardiac death (RR = 0.35, 95% CI 0.26–0.48, p < 0.00001) than CTO-medical treatment (MT) alone; however, this does not apply to non-DM patients. Subsequently, the subgroup analysis also obtained consistent conclusions. In addition, our study also revealed that non-DM patients may suffer less risk from MACEs (RR = 1.26, 95% CI 1.02–1.56, p = 0.03) than DM patients after successful CTO-PCI, especially in the subgroup with a follow-up period of less than 3 years (RR = 1.43, 95% CI 1.22–1.67, p < 0.0001). Conclusions Compared with CTO-MT alone, successful CTO-PCI was found to be related to a better long-term prognosis in DM patients but not in non-DM patients. However, compared with non-DM patients, the risk of MACEs may be higher in DM patients after successful CTO-PCI in the drug-eluting stent era, especially during a follow-up period shorter than 3 years.

scholarly journals Patient Radiation Dose During Chronic Total Occlusion Percutaneous Coronary Intervention

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Evangelia Vemmou ◽  
Khaldoon Alaswad ◽  
Jaikirshan J. Khatri ◽  
Ilias Nikolakopoulos ◽  
Judit Karacsonyi ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radiation Dose ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Patient Radiation Dose

scholarly journals Scoring System for Identification of “Survival Advantage” after Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion

2020 ◽  
Vol 9 (5) ◽  
pp. 1319
Author(s):  
Tatsuya Nakachi ◽  
Shun Kohsaka ◽  
Masahisa Yamane ◽  
Toshiya Muramatsu ◽  
Atsunori Okamura ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Scoring System ◽  
Chronic Total Occlusion ◽  
Clinical Decision Making ◽  
Coronary Intervention ◽  
Survival Advantage ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
One Year

Background: Percutaneous coronary intervention (PCI) is widely used in patients with chronic total occlusion (CTO), but its benefit in improving long-term outcomes is controversial. We aimed to develop a prediction score for grading “survival advantage” conferred by successful results of CTO-PCI and a scoring system for prediction of the influence of CTO-PCI results on major adverse cardiac and cerebrovascular events (MACCEs). Methods: Follow-up data of 2625 patients who underwent CTO-PCI at 65 Japanese centers were analyzed. An integer scoring system was developed by including statistical effect modifiers on the association between successful CTO-PCI and one-year mortality. Results: Follow-up at 12 months was completed in 2034 patients. During follow-up, 76 deaths (3.7%) occurred. Patients with successful CTO-PCI had a better one-year survival than patients with failed CTO-PCI (log rank P = 0.016). Effect modifiers for the association between successful procedure and one-year mortality included diabetes (P interaction = 0.043), multivessel disease (P interaction = 0.175), Canadian Cardiovascular Society class ≥2 (P interaction = 0.088), and prior myocardial infarction (MI) (P interaction = 0.117). Each component was assigned a single point and summed to develop the scoring system. The patients were then categorized to specify the prediction of survival advantage by successful PCI: ≤2 (normal) and ≥3 (distinct). The differences in one-year mortality between patients with successful and failed treatment were −0.7% and 11.3% for normal and distinct score categories, respectively. In the scoring system for MACCE, score components were prior MI (P interaction = 0.19), left anterior descending artery (LAD)-CTO (P interaction = 0.079), and reattempt of CTO-PCI (P interaction = 0.18). The differences in one-year MACCEs between successful and failed patients for each score category (0, 1, and ≥2) were −1.7%, 7.5%, and 15.1%, respectively. Conclusions: The novel scoring system assessing the advantage of successful PCI can be easily applied in patients with CTO. It is a valid instrument for clinical decision-making while assessing the survival advantage of CTO-PCI and the influence of procedural results on MACCEs.

A two year echocardiographic follow-up of patients with chronic total occlusion treated with percutaneous coronary intervention or receiving only medical therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Juricic ◽  
O Petrovic ◽  
M Tesic ◽  
M Dobric ◽  
M Dikic ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Myocardial Function ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Time Intervals ◽  
Total Occlusion ◽  
Mechanical Dispersion ◽  
Percutaneous Coronary

Abstract Background Percutaneous coronary intervention of chronic total occlusion (PCI CTO) can reduce angina and the need for bypass surgery, however, it is still not clear how it effects the myocardial function. Conventional echocardiography is subjective and experience-dependent while tissue Doppler imaging together with strain imaging provides a more objective assessment of myocardial contractility. Purpose Our aim was to access the effectiveness of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) on myocardial function. Methods We compared two groups of patients. The first group of patients underwent PCI CTO with OMT while the second group of patients only received OMT (control group). The echocardiographic exam was performed before randomization and after 24 months of follow-up. Doppler time intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured from mitral inflow and left ventricular outflow Doppler tracings. Myocardial performance index (MPI) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral filling wave (E) was measured and divided by average peak early diastolic annular velocity (e'). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time interval from 17 left ventricular segments, reflecting myocardial contraction heterogeneity Results Comparing the groups at follow up, there was no significant change in ejection fraction (EF), diastolic function, and mechanical dispersion, however, there was improvement in GLS and MPI (Table 1). Conclusion Global longitudinal strain as a parameter of systolic function and Myocardial performance index as a parametar of global systolic and diastolic function are sensitive markers that can detect subtle improvement in myocardial function after recanalisation of CTO. Funding Acknowledgement Type of funding source: None

scholarly journals Relationship between lncRNA-Ang362 and prognosis of patients with coronary heart disease after percutaneous coronary intervention

2020 ◽  
Vol 40 (7) ◽  
Author(s):  
Hui Wang ◽  
Huichao Gong ◽  
Yingwu Liu ◽  
Limin Feng
Keyword(s):  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Quantitative Polymerase Chain Reaction ◽  
Coronary Intervention ◽  
Cox Regression Analysis ◽  
Percutaneous Coronary

Abstract The severity and complexity evaluation of coronary artery disease in patients with coronary heart disease (CHD) require objective and accurate prognosis indexes. We assessed the relationship between lncRNA-Ang362 and prognosis of CHD patients after percutaneous coronary intervention (PCI). Clinical follow-up data of CHD patients were prospectively collected. LncRNA-Ang362 levels were detected by real-time quantitative polymerase chain reaction. Survival rate was calculated by the Kaplan–Meier method, and risk ratios and 95% confidence intervals were computed using univariate and multivariate COX proportional hazard models. Finally, 434 patients were included in the follow-up cohort. The median follow-up time was 24.8 months (6.7–40). The incidence of adverse cardiovascular events was 13.6%. The high expression group significantly tended to be smoker and higher body mass index, low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, creatinine, and uric acid levels compared with the low expression group. According to the SYNTAX grade, the high-risk and medium-risk groups had significantly higher lncRNA expression levels than the low-risk group. The univariate COX regression analysis indicated that high lncRAN-Ang362 expression significantly increased the risk of adverse cardiovascular events in CHD patients after PCI (hazard risk (HR) = 3.19, 95% confidence interval (CI): 1.29–7.92). Multivariate analysis found high lncRNA-Ang362 expression was independently related to worse prognosis in CHD patients after PCI (HR = 2.83, 95%CI: 1.34–6.02). Plasma lncRNA-Ang362 may be a prognosis factor in CHD patients after PCI. The patients with higher lncRNA-Ang362 expression usually have poor prognosis.

scholarly journals Late Survival Benefit of Percutaneous Coronary Intervention Compared With Medical Therapy in Patients With Coronary Chronic Total Occlusion: A 10‐Year Follow‐Up Study

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Taek Kyu Park ◽  
Seung Hun Lee ◽  
Ki Hong Choi ◽  
Joo Myung Lee ◽  
Jeong Hoon Yang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Treatment Strategy ◽  
Initial Treatment ◽  
Cardiac Death ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Relative Reduction ◽  
Total Occlusion ◽  
Percutaneous Coronary

Background As an initial treatment strategy, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) did not show midterm survival benefits compared with optimal medical therapy (OMT). We sought to evaluate the benefit of PCI compared with OMT in patients with CTO over extended long‐term follow‐up. Methods and Results Between March 2003 and February 2012, 2024 patients with CTO were enrolled in a single‐center registry and followed for ≈10 years. We excluded patients with CTO who underwent coronary artery bypass graft (n=477) and classified patients into the CTO‐PCI group (n=883) or OMT group (n=664) according to initial treatment strategy. Patients with multivessel disease received PCI for obstructive non‐CTO lesions in both groups. In the CTO‐PCI group, 699 patients (79.2%) underwent successful revascularization. The CTO‐PCI group had a lower 10‐year rate of cardiac death (10.4% versus 22.3%; hazard ratio [HR], 0.44 [95% CI, 0.32–0.59]; P <0.001) than the OMT group. After propensity score matching analyses, the CTO‐PCI group had a lower 10‐year rate of cardiac death (13.6% versus 20.8%; HR, 0.64 [95% CI, 0.45–0.91]; P =0.01) than the OMT group. The relative reduction in cardiac death at 10 years was mainly driven by a relative reduction between 3 and 10 years (8.3% versus 16.6%; HR, 0.43 [95% CI, 0.27–0.71]; P <0.001) but not at 3 years (5.7% versus 5.0%; HR, 1.12 [95% CI, 0.63–2.00]; P =0.71). The beneficial effects of CTO‐PCI were consistent among subgroups. Conclusions As an initial treatment strategy, CTO‐PCI might reduce late cardiac death compared with OMT in patients with CTO. Extended follow‐up of randomized trials may confirm the findings of the present study.

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