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Dimitri Karmpaliotis - One of the best experts on this subject based on the ideXlab platform.
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Chronic Total Occlusion percutaneous coronary intervention in octogenarians and nonagenarians
Journal of the American Geriatrics Society, 2021Co-Authors: Evangelia Vemmou, Dimitri Karmpaliotis, Khaldoon Alaswad, James W Choi, Farouc A Jaffer, Ehtisham Mahmud, Anthony Doing, Mitul Patel, Phil Dattilo, Oleg KrestyaninovAbstract:OBJECTIVE The outcomes of Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. METHODS We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. <80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. RESULTS There were 415 octogenarians and nonagenarians in our study (7% of the Total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p = 0.0201; 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p = 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE. CONCLUSION CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity.
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definitions and clinical trial design principles for coronary artery Chronic Total Occlusion therapies cto arc consensus recommendations
Circulation, 2021Co-Authors: Luiz F Ybarra, James C Spratt, Stephane Rinfret, Emmanouil S. Brilakis, Dimitri Karmpaliotis, Aaron J Grantham, David E Kandzari, Lorenzo Azzalini, Kambis Mashayekhi, Harindra C WijeysunderaAbstract:Over the past 2 decades, Chronic Total Occlusion (CTO) percutaneous coronary intervention has developed into its own subspecialty of interventional cardiology. Dedicated terminology, techniques, de...
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definitions and clinical trial design principles for coronary artery Chronic Total Occlusion therapies cto arc consensus recommendations
Circulation, 2021Co-Authors: Luiz F Ybarra, James C Spratt, Stephane Rinfret, Emmanouil S. Brilakis, Dimitri Karmpaliotis, Aaron J Grantham, David E Kandzari, Lorenzo Azzalini, Kambis Mashayekhi, Harindra C WijeysunderaAbstract:Over the past 2 decades, Chronic Total Occlusion (CTO) percutaneous coronary intervention has developed into its own subspecialty of interventional cardiology. Dedicated terminology, techniques, devices, courses, and training programs have enabled progressive advancements. However, only a few randomized trials have been performed to evaluate the safety and efficacy of CTO percutaneous coronary intervention. Moreover, several published observational studies have shown conflicting data. Part of the paucity of clinical data stems from the fact that prior studies have been suboptimally designed and performed. The absence of standardized end points and the discrepancy in definitions also prevent consistency and uniform interpretability of reported results in CTO intervention. To standardize the field, we therefore assembled a broad consortium comprising academicians, practicing physicians, researchers, medical society representatives, and regulators (US Food and Drug Administration) to develop methods, end points, biomarkers, parameters, data, materials, processes, procedures, evaluations, tools, and techniques for CTO interventions. This article summarizes the effort and is organized into 3 sections: key elements and procedural definitions, end point definitions, and clinical trial design principles. The Chronic Total Occlusion Academic Research Consortium is a first step toward improved comparability and interpretability of study results, supplying an increasingly growing body of CTO percutaneous coronary intervention evidence.
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technical and procedural outcomes of the retrograde approach to Chronic Total Occlusion interventions
Eurointervention, 2020Co-Authors: Peter Tajti, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A Jaffer, Iosif Xenogiannis, Mitul Patel, Nicholas M Burke, Fotis Gargoulas, Santiago Garcia, Oleg KrestyaninovAbstract:AIMS The retrograde approach is critical for achieving high success rates in Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI), but has been associated with higher risk of complications. We examined the contemporary outcomes of the retrograde approach to CTO PCI aiming to identify areas in need of improvement. METHODS AND RESULTS We compared the technical and procedural outcomes of retrograde (n=1,515) and antegrade-only CTO PCIs (n=2,686) in a contemporary multicentre CTO registry. The mean age of patients undergoing retrograde PCI was 65±10 years and 86% were men, with high prevalence of prior myocardial infarction (51%), prior PCI (71%), and coronary artery bypass graft surgery (45%). The mean J-CTO score (3±1 vs 2±1, p<0.001) was higher in retrograde PCIs. The most commonly used collateral channels were septals (65%), epicardials (32%), saphenous venous grafts (14%) and left internal mammary artery grafts (2%). Overall technical (79% vs 91%, p<0.001) and procedural (75% vs 90%, p<0.001) success rates were lower with the retrograde approach, and these patients had a higher rate of in-hospital major complications than antegrade-only PCI patients (5.1% vs 0.8%, p<0.001), due to higher mortality (1.1% vs 0.1%, p<0.001), acute myocardial infarction (1.9% vs 0.2%, p<0.001), repeat PCI (0.7% vs 0.1%, p=0.001), and pericardiocentesis (1.7% vs 0.3%, p<0.001). CONCLUSIONS In summary, the retrograde approach to CTO PCI is performed in higher complexity lesions and is associated with lower success rates and a higher rate of major complications. CLINICAL TRIAL REGISTRATION NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO).
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outcomes with retrograde versus antegrade Chronic Total Occlusion revascularization
Catheterization and Cardiovascular Interventions, 2020Co-Authors: Michael Megaly, Dimitri Karmpaliotis, Gerald S Werner, Iosif Xenogiannis, Abdelrahman Ali, Marwan Saad, Mohamed Omer, Juan Russo, Masahisa YamaneAbstract:OBJECTIVES The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND The retrograde approach has increased the success rate of CTO PCI but has been associated with a higher risk for complications. METHODS We conducted a meta-analysis of studies published between 2000 and August 2019 comparing the in-hospital and long-term outcomes with retrograde versus antegrade CTO PCI. RESULTS Twelve observational studies (10,240 patients) met our inclusion criteria (retrograde approach 2,789 patients, antegrade approach 7,451 patients). Lesions treated with the retrograde approach had higher J-CTO score (2.8 vs. 1.9, p < .001). Retrograde CTO PCI was associated with a lower success rate (80.9% vs. 87.4%, p < .001). Both approaches had similar in-hospital mortality, urgent revascularization, and cerebrovascular events. Retrograde CTO PCI was associated with higher risk of in-hospital myocardial infarction (MI; odds ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p < .001), urgent pericardiocentesis (OR 2.53, 95% CI 1.41-4.51, p = .002), and contrast-induced nephropathy (OR 2.12, 95% CI 1.47-3.08; p < .001). During a mean follow-up of 48 ± 31 months retrograde crossing had similar mortality (OR 1.79, 95% CI 0.84-3.81, p = .13), but a higher incidence of MI (OR 2.07, 95% CI 1.1-3.88, p = .02), target vessel revascularization (OR 1.92, 95% CI 1.49-2.46, p < .001), and target lesion revascularization (OR 2.08, 95% CI 1.33-3.28, p = .001). CONCLUSIONS Compared with antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions and is associated with a higher risk for acute and long-term adverse events.
Khaldoon Alaswad - One of the best experts on this subject based on the ideXlab platform.
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Chronic Total Occlusion percutaneous coronary intervention in octogenarians and nonagenarians
Journal of the American Geriatrics Society, 2021Co-Authors: Evangelia Vemmou, Dimitri Karmpaliotis, Khaldoon Alaswad, James W Choi, Farouc A Jaffer, Ehtisham Mahmud, Anthony Doing, Mitul Patel, Phil Dattilo, Oleg KrestyaninovAbstract:OBJECTIVE The outcomes of Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. METHODS We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. <80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. RESULTS There were 415 octogenarians and nonagenarians in our study (7% of the Total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p = 0.0201; 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p = 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE. CONCLUSION CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity.
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technical and procedural outcomes of the retrograde approach to Chronic Total Occlusion interventions
Eurointervention, 2020Co-Authors: Peter Tajti, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A Jaffer, Iosif Xenogiannis, Mitul Patel, Nicholas M Burke, Fotis Gargoulas, Santiago Garcia, Oleg KrestyaninovAbstract:AIMS The retrograde approach is critical for achieving high success rates in Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI), but has been associated with higher risk of complications. We examined the contemporary outcomes of the retrograde approach to CTO PCI aiming to identify areas in need of improvement. METHODS AND RESULTS We compared the technical and procedural outcomes of retrograde (n=1,515) and antegrade-only CTO PCIs (n=2,686) in a contemporary multicentre CTO registry. The mean age of patients undergoing retrograde PCI was 65±10 years and 86% were men, with high prevalence of prior myocardial infarction (51%), prior PCI (71%), and coronary artery bypass graft surgery (45%). The mean J-CTO score (3±1 vs 2±1, p<0.001) was higher in retrograde PCIs. The most commonly used collateral channels were septals (65%), epicardials (32%), saphenous venous grafts (14%) and left internal mammary artery grafts (2%). Overall technical (79% vs 91%, p<0.001) and procedural (75% vs 90%, p<0.001) success rates were lower with the retrograde approach, and these patients had a higher rate of in-hospital major complications than antegrade-only PCI patients (5.1% vs 0.8%, p<0.001), due to higher mortality (1.1% vs 0.1%, p<0.001), acute myocardial infarction (1.9% vs 0.2%, p<0.001), repeat PCI (0.7% vs 0.1%, p=0.001), and pericardiocentesis (1.7% vs 0.3%, p<0.001). CONCLUSIONS In summary, the retrograde approach to CTO PCI is performed in higher complexity lesions and is associated with lower success rates and a higher rate of major complications. CLINICAL TRIAL REGISTRATION NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO).
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abstract 16435 contemporary in hospital outcomes of Chronic Total Occlusion interventions update from the progress cto prospective global registry for the study of Chronic Total Occlusion intervention multicenter international registry
Circulation, 2020Co-Authors: Judit Karacsonyi, Khaldoon Alaswad, Dimitrios Karmpaliotis, Oleg Krestyaninov, James W Choi, Jaikirshan Khatri, Farouc A Jaffer, Mitul P Patel, Ehtisham Mahmud, Anthony DoingAbstract:Introduction: Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI) continues to evolve over time. Methods: We analyzed the clinical, angiographic, technical and procedural charact...
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impact of concomitant treatment of non Chronic Total Occlusion lesions at the time of Chronic Total Occlusion intervention
International Journal of Cardiology, 2020Co-Authors: Iosif Xenogiannis, Dimitri Karmpaliotis, Khaldoon Alaswad, James W Choi, Farouc A Jaffer, Ehtisham Mahmud, Robert W Yeh, Mitul Patel, Nicholas M Burke, Anthony DoingAbstract:Abstract Background During Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI), sometimes non-CTO lesions are also treated. Methods We compared the clinical and procedural characteristics and outcomes of CTO PCIs with and without concomitant treatment of a non-CTO lesion in a contemporary multicenter CTO registry. Results Of the 3598 CTO PCIs performed at 21 centers between 2012 and 2018, 814 (23%) also included PCI of at least one non-CTO lesion. Patients in whom non-CTO lesions were treated were older (65 ± 10 vs. 64 ± 10 years, p = 0.03), more likely to present with an acute coronary syndrome (32% vs. 23%, p Conclusions Combined CTO PCI with PCI of non-CTO lesions is associated with similar success and major in-hospital complication rates compared with cases in which only CTOs were treated, but requires longer procedure duration and higher radiation dose and contrast volume.
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usefulness of atherectomy in Chronic Total Occlusion interventions from the progress cto registry
American Journal of Cardiology, 2019Co-Authors: Iosif Xenogiannis, Dimitri Karmpaliotis, Khaldoon Alaswad, James W Choi, Farouc A Jaffer, Ehtisham Mahmud, Robert W Yeh, Mitul Patel, Nicholas M Burke, Anthony DoingAbstract:There is limited data on the use of atherectomy during Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI). We compared the clinical and procedural characteristics and outcomes of CTO PCIs performed with or without atherectomy in a contemporary multicenter CTO PCI registry. Between 2012 and 2018, 3,607 CTO PCIs were performed at 21 participating centers. Atherectomy was used in 117 (3.2%) cases: rotational atherectomy in 105 cases, orbital atherectomy in 8, and both in 4 cases. Patients in whom atherectomy was used, were older (68 ± 8 vs 64 ± 10 years, p
Farouc A Jaffer - One of the best experts on this subject based on the ideXlab platform.
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Chronic Total Occlusion percutaneous coronary intervention in octogenarians and nonagenarians
Journal of the American Geriatrics Society, 2021Co-Authors: Evangelia Vemmou, Dimitri Karmpaliotis, Khaldoon Alaswad, James W Choi, Farouc A Jaffer, Ehtisham Mahmud, Anthony Doing, Mitul Patel, Phil Dattilo, Oleg KrestyaninovAbstract:OBJECTIVE The outcomes of Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. METHODS We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. <80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. RESULTS There were 415 octogenarians and nonagenarians in our study (7% of the Total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p = 0.0201; 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p = 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE. CONCLUSION CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity.
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technical and procedural outcomes of the retrograde approach to Chronic Total Occlusion interventions
Eurointervention, 2020Co-Authors: Peter Tajti, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A Jaffer, Iosif Xenogiannis, Mitul Patel, Nicholas M Burke, Fotis Gargoulas, Santiago Garcia, Oleg KrestyaninovAbstract:AIMS The retrograde approach is critical for achieving high success rates in Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI), but has been associated with higher risk of complications. We examined the contemporary outcomes of the retrograde approach to CTO PCI aiming to identify areas in need of improvement. METHODS AND RESULTS We compared the technical and procedural outcomes of retrograde (n=1,515) and antegrade-only CTO PCIs (n=2,686) in a contemporary multicentre CTO registry. The mean age of patients undergoing retrograde PCI was 65±10 years and 86% were men, with high prevalence of prior myocardial infarction (51%), prior PCI (71%), and coronary artery bypass graft surgery (45%). The mean J-CTO score (3±1 vs 2±1, p<0.001) was higher in retrograde PCIs. The most commonly used collateral channels were septals (65%), epicardials (32%), saphenous venous grafts (14%) and left internal mammary artery grafts (2%). Overall technical (79% vs 91%, p<0.001) and procedural (75% vs 90%, p<0.001) success rates were lower with the retrograde approach, and these patients had a higher rate of in-hospital major complications than antegrade-only PCI patients (5.1% vs 0.8%, p<0.001), due to higher mortality (1.1% vs 0.1%, p<0.001), acute myocardial infarction (1.9% vs 0.2%, p<0.001), repeat PCI (0.7% vs 0.1%, p=0.001), and pericardiocentesis (1.7% vs 0.3%, p<0.001). CONCLUSIONS In summary, the retrograde approach to CTO PCI is performed in higher complexity lesions and is associated with lower success rates and a higher rate of major complications. CLINICAL TRIAL REGISTRATION NCT02061436, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO).
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abstract 16435 contemporary in hospital outcomes of Chronic Total Occlusion interventions update from the progress cto prospective global registry for the study of Chronic Total Occlusion intervention multicenter international registry
Circulation, 2020Co-Authors: Judit Karacsonyi, Khaldoon Alaswad, Dimitrios Karmpaliotis, Oleg Krestyaninov, James W Choi, Jaikirshan Khatri, Farouc A Jaffer, Mitul P Patel, Ehtisham Mahmud, Anthony DoingAbstract:Introduction: Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI) continues to evolve over time. Methods: We analyzed the clinical, angiographic, technical and procedural charact...
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retrograde Chronic Total Occlusion percutaneous coronary intervention via saphenous vein graft
Jacc-cardiovascular Interventions, 2020Co-Authors: Iosif Xenogiannis, Dimitri Karmpaliotis, Oleg Krestyaninov, Jaikirshan Khatri, Farouc A Jaffer, David E Kandzari, Michael R Wyman, Fotios Gkargkoulas, Dmitrii Khelimskii, Anthony DoingAbstract:Abstract Objectives The aim of this study was to examine the use of saphenous vein grafts (SVGs) for retrograde crossing during Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI). Background The use of SVGs for retrograde crossing during CTO PCI has received limited study. Methods A Total of 1,615 retrograde CTO PCIs performed between 2012 and 2019 at 25 centers were examined. Clinical, angiographic, and technical characteristics and procedural outcomes were compared among retrograde cases via SVGs (SVG group) versus other collateral vessels (non-SVG group). Results Retrograde CTO PCI via SVGs was performed in 189 cases (12%). Patients in the SVG group were older (mean age 70 ± 9 years vs. 64 ± 10 years; p Conclusions Use of SVGs for retrograde crossing is associated with higher rates of technical and procedural success and similar rates of in-hospital major adverse cardiac events compared with retrograde CTO PCI via other collateral vessels.
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impact of concomitant treatment of non Chronic Total Occlusion lesions at the time of Chronic Total Occlusion intervention
International Journal of Cardiology, 2020Co-Authors: Iosif Xenogiannis, Dimitri Karmpaliotis, Khaldoon Alaswad, James W Choi, Farouc A Jaffer, Ehtisham Mahmud, Robert W Yeh, Mitul Patel, Nicholas M Burke, Anthony DoingAbstract:Abstract Background During Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI), sometimes non-CTO lesions are also treated. Methods We compared the clinical and procedural characteristics and outcomes of CTO PCIs with and without concomitant treatment of a non-CTO lesion in a contemporary multicenter CTO registry. Results Of the 3598 CTO PCIs performed at 21 centers between 2012 and 2018, 814 (23%) also included PCI of at least one non-CTO lesion. Patients in whom non-CTO lesions were treated were older (65 ± 10 vs. 64 ± 10 years, p = 0.03), more likely to present with an acute coronary syndrome (32% vs. 23%, p Conclusions Combined CTO PCI with PCI of non-CTO lesions is associated with similar success and major in-hospital complication rates compared with cases in which only CTOs were treated, but requires longer procedure duration and higher radiation dose and contrast volume.
Aaron J Grantham - One of the best experts on this subject based on the ideXlab platform.
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definitions and clinical trial design principles for coronary artery Chronic Total Occlusion therapies cto arc consensus recommendations
Circulation, 2021Co-Authors: Luiz F Ybarra, James C Spratt, Stephane Rinfret, Emmanouil S. Brilakis, Dimitri Karmpaliotis, Aaron J Grantham, David E Kandzari, Lorenzo Azzalini, Kambis Mashayekhi, Harindra C WijeysunderaAbstract:Over the past 2 decades, Chronic Total Occlusion (CTO) percutaneous coronary intervention has developed into its own subspecialty of interventional cardiology. Dedicated terminology, techniques, de...
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definitions and clinical trial design principles for coronary artery Chronic Total Occlusion therapies cto arc consensus recommendations
Circulation, 2021Co-Authors: Luiz F Ybarra, James C Spratt, Stephane Rinfret, Emmanouil S. Brilakis, Dimitri Karmpaliotis, Aaron J Grantham, David E Kandzari, Lorenzo Azzalini, Kambis Mashayekhi, Harindra C WijeysunderaAbstract:Over the past 2 decades, Chronic Total Occlusion (CTO) percutaneous coronary intervention has developed into its own subspecialty of interventional cardiology. Dedicated terminology, techniques, devices, courses, and training programs have enabled progressive advancements. However, only a few randomized trials have been performed to evaluate the safety and efficacy of CTO percutaneous coronary intervention. Moreover, several published observational studies have shown conflicting data. Part of the paucity of clinical data stems from the fact that prior studies have been suboptimally designed and performed. The absence of standardized end points and the discrepancy in definitions also prevent consistency and uniform interpretability of reported results in CTO intervention. To standardize the field, we therefore assembled a broad consortium comprising academicians, practicing physicians, researchers, medical society representatives, and regulators (US Food and Drug Administration) to develop methods, end points, biomarkers, parameters, data, materials, processes, procedures, evaluations, tools, and techniques for CTO interventions. This article summarizes the effort and is organized into 3 sections: key elements and procedural definitions, end point definitions, and clinical trial design principles. The Chronic Total Occlusion Academic Research Consortium is a first step toward improved comparability and interpretability of study results, supplying an increasingly growing body of CTO percutaneous coronary intervention evidence.
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patient characteristics associated with antianginal medication escalation and de escalation following Chronic Total Occlusion percutaneous coronary intervention
Circulation-cardiovascular Quality and Outcomes, 2019Co-Authors: Taishi Hirai, James Sapontis, William Lombardi, Dimitri Karmpaliotis, William J Nicholson, Mohammed Qintar, Aaron J Grantham, David J Cohen, Jeffrey W Moses, Karen NugentAbstract:Background: Prior research has shown that providers may infrequently adjust antianginal medications (AAMs) following Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI). Patient ...
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depression and angina among patients undergoing Chronic Total Occlusion percutaneous coronary intervention the open cto registry
Jacc-cardiovascular Interventions, 2019Co-Authors: Robert W Yeh, James Sapontis, William J Nicholson, Aaron J Grantham, David J Cohen, Hector Tamez, Eric A Secemsky, John A Spertus, Kensey Gosch, Philip G JonesAbstract:Abstract Objectives This study sought to examine depression prevalence among Chronic Total Occlusion (CTO) patients and compared symptom improvement among depressed and nondepressed patients after percutaneous coronary intervention (PCI). Background Depression in cardiovascular patients is common, but its prevalence among CTO patients and its association with PCI response is understudied. Methods Among 811 patients from the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry, we evaluated change in health status between baseline and 1-year post-PCI, as measured by the Seattle Angina Questionnaire (SAQ) and the Rose Dyspnea Score. Depression was defined using the Personal Health Questionnaire-8. The independent association between health status and depression following PCI was assessed using multivariable regression. Results Among the 811 patients, 190 (23%) screened positive for major depression, of whom 6.3% were on antidepressant therapy at intervention. Depressed patients experienced more baseline angina, but by 1-year post-PCI they experienced greater improvements than nondepressed patients (change in SAQ Summary: 31.4 ± 22.4 vs. 24.2 ± 20.0; p Conclusions Depression is common among CTO PCI patients, but few were treated with antidepressants at baseline. Depressed patients had more severe baseline angina and significant improvement in health status after PCI. (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion [OPEN-CTO]; NCT02026466)
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quality of life changes after Chronic Total Occlusion angioplasty in patients with baseline refractory angina
Circulation-cardiovascular Interventions, 2019Co-Authors: Taishi Hirai, James Sapontis, Steven P Marso, William Lombardi, Dimitri Karmpaliotis, Aaron J Grantham, Jeffrey W Moses, William J Nicholso, David J Cohe, Ashish PershadAbstract:Background: Health status and quality of life improvement after Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI) among patients with refractory angina has not been reported. W...
William Lombardi - One of the best experts on this subject based on the ideXlab platform.
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a detailed analysis of perforations during Chronic Total Occlusion angioplasty
Jacc-cardiovascular Interventions, 2019Co-Authors: Taishi Hirai, James Sapontis, Steven P Marso, William Lombardi, Dimitri Karmpaliotis, Ashish Pershad, Jeffrey W Moses, William J Nicholso, Adam C Salisbury, Michael R WymaAbstract:Abstract Objectives This study sought to describe the angiographic characteristics, strategy associated with perforation, and the management of perforation during Chronic Total Occlusion percutaneous coronary intervention (CTO PCI). Background The incidence of perforation is higher during CTO PCI compared with non-CTO PCI and is reportedly highest among retrograde procedures. Methods Among 1,000 consecutive patients who underwent CTO PCI in a 12-center registry, 89 (8.9%) had core lab–adjudicated angiographic perforations. Clinical perforation was defined as any perforation requiring treatment. Major adverse cardiac events (MAEs) were defined as in-hospital death, cardiac tamponade, and pericardial effusion. Results Among the 89 perforations, 43 (48.3%) were clinically significant, and 46 (51.7%) were simply observed. MAE occurred in 25 (28.0%), and in-hospital death occurred in 9 (10.1%). Compared with nonclinical perforations, clinical perforations were larger in size, more often at a collateral location, had a high-risk shape, and less likely to cause staining or fast filling. Compared with perforations not associated with MAE, perforations associated with MAE were larger in size, more proximal or at collateral location, and had a high-risk shape. When the core lab attributed the perforation to the approach used when the perforation occurred, 61% of retrograde perforations by other classifications were actually antegrade. Conclusions Larger size, proximal or collateral location, and high-risk shapes of a coronary perforation were associated with MAE. Six of 10 perforations occurred with antegrade approaches among patients who had both strategies attempted. These finding will help emerging CTO operators understand high-risk features of the perforation that require treatment and inform future comparisons of retrograde and antegrade complications.
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patient characteristics associated with antianginal medication escalation and de escalation following Chronic Total Occlusion percutaneous coronary intervention
Circulation-cardiovascular Quality and Outcomes, 2019Co-Authors: Taishi Hirai, James Sapontis, William Lombardi, Dimitri Karmpaliotis, William J Nicholson, Mohammed Qintar, Aaron J Grantham, David J Cohen, Jeffrey W Moses, Karen NugentAbstract:Background: Prior research has shown that providers may infrequently adjust antianginal medications (AAMs) following Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI). Patient ...
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quality of life changes after Chronic Total Occlusion angioplasty in patients with baseline refractory angina
Circulation-cardiovascular Interventions, 2019Co-Authors: Taishi Hirai, James Sapontis, Steven P Marso, William Lombardi, Dimitri Karmpaliotis, Aaron J Grantham, Jeffrey W Moses, William J Nicholso, David J Cohe, Ashish PershadAbstract:Background: Health status and quality of life improvement after Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI) among patients with refractory angina has not been reported. W...
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in hospital costs and costs of complications of Chronic Total Occlusion angioplasty insights from the open cto registry
Jacc-cardiovascular Interventions, 2019Co-Authors: Adam C Salisbury, James Sapontis, William Lombardi, Dimitri Karmpaliotis, Aaron J Grantham, Jeffrey W Moses, Qingrui Meng, Elizabeth A Magnuson, Hemal Gada, Suzanne V ArnoldAbstract:Abstract Objectives The aim of this study was to describe the costs of Chronic Total Occlusion (CTO) percutaneous coronary intervention (PCI) and the association of complications during CTO PCI with costs and length of stay (LOS). Background CTO PCI generally requires more procedural resources and carries higher risk for complications than PCI of non-CTO vessels. The costs of CTO PCI using the hybrid approach have not been described, and no studies have examined the impact of complications on in-hospital costs and LOS in this population. Methods Costs were calculated for 964 patients in the 12-center OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry using prospectively collected resource utilization and billing data. Multivariate models were developed to estimate the incremental costs and LOS associated with complications. Attributable costs and LOS were calculated by multiplying the independent cost of each event by its frequency in the population. Results Mean costs for the index hospitalization were $17,048 ± 9,904; 14.5% of patients experienced at least 1 complication. Patients with complications had higher mean hospital costs (by $8,603) and LOS (by 1.5 days) than patients without complications. Seven complications were independently associated with increased costs and 6 with LOS; clinically significant perforation and myocardial infarction had the greatest attributable cost per patient. Overall, complications accounted for $911 per patient in hospital costs (5.3% of the Total costs) and 0.2 days of additional LOS. Conclusions Complications have a significant impact on both LOS and in-hospital costs for patients undergoing CTO PCI. Methods to identify high-risk patients and develop strategies to prevent complications may reduce CTO PCI costs.
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safety and efficacy of dedicated guidewire and microcatheter technology for Chronic Total coronary Occlusion revascularization principal results of the asahi intecc Chronic Total Occlusion study
Coronary Artery Disease, 2018Co-Authors: David E Kandzari, William Lombardi, William J Nicholson, Ashish Pershad, Jeffrey W Moses, Dimitrios Karmpaliotis, James Aaron Grantham, Stephen Cook, Jeffrey J PopmaAbstract:BackgroundLimited study has detailed the procedural outcomes and utilization of contemporary coronary guidewires and microcatheters designed for Chronic Total Occlusion (CTO) percutaneous revascularization and with application of modern techniques.Patients and methodsA prospective, multicenter, sing