Chronic Total Occlusions Rajan Patel, MD FACC FAHA FSCAI
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1 Chronic Total Occlusions Rajan Patel, MD FACC FAHA FSCAI Senior Lecturer Univ. of Queensland Ochsner Clinical School Ochsner Medical Center New Orleans, LA
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5 Overview I. Epidemiology II. Outcome Data III. DES Performance IV. CABG vs. PCI V. AUC for CTO PCI
6 Epidemiology Canadian Registry Data Patients with Coronary Artery Disease N = 14,439 Treatment of Patients with CTOs N = 1,697 Fefer P, et al. J Am Coll Cardiol 2012;59:991 7 * 52% Cleveland Clinic Registry Christofferson RD, et al. Am J Cardiol May 1;95(9):
7 Overview I. Epidemiology II. Outcome Data III. DES Performance IV. CABG vs. PCI V. AUC for CTO PCI
8 CTO: Impact of Completeness of Revascularization on Mortality Hannan et al. CirculaOon. 2006;113: MulOvessel CAD paoents NY State PCI Registry P = 0.01 for 2+ vessels IR with no CTO vs CR P < for all other groups vs CR
9 CTO: Impact of Completeness of Revascularization on Mortality SYNTAX Trial PCI Patients P = Percent Mortality P = Complete RevascularizaOon (n = 579) Incomplete RevascularizaOon (n = 510) 2 0 All Cause Death Cardiac Death Farooq V et al. J Am Coll Cardiol 2013;61:282 94
10 CTO: Impact of Completeness of Revascularization on Mortality SYNTAX Trial CABG Patients 14 P = Percent Mortality P = Complete RevascularizaOon (n = 1031) Incomplete RevascularizaOon (n = 483) 2 0 All Cause Death Cardiac Death Farooq V et al. J Am Coll Cardiol 2013;61:282 94
11 Long- term Outcome of Incomplete Revasculariza<on A>er Percutaneous Coronary Interven<on in SCAAR p < Hambraeus K et al. J Am Coll Cardiol Intv 2016;9(3):
12 CTO: Impact for STEMI Patients Landmark Analysis Claesen et al. J Am Coll Cardiol Intv 2009;2: STEMI paoent, Netherlands P < 0.01 between all groups
13 Impact of CTO on Mortality Jones DA, et al. J Am Coll Cardiol Intv 2012;5:380 8
14 Meta-analysis of CTO PCI All Cause Mortality Joyal D, et al. Am Heart J. 2010; 160:
15 Overview I. Epidemiology II. Outcome Data III. DES Performance IV. CABG vs. PCI V. AUC for CTO PCI
16 DES Performance for CTO PCI TWENTE: CTO PCI with 2 nd Gen DES Analysis of 59 CTO pts treated with ZES (Resolute) or EES (Xience V) 56% with J- CTO scores 2; mean lesion length 31.3 mm Similar rates of ST (1.7% CTO vs. 1.5% for non- CTO) Houwelingen GK, et al. Catheter Cardiovasc Interv Feb 15;85(3):E76-82
17 Performance of ZES in Coronary Occlusions 2 year outcomes: 256 CTO lesions, 292 non- chronic TO lesions Kelbaek H, et al. EuroIntervenOon Oct;11(6):650-7
18 Overview I. Epidemiology II. Outcome data III. DES performance IV. CABG vs. PCI V. AUC for CTO PCI
19 PRAGUE 4: 1 Year Patency of SVG to CTO Vessel Widimsky P, et al. CirculaOon. 2004;110:
20 Operative Mortality STS Database First ElecOve Percent 5.2 Re- do ElecOve Percent
21 CTO PCI Success Rate Success Rate Complica on Rate Angiographic Success Rate % 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% (n = 2766) (n = 1607) (n = 6677) Publica on Year (n = 8357) 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Complica on Rate Patel VG et al. J Am Coll Cardiol 2013;6:
22 Overview I. Epidemiology II. Outcome Data III. DES Performance IV. CABG vs. PCI V. AUC for CTO PCI
23 Patel, M. et al. J Am Coll Cardiol. 2012;59(9):1-25. Appropriate Use Criteria
24 Summary Coronary CTO s are not uncommon Clinical outcome is worse unrevascularized Complete revascularization has mortality benefit DES performance for coronary CTO s is good AUC support CTO PCI Treat the patient not the lesion
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