Home

Patients who have a percutaneous coronary intervention (PCI) for chronic total occlusion following a coronary artery bypass graft (CABG) have worse outcomes than those without prior surgery, a meta-analysis published in JACC: Cardiovascular Interventions has found. The research was due to be presented at the now-cancelled American College of Cardiology’s Scientific Session Together with World Congress of Cardiology (ACC.20/WCC), which was scheduled to take place March 28–30 in Chicago, USA.

Michael Megaly (Minneapolis Heart Institute, Abbott Northwestern Hospital, and Hennepin Healthcare, Minneapolis, USA) et al recommend: “Given the higher complexity of CTO PCIs in prior CABG patients, these procedures should ideally be performed at experienced centres by seasoned CTO operators who can promptly treat complications should they arise.”

The authors conducted a meta-analysis of studies that compared in-hospital outcomes of CTO PCI between patients with and without prior CABG, calculating odds ratios (OR) or mean difference (MD) with 95% confidence intervals (CI). They compared categorical variables using the Chi-square test, and continuous variables using the two-sample t-test. Statistical heterogeneity was considered substantial for I² >50%, and considerable for I² >75%. Baseline characteristics and event rates were weighted according to sample size.

Four observational studies with a total of 8,131 patients (8,544 lesions) were included: 2,163 patients (2,236 lesions) had prior CABG and 5,968 patients (6,308 lesions) did not. Patients were enrolled between 1999 and 2018. Patients with previous bypass surgery were older (67.8±8.7 vs. 64.1±9.6 years, p<0.001), and had more comorbidities and more complex lesions (J-CTO score: 2.7±1.2 vs. 2±1.3, p<0.001). Their target CTO vessel was more likely to be the right coronary artery (RCA) (54.6% vs. 50.7%) or the circumflex artery (LCX) (26.8% vs. 19.2%, p<0.001). They were more likely to undergo retrograde CTO crossing attempts (34.7% vs. 21.9%, p<0.001).

The analysis found that prior CABG was associated with lower technical success (80.7% vs. 86.5%, OR for procedural failure 1.66, 95% CI 1.42–1.94, p<0.001, I² 24%), longer fluoroscopy time (MD 16.9 minutes, 95% CI 10.3–23.7, p<0.001, I² 95%), and higher contrast use (MD 16.4ml, 95% CI 7.5–25.3, p<0.001, I² 49%). Prior CABG patients had a higher incidence of in-hospital mortality (0.8% vs. 0.3%; OR 2.77, 95% CI 1.43–5.39, p=0.003, I² 0%), coronary perforation (7.3% vs. 4.9%; OR 2.07, 95% CI 1.49–2.86, p<0.001, I²50%), and myocardial infarction (1.4% vs. 0.5%, OR 2.46, 95% CI 1.46–4.15, p<0.001, I² 1%), but a lower incidence of cardiac tamponade (0.1% vs. 0.8%; OR 0.19, 95% CI 0.04–0.87, p=0.03, I² 11%) compared to those without prior CABG. Both groups had a similar incidence of acute cerebrovascular events (0.3% vs. 0.3%, OR 1.51, 95% CI 0.49–4.66, p=0.47, I² 15%) and vascular complications (1.7% vs. 1.2%, OR 1.39, 95% CI 0.84–2.31, p=0.2, I² 0%).

Megaly and colleagues suggest that older age, more comorbidities and more complex lesions may explain the worse outcomes in prior CABG patients, adding: “CTOs in bypassed vessels were more calcified, leading to a higher risk of procedural failure. CTO crossing in prior CABG patients often required the use of the retrograde approach which could be associated with worse outcomes.” They acknowledge that the study was limited by the small number and observational nature of the included studies, but say that the findings have implications for clinical practice.

“In patients with multivessel disease, ensuring that lesions need bypass via invasive physiological or imaging assessment is strongly recommended. Because the longevity of saphenous venous grafts is not guaranteed, CTO PCI of the native vessel might be unavoidable, and is associated with worse outcomes. A consideration of full arterial grafts, or upfront PCI to the native RCA or LCX in combination with arterial grafting of the left anterior descending artery might be favourable solutions, and should be further studied.”

Source CardiovascularNews

Duc Tin Clinic

Chia sẽ qua facebook bài: PCI for chronic total occlusion less successful after bypass surgery

Chia sẽ qua google bài: PCI for chronic total occlusion less successful after bypass surgery

Chia sẽ qua twitter bài: PCI for chronic total occlusion less successful after bypass surgery

Chia sẽ qua MySpace bài: PCI for chronic total occlusion less successful after bypass surgery

Chia sẽ qua LinkedIn bài: PCI for chronic total occlusion less successful after bypass surgery

Chia sẽ qua stumbleupon bài: PCI for chronic total occlusion less successful after bypass surgery

Chia sẽ qua icio bài: PCI for chronic total occlusion less successful after bypass surgery

Chia sẽ qua digg bài: PCI for chronic total occlusion less successful after bypass surgery

Chia sẽ qua yahoo bài: PCI for chronic total occlusion less successful after bypass surgery

Tin tức liên quan

Enrolment reaches midway point in trial of Early Bird bleed monitoring system

Eight-fold increased risk of heart attack seen in patients with subclinical obstructive coronary atherosclerosis

ACC 2023: REVIVED-BCIS-2 results challenge “long-held beliefs” on myocardial viability testing prior to PCI

Blood pressure successfully cut in RADIANCE II ultrasound renal denervation trial

New data examine mortality rates and cardiac damage in early-stage aortic stenosis patients

SUPPORT CONSULTANT

Make an Appointment

I am Nguyen Thanh Sang, born in 1990. Since the examination and treatment at the clinic Duc Tin, I am very grateful to the Doctor for explaining and sharing about my illness. During the treatment time in the clinic I was very caring staff of the clinic. Now my illness has improved in a good way. Expect more and more clinic to be able to save many patients.

I sincerely thank you !. Tel: 0938303275

Huynh Thi Muoi, born in 1940, was examined and treated at Duc Tin Clinic. I am very pleased about how to serve and care patients of the clinic. The doctor is committed to explaining and sharing with the patient.

Huynh Thi Muoi sincerely thank you! Phone number: 0972868746

As I said Duc Tin surgical clinin is where my family trust, hope to visit. Physicians caring, thoughtful, gentle to the patient. Nurses and staff clinic polite, cheerful and thoughtful. This clinic clean, sterile, so I would love to. Tel: +84949914060.

The doctor is very caring, attentive and very gentle nurse, courteous, affable with me. The clinic is clean, comfortable, polite. I enjoyed this faith. Every visit I was very relieved disease. Tel: 0839820792.

I was patient, had to clinics of Dr. Le Duc Tin. I see very conscientious doctor patient care, answer any questions and very dedicated staff from the receptionist to the children tested, nursing. Clinics very clean and spacious. I'm very satisfied. Tel: +841227880829.