3.Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease.
Wei LIU ; Chang-sheng MA ; Jun-ping KANG ; Xin DU ; Fang CHEN ; Yu-jie ZHOU ; Shu-zheng LÜ ; Fang-jiong HUANG ; Cheng-xiong GU ; Xiao-ling ZHU
Chinese Medical Journal 2011;124(8):1169-1174
BACKGROUNDIn patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG) in the patients with CTO and multivessel disease.
METHODSFrom a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n = 679) or DES (n = 267) treatment. Their propensity risk score was used for adjusting baseline differences.
RESULTSAt a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95%CI 1.219 - 3.179, P = 0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95%CI 5.739 - 45.391, P < 0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.
CONCLUSIONSOur study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.
Angioplasty, Balloon, Coronary ; methods ; Chronic Disease ; Coronary Angiography ; Coronary Artery Bypass ; methods ; Coronary Artery Disease ; surgery ; therapy ; Coronary Occlusion ; surgery ; therapy ; Drug-Eluting Stents ; Humans ; Prospective Studies
4.Effect of complete percutaneous revascularization on improving long-term outcomes of patients with chronic total occlusion and multi-vessel disease.
Zeya LI ; Ziru ZHOU ; Lei GUO ; Lei ZHONG ; Jingnan XIAO ; Shaoke MENG ; Yingdong WANG ; Huaiyu DING ; Bo ZHANG ; Hao ZHU ; Xuchen ZHOU ; Rongchong HUANG
Chinese Medical Journal 2023;136(8):959-966
BACKGROUND:
Limited data are available on the comparison of clinical outcomes of complete vs. incomplete percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) and multi-vessel disease (MVD). The study aimed to compare their clinical outcomes.
METHODS:
A total of 558 patients with CTO and MVD were divided into the optimal medical treatment (OMT) group ( n = 86), incomplete PCI group ( n = 327), and complete PCI group ( n = 145). Propensity score matching (PSM) was performed between the complete and incomplete PCI groups as sensitivity analysis. The primary outcome was defined as the occurrence of major adverse cardiovascular events (MACEs), and unstable angina was defined as the secondary outcome.
RESULTS:
At a median follow-up of 21 months, there were statistical differences among the OMT, incomplete PCI, and complete PCI groups in the rates of MACEs (43.0% [37/86] vs. 30.6% [100/327] vs. 20.0% [29/145], respectively, P = 0.016) and unstable angina (24.4% [21/86] vs. 19.3% [63/327] vs. 10.3% [15/145], respectively, P = 0.010). Complete PCI was associated with lower MACE compared with OMT (adjusted hazard ratio [HR] = 2.00; 95% confidence interval [CI] = 1.23-3.27; P = 0.005) or incomplete PCI (adjusted HR = 1.58; 95% CI = 1.04-2.39; P = 0.031). Sensitivity analysis of PSM showed similar results to the above on the rates of MACEs between complete PCI and incomplete PCI groups (20.5% [25/122] vs. 32.6% [62/190], respectively; adjusted HR = 0.55; 95% CI = 0.32-0.96; P = 0.035) and unstable angina (10.7% [13/122] vs. 20.5% [39/190], respectively; adjusted HR = 0.48; 95% CI = 0.24-0.99; P = 0.046).
CONCLUSIONS
For treatment of CTO and MVD, complete PCI reduced the long-term risk of MACEs and unstable angina, as compared with incomplete PCI and OMT. Complete PCI in both CTO and non-CTO lesions can potentially improve the prognosis of patients with CTO and MVD.
Humans
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Treatment Outcome
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Percutaneous Coronary Intervention/methods*
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Coronary Occlusion/surgery*
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Prognosis
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Angina, Unstable/surgery*
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Chronic Disease
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Risk Factors
5.Atypical Coronary Occlusion in a Patient with ST-Elevation Myocardial Infarction Caused by a Masked Aortic Dissection.
Byoung Won PARK ; Dae Chul SEO ; In Ki MOON ; Jin Wook CHUNG ; Duk Won BANG ; Min Su HYON ; Won Ho CHANG
Korean Journal of Medicine 2013;85(5):516-520
ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.
Aorta
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Atherosclerosis
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Chest Pain
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Coronary Occlusion*
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Coronary Vessels
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Diagnosis
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Emergencies
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General Surgery
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Humans
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Masks*
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Myocardial Infarction*
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Myocardial Revascularization
6.Atypical Coronary Occlusion in a Patient with ST-Elevation Myocardial Infarction Caused by a Masked Aortic Dissection.
Byoung Won PARK ; Dae Chul SEO ; In Ki MOON ; Jin Wook CHUNG ; Duk Won BANG ; Min Su HYON ; Won Ho CHANG
Korean Journal of Medicine 2013;85(5):516-520
ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.
Aorta
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Atherosclerosis
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Chest Pain
;
Coronary Occlusion*
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Coronary Vessels
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Diagnosis
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Emergencies
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General Surgery
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Humans
;
Masks*
;
Myocardial Infarction*
;
Myocardial Revascularization
7.Long-term outcome of patients undergoing recanalization procedures for chronic total coronary occlusion.
Jing-Jing GAI ; Lu-Yue GAI ; Xue ZHAI ; Kai-Yi ZHANG ; Qin-Hua JIN ; Yun-Dai CHEN
Journal of Southern Medical University 2015;35(10):1380-1383
OBJECTIVETo compare the long-term outcomes of patients receiving percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy for treatment of chronic total coronary occlusion (CTO).
METHODSThe patients with CTO were selected from a consecutive cohort of patients who underwent coronary angiography (CAG) between 2008 and 2009. The patients with multiple CAG were excluded. The patients received treatments with PCI, CABG, or conservative medication therapy and were followed for major adverse cardiovascular events (MACE) within 5 years.
RESULTSA total of 253 patients were enrolled in this study, including 192 receiving PCI, 48 receiving CABG, and 13 treated conservatively with medications. The baseline clinical characteristics were similar among the 3 groups except for increased low-density lipoprotein (LDL) and total cholesterol (TC) in the medication group, and increased Syndax score in CABG group. During the follow-up, the incidences of MACE, AMI, death, stroke or heart failure did not differ significantly among the 3 groups (P>0.05). However, CABG group showed a higher incidence of the stroke than the other two groups although this difference did not reach a statistically significantly level (P=0.06).
CONCLUSIONOur study did not demonstrate that recanalization offers greater long-term benefits than medications for treatment of CTO, and the patients receiving CABG appeared to have a higher incidence of stroke.
Chronic Disease ; Cohort Studies ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Occlusion ; surgery ; therapy ; Humans ; Incidence ; Percutaneous Coronary Intervention ; Stroke ; epidemiology ; Treatment Outcome
8.Sixty-four cases of percutaneous coronary angioplasty on saphenous vein bypass grafts.
Zhi-zhong LI ; L SIDNEY ; C P JUERGENS ; Xiao-ling ZHU ; Ying TAO ; Tong LIU ; Su WANG ; Yong LI
Chinese Journal of Cardiology 2005;33(3):221-223
OBJECTIVETo evaluate the early clinical result of percutaneous transluminal coronary intervention (PCI) and stenting on saphenous vein grafts.
METHODSPercutaneous intervention was performed in 91 saphenous vein grafts in 64 patients. The data of clinical results during operation and hospitalization and that of other interventional assisting device were recorded in database and were analyzed.
RESULTSThe success rate of operation was 95.3%, non-Q wave myocardial infarction occurred in 1 patient (1.6%) and temporary no-reflow phenomenon occurred in 4 patients (6.3%) during operation. Reduced antegrade flow and ventricular fibrillation happened in 1 patient after stenting and normal antegrade flow obtained after cardiac compression and tracheal intubation and insertion of IABP. The distal protection devices were used in 7 patients (10.9%), X-sizer extraction system in 4 patients. Platelet glycoprotein IIb/IIIa receptor blockers were administered in 25 patients (35.9%). Non-Q wave myocardial infarction occurred in two cases, the incidence of major adverse clinical event was 3.1% during the period of hospitalization.
CONCLUSIONSThe instant success rate of PTCA and stenting of saphenous vein bypass grafts is high and recent clinical result is promising, but the middle and long term results remain to be further followed. The use of distal embolic protection device and GPIIb/IIIa receptor blockers may improve its prognosis.
Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Graft Occlusion, Vascular ; surgery ; Humans ; Male ; Middle Aged ; Platelet Glycoprotein GPIIb-IIIa Complex ; antagonists & inhibitors ; Saphenous Vein ; surgery ; Treatment Outcome
9.A case report of very late thrombosis in two sirolimus-eluting stents.
Chinese Journal of Cardiology 2010;38(12):1131-1134
10.One-year Outcomes in Patients with ST-segment Elevation Myocardial Infarction Caused by Unprotected Left Main Coronary Artery Occlusion Treated by Primary Percutaneous Coronary Intervention.
Hai-Wei LIU ; Ya-Ling HAN ; Quan-Min JIN ; Xiao-Zeng WANG ; Ying-Yan MA ; Geng WANG ; Bin WANG ; Kai XU ; Yi LI ; Shao-Liang CHEN
Chinese Medical Journal 2018;131(12):1412-1419
BackgroundVery few data have been reported for ST-segment elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention (PCI). The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion.
MethodsFrom January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion (ULMCA-STEMI) who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI (NSTEMI) caused by ULMCA lesion (ULMCA-NSTEMI) who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events (MACEs) in-hospital, at 1 month, and at 1 year.
ResultsCompared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥III (21.2% vs. 3.5%, χ = 36.253, P < 0.001) and cardiac arrest (8.3% vs. 3.5%, χ = 5.529, P = 0.019). For both groups, the proportions of one-year cardiac death in the patients with a post-procedure thrombolysis in myocardial infarction (TIMI) flow grade<3 were significantly higher than those in the patients with a TIMI flow grade of 3 (STEMI group: 51.7% [15/29] vs. 4.1% [14/343], P < 0.001; NSTEMI group: 33.3% [3/9] vs. 13.6% [3/221], P = 0.001; respectively]. Landmark analysis showed that the patients in STEMI group were associated with higher risks of MACE (16.7% vs. 9.1%, P = 0.009) and cardiac death (5.4% vs. 1.3%, P = 0.011) compared with NSTEMI patients at 1 month. Meanwhile, in patients with ULMCA, the landmark analysis for incidences of MACE and cardiac death was similar between the STEMI and NSTEMI (all P = 0.72) in the intervals of 1-12 months. However, patients who were diagnosed with STEMI or NSTEMI had no significant difference in reinfarction (all P > 0.05) and TVR (all P > 0.05) in the intervals of 0-1 month as well as 1 month to 1 year. The results of Cox regression analysis showed that the differences in the independent predictors for MACE included the variables of Killip class ≥ III and intra-aortic balloon pump support for the STEMI patients and the variables of previous MI, ULMCA distal bifurcation, and 2-stent for distal ULMCA lesions for the NSTEMI patients.
ConclusionsCompared to the NSTEMI patients, the patients with STEMI and ULMCA lesions still remain at a much higher risk for adverse events at 1 year, especially on 1 month. If a successful PCI procedure is performed, the 1-year outcomes in those patients might improve.
Aged ; Coronary Occlusion ; pathology ; surgery ; Coronary Vessels ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; pathology ; surgery ; Percutaneous Coronary Intervention ; methods ; Retrospective Studies ; Risk Factors ; ST Elevation Myocardial Infarction ; pathology ; surgery ; Treatment Outcome