Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 42
Filter
1.
Clin Res Cardiol ; 108(2): 175-184, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30051181

ABSTRACT

AIMS: Percutaneous coronary intervention (PCI) of unprotected distal left main stenosis (UDLM) is increasingly performed as an alternative to surgical treatment. The optimal strategy for stenting in this setting is still a matter of debate. Therefore, this analysis investigated the long-term clinical outcome of a single- versus a double-stenting strategy for treatment of UDLM. METHODS AND RESULTS: From a large registry, 867 consecutive patients with UDLM undergoing either single or double stenting with drug-eluting stents (DES) were identified. Follow-up was up to 10 (median 3.1, interquartile range 1.1-5.3) years. Primary endpoint was MACE consisting of all-cause death, myocardial infarction, or target lesion re-intervention (TLR). Secondary clinical endpoints included these single endpoints and stent thrombosis. MACE occurred in 41.5% after single and in 49.0% after double stenting (P = 0.03). TLR was lower after single (17.4%) as compared to double stenting (27.2%; P < 0.01). Between single and double stenting, there were no significant differences for death (26.4 versus 23.3%; P = 0.31), death or myocardial infarction (29.1 versus 27.2%; P = 0.55), or definite/probable stent thrombosis (1.3 versus 2.1%; P = 0.42). CONCLUSIONS: Compared with single stenting, double stenting was associated with a significantly higher long-term risk of MACE. This was driven by a higher incidence of TLR, whereas the risk of death, MI, or stent thrombosis was similar between the two strategies.


Subject(s)
Coronary Stenosis/surgery , Coronary Vessels/surgery , Drug-Eluting Stents , Percutaneous Coronary Intervention/methods , Registries , Aged , Cause of Death/trends , Coronary Angiography , Coronary Stenosis/diagnosis , Coronary Stenosis/mortality , Coronary Vessels/diagnostic imaging , Female , Follow-Up Studies , Germany/epidemiology , Humans , Male , Prognosis , Retrospective Studies , Risk Factors , Survival Rate/trends , Time Factors , Treatment Outcome
2.
JACC Cardiovasc Interv ; 11(19): 1982-1991, 2018 10 08.
Article in English | MEDLINE | ID: mdl-30219327

ABSTRACT

OBJECTIVES: The aim of this study was to investigate whether percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) improves left ventricular function. BACKGROUND: The benefit of PCI in CTOs is still controversial. METHODS: Patients with CTOs who were candidates for PCI were eligible for the study and were randomized to PCI or no PCI of CTO. Relevant coexisting non-CTO lesions were treated as indicated. Patients underwent cardiac magnetic resonance imaging at baseline and at 6 months. The primary endpoint was the change in segmental wall thickening (SWT) in the CTO territory. Secondary endpoints were improvement of regional wall motion and changes in left ventricular volumes and ejection fraction. Furthermore, major adverse coronary events after 12 months were assessed. RESULTS: The CTO PCI group comprised 101 patients and the no CTO PCI group 104 patients. The change in SWT did not differ between the CTO PCI (4.1% [interquartile range: 14.6 to 19.3]) and no CTO PCI (6.0% [interquartile range: 8.6 to 6.0]) groups (p = 0.57). Similar results were obtained for other indexes of regional and global left ventricular function. Subgroup analysis revealed that only in patients without major non-CTO lesions (basal SYNTAX [Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery] score ≤13) CTO PCI was associated with larger improvement in SWT than no CTO PCI (p for interaction = 0.002). Driven by repeat intervention, major adverse coronary event rates at 12 months were significantly lower in the CTO PCI group (16.3% vs. 5.9%; p = 0.02). CONCLUSIONS: No benefit was seen for CTO PCI in terms of the primary endpoint, SWT, or other indexes of left ventricular function. CTO PCI resulted in clinical benefit over no CTO PCI, as evidenced by reduced major adverse coronary event rates at 12 months.


Subject(s)
Coronary Occlusion/therapy , Percutaneous Coronary Intervention/instrumentation , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left , Aged , Chronic Disease , Coronary Angiography , Coronary Occlusion/diagnostic imaging , Coronary Occlusion/physiopathology , Female , Humans , Magnetic Resonance Imaging, Cine , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Prospective Studies , Recovery of Function , Risk Factors , Time Factors , Treatment Outcome , Ventricular Dysfunction, Left/diagnostic imaging
3.
JACC Cardiovasc Interv ; 11(12): 1164-1171, 2018 06 25.
Article in English | MEDLINE | ID: mdl-29929639

ABSTRACT

OBJECTIVES: The aim of this study was to investigate medium-term outcomes in patients with leaflet thrombosis (LT). BACKGROUND: The clinical significance of early LT after transcatheter aortic valve replacement, diagnosed by computed tomography angiography in approximately 10% of patients, is uncertain. METHODS: In this observational study, computed tomographic angiography was performed a median of 5 days after transcatheter aortic valve replacement and assessed for evidence of LT. Follow-up consisted of clinical visits, telephone contact, or questionnaire. RESULTS: LT was diagnosed in 120 of 754 patients (15.9%). Patients with LT were less likely male (36.7% vs. 47.0%, p = 0.045), with a lower rate of atrial fibrillation (28.3% vs. 41.5%, p = 0.008). Peri- and post-procedural characteristics were comparable between groups (e.g., valve implantation technique; p = 0.116). During a median follow-up period of 406 days, there were no significant differences in the primary endpoint of all-cause mortality and the secondary combined endpoint of stroke and transient ischemic attack between patients with LT and those without LT (18-month Kaplan-Meier estimate for mortality 86.6% vs. 85.4%, p = 0.912; for stroke- or transient ischemic attack-free survival 98.5% vs. 96.8%, p = 0.331). In univariate and multivariate analyses, LT was not predictive of either endpoint, whereas male sex (p = 0.03), atrial fibrillation (p = 0.002), and more than mild paravalvular leak (p = 0.015) were associated with all-cause mortality. CONCLUSIONS: In this prospective observational cohort undergoing post-transcatheter aortic valve replacement computed tomographic angiography, LT was not associated with increased mortality or rates of stroke over a follow-up period of 406 days.


Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Thrombosis/etiology , Transcatheter Aortic Valve Replacement/adverse effects , Aged , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve Stenosis/diagnostic imaging , Computed Tomography Angiography , Female , Heart Valve Prosthesis , Humans , Ischemic Attack, Transient/etiology , Male , Prospective Studies , Risk Factors , Stroke/etiology , Thrombosis/diagnostic imaging , Thrombosis/mortality , Time Factors , Transcatheter Aortic Valve Replacement/instrumentation , Transcatheter Aortic Valve Replacement/mortality , Treatment Outcome
5.
Eur J Cardiothorac Surg ; 53(4): 778-783, 2018 04 01.
Article in English | MEDLINE | ID: mdl-29309547

ABSTRACT

OBJECTIVES: The aim of this study was to investigate whether balloon-expandable and self-expandable transcatheter heart valves (THVs) differ in terms of the incidence of early subclinical leaflet thrombosis (LT). METHODS: Electrocardiographic-gated cardiac dual-source computed tomography angiography was performed at a median of 5 days after transcatheter aortic valve implantation and assessed for evidence of LT. RESULTS: Of the 629 consecutive patients, 538 (86%) received a balloon-expandable THV and 91 (14%) a self-expandable THV. LT was documented in 77 (14%) patients with a balloon-expandable valve and in 16 (18%) with a self-expandable valve (P = 0.42). Similarly, LT was not significantly related to THV size (P = 0.62). Corresponding to a lower rate of atrial fibrillation in the group with LT [25 (27%) vs 222 (41%), P = 0.01], anticoagulation at the time of computed tomography angiography was less frequent in this group [21 (23%) vs 183 (34%), P = 0.03]. Among the other potentially relevant covariables, there was no significant difference in the clinical baseline and the procedural characteristics between patients with and without LT (age 82 ± 6 years vs 82 ± 6 years, P = 0.51; ejection fraction 49 ± 10% vs 50 ± 10%, P = 0.47). In multivariate logistic regression analysis, including potentially relevant covariables, valve type was not significantly associated with LT (P = 0.36). In the univariate and multivariate analyses, only the lack of anticoagulation at the time of computed tomography angiography was predictive of thrombus formation [0.563 (0.335-0.944), P = 0.03; 0.576 (0.343-0.970), P = 0.04]. CONCLUSIONS: In this large retrospective study of 629 patients, the type and the size of THV was not predictive of early LT.


Subject(s)
Heart Valve Prosthesis/adverse effects , Thrombosis/etiology , Transcatheter Aortic Valve Replacement/adverse effects , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Balloon Valvuloplasty/adverse effects , Computed Tomography Angiography , Echocardiography , Humans , Incidence , Male , Retrospective Studies , Thrombosis/epidemiology , Transcatheter Aortic Valve Replacement/instrumentation
6.
Clin Res Cardiol ; 107(6): 449-459, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29356881

ABSTRACT

OBJECTIVE: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has undergone impressive progress during the last decade, both in strategies and equipment. It is unknown whether technical refinement has translated into improved outcomes in women undergoing CTO-PCI. METHOD AND RESULTS: A total of 2002 consecutive patients (17% females, mean age 65.2 ± 10.7 years) undergoing PCI of at least one CTO lesion at our center between 01/2005 and 12/2013 were evaluated. The incidence of adverse events was compared between two time series (2005-2009 and 2010-2013). A significant increase in adverse lesion characteristics over time was noted in both, women and men (p < 0.001), while technical success rates significantly increased in men but not in women (ptrend < 0.001 in men and ptrend=0.9 in women). The incidence of procedural complications was significantly higher in women as compared to men and increased over the study period in women (p < 0.05) but not in men. Accordingly, multivariate logistic regression analysis identified female sex as a strong predictor of PCI-related complications in recent years, while this was not the case in earlier years (adjusted HR 2.03, 95% CI 0.62-6.6, p = 0.2 and adjusted HR 4.7, 95% CI 1.8-12.3, p = 0.002, respectively, p < 0.001 for log LH ratio). In addition, major adverse cardiovascular events (MACE) after a 3-year follow-up significantly declined in men (log rank = 0.046), while no changes were observed in women. CONCLUSION: While higher success rates and a reduced rate of MACE have been achieved in men, the incidence of procedural complications in women undergoing CTO-PCI has increased over time.


Subject(s)
Coronary Occlusion/diagnosis , Percutaneous Coronary Intervention/adverse effects , Postoperative Complications/epidemiology , Registries , Aged , Chronic Disease , Coronary Angiography , Coronary Occlusion/epidemiology , Coronary Occlusion/surgery , Female , Follow-Up Studies , Germany/epidemiology , Humans , Incidence , Magnetic Resonance Imaging, Cine , Male , Middle Aged , Postoperative Complications/diagnosis , Retrospective Studies , Sex Distribution , Sex Factors , Time Factors
7.
EuroIntervention ; 13(17): 2051-2059, 2018 04 20.
Article in English | MEDLINE | ID: mdl-28943496

ABSTRACT

AIMS: Periprocedural myocardial injury (PMI) is frequently observed after percutaneous coronary interventions (PCI) for chronic total occlusion (CTO). We aimed to investigate the prognostic impact of PMI with the antegrade as compared to the retrograde crossing technique. METHODS AND RESULTS: A total of 1,909 patients undergoing CTO PCI were stratified according to the presence/absence of PMI (elevation of cardiac troponin T [cTnT] >5x99th percentile of normal), and divided according to tertiles of the difference between peak and baseline cTnT within 24 hours (∆cTnT). The primary endpoint was all-cause mortality at a median follow-up of 3.1 (interquartile range 3.0-4.4) years. PMI occurred in 19.4% and 25.4% after antegrade (n=1,447) and retrograde (n=462) procedures (p<0.001). PMI was significantly associated with mortality after antegrade (adjusted HR 1.39, 95% CI: 1.02-1.88, p=0.04), but not retrograde CTO PCI (adjusted HR 0.93, 95% CI: 0.53-1.63, p=0.80, pint=0.02). With the antegrade, but not with the retrograde approach, mortality also increased with tertiles of ∆cTnT (T1: 11.0%, T2: 18.6%, T3: 21.6%, log-rank p<0.001). CONCLUSIONS: Periprocedural myocardial injury was significantly associated with all-cause mortality following antegrade, but not retrograde CTO PCI. Hence, the higher risk of PMI following retrograde procedures did not translate into worse survival.


Subject(s)
Myocardium/pathology , Percutaneous Coronary Intervention , Postoperative Complications , Aged , Coronary Angiography/methods , Coronary Occlusion/diagnosis , Coronary Occlusion/surgery , Female , Germany/epidemiology , Humans , Magnetic Resonance Imaging, Cine/methods , Male , Middle Aged , Outcome Assessment, Health Care , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/mortality , Perfusion Imaging/methods , Postoperative Complications/etiology , Postoperative Complications/pathology , Prognosis , Registries/statistics & numerical data , Risk Assessment , Risk Factors
8.
Catheter Cardiovasc Interv ; 91(4): 669-678, 2018 03 01.
Article in English | MEDLINE | ID: mdl-28795482

ABSTRACT

AIM: The prognostic value of coronary artery dominance pattern in patients with chronic total occlusions (CTO) is unknown. The aim of this study was to assess the influence of coronary vessel dominance on short and long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) for CTO. METHODS AND RESULTS: Our study population consisted of 2002 consecutive patients (17% females, mean age 65.2 ± 10.7 years) who underwent PCI of at least one coronary CTO lesion at our center between 01/2005 and 12/2013. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left, right, and balanced coronary dominance. Right coronary dominance (RD) was present in 88% (n = 1759), left coronary dominance (LD) in 7% (n = 136), and balanced coronary dominance (BD) in 5% (n = 107) of the study population. After a median follow-up duration of 2.6 years [interquartile range 1.1-3.1 years] all-cause mortality was significantly higher in patients with LD as compared with RD and BD (log rank = 0.001). Accordingly, the presence of a LD system was identified as a significant predictor for all-cause mortality (adjusted HR 1.7, 95% CI: 1.2-2.6, P = .007) and major adverse cardiac events (MACE) (adjusted HR 1.4, 95% CI: 1.1-1.8, P = 0.02). CONCLUSION: Our data suggest that LD is an independent predictor of increased all-cause death and MACE in patients with CTO. Therefore, assessment of coronary vessel dominance by angiography may contribute to risk stratification in these patients.


Subject(s)
Coronary Artery Disease/surgery , Coronary Occlusion/surgery , Coronary Vessels/surgery , Percutaneous Coronary Intervention , Aged , Chronic Disease , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/mortality , Coronary Occlusion/diagnostic imaging , Coronary Occlusion/mortality , Coronary Vessels/diagnostic imaging , Databases, Factual , Female , Humans , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Postoperative Complications/etiology , Progression-Free Survival , Retrospective Studies , Risk Factors , Time Factors
9.
Catheter Cardiovasc Interv ; 91(2): 226-233, 2018 02 01.
Article in English | MEDLINE | ID: mdl-29130613

ABSTRACT

OBJECTIVES: A single-centre, observational study was performed in order to investigate the relationship between anemia and outcomes after percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). BACKGROUND: Anemia has been identified as adverse predictor in patients with coronary artery disease undergoing coronary revascularization. Data on the impact of anemia on outcomes in patients undergoing PCI for CTO lesions are lacking. METHODS: A total of 1,964 patients undergoing CTO PCI were stratified according to the presence/absence of anemia (hemoglobin of <13 g/dl for men and <12 g/dl for women). The primary endpoint was all-cause mortality. Median follow-up was 2.6 (interquartile range 1.1-3.1) years. RESULTS: Of the 1,964 patients, 297 (15.1%) had anemia. Anemic as compared to nonanemic patients had and an increased all-cause mortality (27.9% versus 9.1%, P < 0.001), and associations remained significant after multivariable adjustments (adjusted HR 2.26, 95% CI 1.71-2.98, P < 0.001). All-cause mortality decreased with increasing hemoglobin tertiles (T1: 18.6%, T2: 8.6%, T3: 8.2%, log rank P < 0.001). Procedural success was associated with reduced all-cause mortality both in anemic (21.8% versus 47.2%, adjusted HR 0.59, 95% CI 0.37-0.93, P = 0.02) and nonanemic patients (7.8% versus 16.3%, adjusted HR 0.64, 95% CI 0.42-0.98, P = 0.02, interaction P = 0.69). CONCLUSIONS: Although anemia is associated with an increased all-cause mortality in patients undergoing CTO PCI, the survival benefit associated with successful CTO recanalization is maintained.


Subject(s)
Anemia/complications , Coronary Occlusion/surgery , Percutaneous Coronary Intervention , Aged , Anemia/blood , Anemia/diagnosis , Anemia/mortality , Biomarkers/blood , Coronary Angiography , Coronary Occlusion/complications , Coronary Occlusion/diagnostic imaging , Coronary Occlusion/mortality , Female , Germany , Hemoglobins/metabolism , Humans , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome
10.
Catheter Cardiovasc Interv ; 91(6): E56-E63, 2018 05 01.
Article in English | MEDLINE | ID: mdl-29105984

ABSTRACT

OBJECTIVES: We sought to assess angiographic, echocardiographic and hemodynamic grading of paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI) with respect to prediction of 1-year mortality. BACKGROUND: Meaningful criteria for the severity of PVL are needed to allow intraprocedural guidance and patient management after TAVI. METHODS: We pooled the prospective TAVI databases of 2 German centers. During TAVI, PVL was assessed angiographically and by the aortic regurgitation index (ARI). ARI was calculated as ratio of the gradient between diastolic blood pressure and left ventricular end-diastolic pressure to systolic blood pressure times hundred. In addition, we performed transthoracic echocardiography before discharge. RESULTS: A total of 723 patients undergoing TAVI with self-expandable (20.9%) or balloon-expandable (79.1%) valves were included. Grades of PVL as assessed during the procedure by angiography or ARI (below the previously defined cut-off of 25) did not show a significant association with 1-year mortality (P = 0.312 and 0.776, respectively). One-year mortality was 15.7% (39/249) in patienths with an ARI < 25 and 16.5% (71/430) in patients with an ARI ≥ 25. Echocardiographic classes of PVL at discharge showed a significant (P = 0.029) association with 1-year mortality, which was 11.5% (37/322) in patients with no/trace PVL, 18.0% (62/345) in patients with mild PVL and 23.1% (6/26) in patients with more than mild PVL. These findings prevailed after multivariable adjustment. CONCLUSIONS: ARI did not help identify PVLs that are relevant to 1-year survival. Angiographic assessment during the procedure was less predictive than echocardiographic assessment before discharge.


Subject(s)
Angiography , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Echocardiography , Hemodynamics , Transcatheter Aortic Valve Replacement/adverse effects , Aged , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Insufficiency/mortality , Aortic Valve Insufficiency/physiopathology , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/physiopathology , Balloon Valvuloplasty , Databases, Factual , Female , Germany/epidemiology , Heart Valve Prosthesis , Humans , Incidence , Male , Predictive Value of Tests , Prosthesis Design , Reproducibility of Results , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Transcatheter Aortic Valve Replacement/instrumentation , Transcatheter Aortic Valve Replacement/mortality , Treatment Outcome
11.
Clin Res Cardiol ; 107(3): 259-267, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29134346

ABSTRACT

BACKGROUND: Chronic kidney disease (CKD) adversely affects outcomes in patients with coronary artery disease. Data on the impact of renal impairment on prognosis of patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) are scarce. METHODS: A total of 2002 patients undergoing CTO PCI were stratified according to baseline renal function (group 1: estimated glomerular filtration rate [eGFR] ≥ 90 ml/min/1.73 m2, group 2: 60 to 89 ml/min/1.73 m2, group 3: 30 to 59 ml/min/1.73 m2, and group 4: <30 ml/min/1.73 m2). The primary outcome measure was all-cause mortality at a median follow-up of 2.6 (interquartile range 1.1-3.1) years. RESULTS: All-cause mortality increased with decreasing renal function (group 1: 5.0%, group 2: 9.5%, group 3: 26.4%, and group 4: 38.7%, log rank p < 0.001). Continuous eGFR values were significantly related with all-cause mortality (adjusted HR 0.98, 95% CI 0.98-0.99, p < 0.001). Procedural failure was associated with all-cause mortality both in patients with an eGFR < 60 ml/min/1.73 m2 (42.6 vs. 23.7%, adjusted HR 1.59, 95% CI 1.08-2.32, p = 0.02) and in those with an eGFR ≥ 60 ml/min/1.73 m2 (14.6 vs. 6.5%, adjusted HR 1.73, 95% CI 1.15-2.60, p = 0.009, interaction p = 0.47). CONCLUSIONS: Although renal impairment is associated with all-cause mortality in patients undergoing CTO PCI, successful CTO recanalization is related to improved survival irrespective of renal function.


Subject(s)
Coronary Occlusion/surgery , Elective Surgical Procedures , Glomerular Filtration Rate/physiology , Percutaneous Coronary Intervention , Registries , Renal Insufficiency, Chronic/complications , Aged , Cause of Death/trends , Chronic Disease , Coronary Occlusion/complications , Coronary Occlusion/mortality , Female , Follow-Up Studies , Germany/epidemiology , Humans , Male , Middle Aged , Prognosis , Renal Insufficiency, Chronic/physiopathology , Risk Factors , Survival Rate/trends , Time Factors , Treatment Outcome
12.
Thromb Haemost ; 117(11): 2105-2115, 2017 11.
Article in English | MEDLINE | ID: mdl-29044291

ABSTRACT

Background As technologies of percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) have improved, great uncertainty exists regarding patient selection and long-term benefit of CTO-PCI. Given that white blood cell (WBC) count has been associated with cardiovascular risk, we hypothesized that the latter might provide incremental prognostic value in patients undergoing CTO-PCI. Methods and Results Our study population consisted of 1,262 consecutive patients (76.3% males, mean age of 67.7 ± 10.3 years) who underwent elective PCI at our centre between January 2002 and December 2008. Four hundred seventy-five patients had at least one CTO, while 787 patients with non-occlusive coronary lesions served as controls. Baseline WBC count was higher in CTO patients as compared with controls (8,072 ± 3,459/µL vs. 7,469 ± 2,668/µL, p = 0.001) and independently predicted the occurrence of a CTO lesion (odds ratio: 1.8; 95% confidence interval [CI]: 1.3-2.4; p < 0.001). After a median follow-up of 3.1 years (interquartile range: 2.1-4.2 years), CTO patients with WBC counts ranging in the highest tertile had significantly worse outcomes than CTO patients with lower WBC counts (log-rank = 0.009 for all-cause mortality and log-rank = 0.01 for major adverse cardiac events). These associations were not seen in controls. Accordingly, elevated WBC count was identified as a significant predictor for all-cause mortality (adjusted hazard ratio: 3.1; 95% CI: 1.6-6.2; p = 0.001) in CTO patients but not in patients with non-occlusive coronary artery disease (pint = 0.088). Conclusion Assessment of the inflammatory status of CTO patients may be an important element in selecting CTO patients at low risk who may be referred to CTO-PCI.


Subject(s)
Coronary Occlusion/blood , Coronary Occlusion/therapy , Leukocytes , Percutaneous Coronary Intervention/adverse effects , Aged , Biomarkers/blood , C-Reactive Protein/analysis , Case-Control Studies , Chronic Disease , Coronary Angiography , Coronary Occlusion/diagnosis , Coronary Occlusion/mortality , Female , Germany , Humans , Inflammation Mediators/blood , Kaplan-Meier Estimate , Leukocyte Count , Leukocytes/metabolism , Male , Middle Aged , Percutaneous Coronary Intervention/mortality , Predictive Value of Tests , Proportional Hazards Models , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
13.
Am J Cardiol ; 120(10): 1780-1786, 2017 Nov 15.
Article in English | MEDLINE | ID: mdl-28867125

ABSTRACT

Successful recanalization of chronic total occlusions (CTO) has been associated with improved survival. Data on outcomes in patients with left ventricular (LV) systolic dysfunction undergoing percutaneous coronary intervention for CTO, however, are scarce. Between January 2005 and December 2013, a total of 2,002 consecutive patients undergoing elective CTO percutaneous coronary intervention at a tertiary care center were divided into patients with (LV ejection fraction ≤ 40%) and without (LV ejection fraction > 40%) LV systolic dysfunction as defined by transthoracic echocardiography. The primary end point was all-cause mortality. Median follow-up was 2.6 (1.1 to 3.1) years. A total of 348 (17.4%) patients had LV dysfunction. All-cause mortality was higher in patients with LV dysfunction (30.2%) than in those with normal LV function (8.2%, p <0.001), and associations remained significant after adjustment for baseline differences (adjusted hazard ratio [HR] 3.39, 95% confidence interval [CI] 2.57 to 4.47, p <0.001). Successful CTO recanalization was independently associated with reduced all-cause mortality, with similar relative risk reductions in both the preserved (6.6% vs 16.9%, adjusted HR 0.48, 95% CI 0.34 to 0.70, p <0.001) and the reduced LV function groups (26.2% vs 45.2%, adjusted HR 0.63, 95% CI 0.41 to 0.98, p = 0.04, interaction p = 0.28). In conclusion, irrespective of LV function, successful CTO recanalization is associated with a clear survival benefit.


Subject(s)
Coronary Occlusion/surgery , Percutaneous Coronary Intervention/methods , Registries , Stroke Volume/physiology , Ventricular Dysfunction, Left/complications , Ventricular Function, Left/physiology , Aged , Cause of Death/trends , Chronic Disease , Coronary Occlusion/complications , Coronary Occlusion/mortality , Echocardiography , Female , Follow-Up Studies , Germany/epidemiology , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Humans , Male , Retrospective Studies , Risk Factors , Survival Rate/trends , Time Factors , Treatment Outcome , Ventricular Dysfunction, Left/mortality , Ventricular Dysfunction, Left/physiopathology
14.
Clin Res Cardiol ; 106(12): 986-994, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28776267

ABSTRACT

BACKGROUND: Successful CTO recanalization has been associated with clinical benefit. Outcomes of patients with atrial fibrillation undergoing CTO PCI have not been investigated, yet. AIMS: This study sought to evaluate the association between atrial fibrillation and outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). METHODS: Consecutive patients undergoing CTO PCI between January 2005 and December 2013 were divided into patients with and without atrial fibrillation, and propensity-matched models used to adjust for baseline differences between groups. The primary outcome was all-cause mortality at a median follow-up of 3.2 (interquartile range 3.1-4.5) years. RESULTS: Of 2002 patients undergoing CTO PCI, atrial fibrillation was present in 169 (8.4%) patients. Patients with atrial fibrillation were older, and more frequently had hypertension, left ventricular systolic dysfunction, and chronic kidney disease. Before matching, all-cause mortality was 39.6 and 14.5% in the atrial fibrillation and the sinus rhythm groups (HR 2.92, 95% CI 2.23-3.82, p < 0.001). In the propensity-matched model, atrial fibrillation remained associated with an increased risk of mortality (HR 1.62, 95% CI 1.06-2.47, p = 0.03). In the unmatched patient cohort, all-cause mortality was significantly reduced in patients with procedural success, both in the atrial fibrillation (34.9 versus 55.0%, adjusted HR 0.99, 95% CI 0.97-1.00, p = 0.02) and the sinus rhythm groups (12.8 versus 23.0%, adjusted HR 0.70, 95% CI 0.53-0.92, p = 0.01). CONCLUSIONS: Although atrial fibrillation is independently associated with mortality after CTO PCI, substantial survival benefit of successful CTO recanalization is observed in both patients with and without atrial fibrillation.


Subject(s)
Atrial Fibrillation/etiology , Coronary Occlusion/surgery , Percutaneous Coronary Intervention/adverse effects , Registries , Risk Assessment , Aged , Atrial Fibrillation/epidemiology , Chronic Disease , Coronary Angiography , Coronary Occlusion/diagnosis , Female , Follow-Up Studies , Germany/epidemiology , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Risk Factors , Survival Rate/trends , Time Factors
15.
Am J Cardiol ; 119(12): 1931-1936, 2017 06 15.
Article in English | MEDLINE | ID: mdl-28434645

ABSTRACT

Conflicting evidence exists on gender differences in outcomes after coronary stenting, and gender-based data in patients with chronic total occlusions (CTO) who underwent percutaneous coronary intervention (PCI) are scarce. Consecutive patients who underwent CTO PCI from January 2005 to December 2013 were included in the analysis and stratified according to gender. The primary outcome measure was all-cause mortality. Median follow-up was 2.6 years (interquartile range 1.1 to 3.1). Of 2002 patients, 332 (17%) were women. Procedural success was achieved in 82% and 83% of women and men (p = 0.31). All-cause mortality was 15% and 11% in women and men (log-rank p = 0.17) with an adjusted hazard ratio of 0.85 (95% confidence interval [CI] 0.61 to 1.17, p = 0.31). All-cause mortality was significantly reduced in patients with procedural success, both in women (12% vs 32%, adjusted hazard ratio 0.44, 95% CI 0.24 to 0.79, p = 0.006) and men (9% vs 21%, adjusted hazard ratio 0.64, 95% CI 0.47 to 0.88, p = 0.006), with similar mortality benefits associated with successful revascularization in both groups (interaction p = 0.35). In conclusion, recanalization of coronary arterial CTO is equally successful in both women and men.


Subject(s)
Coronary Occlusion/surgery , Percutaneous Coronary Intervention , Postoperative Complications/epidemiology , Registries , Risk Assessment/methods , Age Factors , Aged , Cause of Death/trends , Chronic Disease , Coronary Angiography , Coronary Occlusion/diagnosis , Coronary Occlusion/mortality , Female , Follow-Up Studies , Germany/epidemiology , Humans , Incidence , Kaplan-Meier Estimate , Male , Middle Aged , Retrospective Studies , Risk Factors , Sex Distribution , Sex Factors , Survival Rate/trends , Time Factors , Treatment Outcome
16.
Clin Res Cardiol ; 106(6): 428-435, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28236020

ABSTRACT

BACKGROUND: Successful chronic total occlusion (CTO) revascularization has been associated with prognostic benefits. Whether the extent of coronary artery disease interferes with these benefits has not been investigated yet. AIMS: We sought to compare the survival after percutaneous coronary intervention (PCI) for CTO between patients with multi- (MVD) and single-vessel disease (SVD). METHODS: A total of 2002 consecutive patients undergoing CTO PCI between 01/2005 and 12/2013 were identified and stratified according to the presence/absence of MVD. The primary endpoint was all-cause mortality. Median follow-up was 2.6 (interquartile range 1.1-3.1) years. RESULTS: A total of 1634 (81.6%) patients had MVD. Procedural success rates were 81.5 and 89.7% in the MVD and SVD groups (p < 0.001). All-cause mortality during entire follow-up was higher in MVD as compared to SVD patients (13.5 versus 5.7%, p < 0.001), and differences were attenuated after multivariable adjustment for baseline characteristics [adjusted hazard ratio (HR) 1.51, 95% CI 0.98-2.33, p = 0.06]. The effect of successful CTO PCI on all-cause mortality was consistent among patients with MVD [11.0 versus 24.5%; adjusted HR 0.60, 95% CI 0.45-0.80, p < 0.001] and SVD [5.2 versus 10.5%; adjusted HR 0.74, 95% CI 0.24-2.26, p = 0.59, P int = 0.65]. However, due to the greater baseline risk in the former group, the absolute survival benefit after successful CTO PCI was higher. CONCLUSIONS: Successful recanalization of a CTO is a strong independent predictor for reduced long-term mortality. Due a higher baseline risk, the absolute benefit in patients with MVD is substantially larger than in patients with SVD.


Subject(s)
Coronary Occlusion/surgery , Percutaneous Coronary Intervention/methods , Aged , Chronic Disease , Coronary Occlusion/mortality , Coronary Occlusion/pathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Proportional Hazards Models , Prospective Studies , Treatment Outcome
17.
Clin Res Cardiol ; 106(2): 85-95, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27853942

ABSTRACT

BACKGROUND: After transcatheter aortic valve implantation, early leaflet thickening, presumably reflecting thrombus, has recently been described on computed tomography angiography (CTA) in ~10% of the patients. We sought to investigate the impact of the antithrombotic regimen on the course of leaflet thickening. METHODS: The study comprised 51 patients with leaflet thickening. Based on the time period, patients without an established indication for anticoagulation were put on phenprocoumon plus clopidogrel for at least 3 months or on dual antiplatelet therapy with aspirin and clopidogrel. Follow-up CTAs were evaluated for leaflet restriction, assessed by four-point-grading score, and maximal thickness. FINDINGS: The anticoagulation and the dual antiplatelet therapy group comprised 29 and 22 patients, respectively. After a median of 86 days, we obtained follow-up CTAs in 22 patients on anticoagulation and in 16 patients on dual antiplatelet therapy. Leaflet thickening progressed in 11 on dual antiplatelet therapy, but always regressed onanticoagulation. The course of leaflet restriction and maximal thickness was significantly different between the two groups (P < 0.001): in the dual antiplatelet therapy group, maximal thickness increased by a mean of 1.37 ± 1.67 mm (P = 0.005) and leaflet restriction score by a median 1[quartiles 0;2] (P = 0.013), whereas in the anticoagulation group, maximal thickness regressed by 2.57 ± 1.52 mm (P < 0.001) and leaflet restriction score decreased by 1[-4;0] (P = 0.001). After a median of 91 days after discontinuation of anticoagulation, CTA performed in ten patients revealed a significant recurrent increase in leaflet restriction score and maximal thickness (P = 0.023, P = 0.007). In the entire cohort, changes in leaflet restriction correlated significantly with changes in transvalvular pressure gradients (r = 0.511, P < 0.001). INTERPRETATION: The course of leaflet restriction was fundamentally different depending on the presence or absence of anticoagulation, with consistent regression under phenprocoumon, but mostly progression under antiplatelet therapy alone. Changes in leaflet restriction were associated with changes in transvalvular pressure gradients.


Subject(s)
Anticoagulants/administration & dosage , Aortic Valve Stenosis/therapy , Aortic Valve/drug effects , Cardiac Catheterization/adverse effects , Heart Valve Prosthesis Implantation/adverse effects , Phenprocoumon/administration & dosage , Thrombosis/prevention & control , Administration, Oral , Aged , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Cardiac Catheterization/instrumentation , Cardiac Catheterization/methods , Drug Administration Schedule , Female , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis Implantation/methods , Hemodynamics , Humans , Male , Platelet Aggregation Inhibitors/administration & dosage , Prospective Studies , Registries , Risk Factors , Thrombosis/diagnosis , Thrombosis/etiology , Time Factors , Tomography, X-Ray Computed , Treatment Outcome
18.
EuroIntervention ; 13(2): e228-e235, 2017 Jun 02.
Article in English | MEDLINE | ID: mdl-27867143

ABSTRACT

AIMS: Few data are available on outcomes of percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) in very elderly patients in the drug-eluting stent (DES) era. We aimed to investigate long-term survival in a single-centre cohort of elderly patients following CTO PCI using DES. METHODS AND RESULTS: A total of 2,002 consecutive patients who underwent PCI of a CTO at our centre between January 2005 and December 2013 were followed for a median of 2.6 years (interquartile range 1.1-3.1 years). Four hundred and nine (409) patients were older than 75 years. The absolute reduction in all-cause mortality by successful CTO PCI was numerically greater in elderly patients as compared to younger patients (22.1% vs. 7.2% at three years). In multivariate models, successful CTO PCI was significantly associated with improved survival in both elderly (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI]: 0.39 to 0.87; p=0.009) and younger patients (adjusted HR 0.59, 95% CI: 0.40 to 0.86; p=0.006). CONCLUSIONS: In the DES era, elderly patients (≥75 years) derive a similar survival benefit from successful CTO PCI to younger patients. These findings suggest that CTO PCI, when indicated, should not be withheld from the elderly.


Subject(s)
Coronary Occlusion/therapy , Percutaneous Coronary Intervention , Age Factors , Aged , Aged, 80 and over , Chi-Square Distribution , Coronary Occlusion/diagnosis , Coronary Occlusion/mortality , Drug-Eluting Stents , Female , Germany , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/instrumentation , Percutaneous Coronary Intervention/mortality , Proportional Hazards Models , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome
19.
Am J Cardiol ; 118(11): 1641-1646, 2016 Dec 01.
Article in English | MEDLINE | ID: mdl-27692593

ABSTRACT

Successful revascularization of chronic total occlusions (CTOs) has been associated with clinical benefit. Data on outcomes in patients with previous coronary artery bypass grafting (CABG) undergoing percutaneous coronary intervention (PCI) for CTO, however, are scarce. A total of 2,002 consecutive patients undergoing PCI for CTO from January 2005 to December 2013 were divided into patients with and without previous CABG, and outcomes were retrospectively assessed. The primary outcome measure was all-cause mortality. Median follow-up was 2.6 years (interquartile range 1.1 to 3.1). A total of 292 patients (15%) had previous CABG; they were older and had a greater prevalence of comorbidities. Procedural success was achieved in 75% and 84% of patients in the previous CABG and the non-CABG groups (p <0.001), respectively. All-cause mortality was 16% and 11% in the previous CABG and the non-CABG groups (p = 0.002), and differences were mitigated after adjustment for baseline characteristics (adjusted hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.86 to 1.74, p = 0.27). All-cause death was significantly reduced in patients with procedural success, both in the previous CABG (11% vs 32%, adjusted HR 0.43, 95% CI 0.24 to 0.77, p = 0.005) and the non-CABG groups (10% vs 20%, adjusted HR 0.63, 95% CI 0.45 to 0.86, p = 0.004), with similar mortality benefits associated with successful revascularization in both groups (interaction p = 0.24). In conclusion, the relative survival benefit of successful recanalization of CTO is independent of previous CABG. However, owing to a greater baseline risk, the absolute survival benefit of successful CTO procedures is more pronounced in patients with previous CABG than in non-CABG patients.


Subject(s)
Coronary Artery Bypass , Coronary Occlusion/surgery , Percutaneous Coronary Intervention , Registries , Aged , Cause of Death/trends , Chronic Disease , Coronary Angiography , Coronary Occlusion/diagnosis , Coronary Occlusion/epidemiology , Female , Follow-Up Studies , Global Health , Humans , Male , Prevalence , Prognosis , Reoperation , Retrospective Studies , Risk Factors , Time Factors
20.
Int J Cardiol ; 224: 305-309, 2016 Dec 01.
Article in English | MEDLINE | ID: mdl-27665402

ABSTRACT

BACKGROUND: The obesity paradox has been described in different patient populations. Data on the relation between obesity and outcomes in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) are lacking. Therefore, long-term mortality in patients undergoing CTO PCI was assessed according to different body mass index (BMI) categories. METHODS: A total of 1993 patients undergoing CTO PCI at a tertiary care center between January 2005 and December 2013 were divided into five different BMI categories: underweight, <18.5kg/m2; normal BMI, 18.5-24.9kg/m2; overweight, 25.0-29.9kg/m2; obese, 30.0-34.9kg/m2; and very obese, ≥35.0kg/m2. The primary endpoint was all-cause mortality. RESULTS: Median follow-up was 2.6 (interquartile range 1.1-3.1) years. Of the 1993 patients, 461 (23.1%) were of normal weight, 985 (49.4%) overweight, 396 (19.9%) obese, and 144 (7.2%) very obese. Compared with normal weight BMI patients (16.3%), overweight patients had a lower all-cause mortality (10.2%, Log Rank p=0.001), while obese (11.1%, Log Rank p=0.08) and severely obese (13.2%, Log Rank p=0.39) patients had similar mortality rates. Being overweight was significantly associated with a lower all-cause mortality (HR 0.69, 95% CI 0.53-0.89, p=0.005), and associations remained significant after multivariable adjustments for confounding factors (HR 0.73, 95% CI 0.56-0.95, p=0.02). While being overweight was linked with a reduced all-cause mortality in men (HR 0.65, 95% CI 0.48-0.88, p=0.005), it was not in women (HR 1.25, 95% CI 0.60-2.52, p=0.58). CONCLUSIONS: Overweight is associated with an improved survival in patients undergoing PCI for CTO, particularly in men.


Subject(s)
Body Mass Index , Coronary Occlusion/mortality , Coronary Occlusion/surgery , Overweight/mortality , Overweight/surgery , Percutaneous Coronary Intervention/mortality , Aged , Aged, 80 and over , Chronic Disease , Female , Follow-Up Studies , Humans , Male , Middle Aged , Mortality/trends , Percutaneous Coronary Intervention/trends
SELECTION OF CITATIONS
SEARCH DETAIL
...