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1.
Circ Cardiovasc Interv ; 12(3): e007338, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30871357

RESUMO

BACKGROUND: We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG). METHODS AND RESULTS: We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32% of total cohort) were older (67±9 versus 63±10 years; P<0.001) and had more comorbidities and lower left ventricular ejection fraction (50% [40-58] versus 55% [45-60]; P<0.001). The CTO target vessel in prior CABG patients was the right coronary artery (56%), circumflex (26%), and left anterior descending artery (17%). The mean J-CTO (2.9±1.2 versus 2.2±1.3; P<0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; 1.5±1.1 versus 1.2±1.0; P<0.001) score was higher in prior CABG patients. Retrograde (53% versus 30%, P<0.001) and antegrade dissection reentry (35% versus 28%; P<0.001) techniques were used more frequently in prior CABG patients. Prior CABG patients had lower technical (84% versus 89%; P<0.001) and procedural (82% versus 87%, P<0.001) success, but similar incidence of in-hospital major complications (3.1% versus 2.5%; P=0.287). In-hospital mortality (1% versus 0.4%; P=0.016) and coronary perforation (7.1% versus 3.1%; P<0.001) occurred more frequently in prior CABG patients, however, CABG patients had a lower incidence of pericardial tamponade (0.1% versus 1.0%; P=0.002) and pericardiocentesis (0% versus 1.3%; P<0.001). CONCLUSIONS: In a large multicenter CTO percutaneous coronary interventions registry, prior CABG patients had lower success rate but similar overall risk for complications, although mortality was higher and the incidence of tamponade was lower. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02061436.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Oclusão Coronária/terapia , Intervenção Coronária Percutânea , Idoso , Doença Crônica , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/mortalidade , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/mortalidade , Europa (Continente) , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Estudos Retrospectivos , Fatores de Risco , Federação Russa , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
2.
Am J Cardiol ; 123(9): 1422-1428, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30798947

RESUMO

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 <0.0001) and had higher Japan-chronic total occlusion score (3.0 ± 1.2 vs 2.4 ± 1.3, p <0.0001). CTO PCI cases in which atherectomy was used had similar technical (91% vs 87%, p = 0.240) and procedural (90% vs 85%, p = 0.159) success and in-hospital major adverse cardiac event (4% vs 3%, p = 0.382) rates. However, atherectomy cases were associated with higher rates of donor vessel injury (4% vs 1%, p = 0.031), tamponade requiring pericardiocentesis (2.6% vs 0.4%, p = 0.012) and more often required use of a left ventricular assist device (9% vs 5%, p = 0.031). Atherectomy cases were associated with longer procedural duration (196 [141, 247] vs 119 [76, 180] minutes, p <0.0001), and higher patient air kerma radiation dose (3.6 [2.5, 5.6] vs 2.8 [1.6, 4.7] Gray, p = 0.001). In conclusion, atherectomy is currently performed in approximately 3% of CTO PCI cases and is associated with similar technical and procedural success and overall major adverse cardiac event rates, but higher risk for donor vessel injury and tamponade.


Assuntos
Aterectomia/métodos , Oclusão Coronária/cirurgia , Vasos Coronários/cirurgia , Sistema de Registros , Idoso , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
3.
Catheter Cardiovasc Interv ; 69(6): 902-7, 2007 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-17192944

RESUMO

OBJECTIVE: To assess the impact of stent revascularization on the renal function of diabetic and nondiabetic patients with renal insufficiency. BACKGROUND: Renal artery revascularization has been shown to stabilize or improve renal function in patients with significant renal artery stenosis and impaired renal function. However, some studies have suggested negligible or no benefit of renal function in diabetic patients with the same condition. METHODS: We retrospectively compared data from 50 consecutive patients undergoing renal artery stent placement with renal insufficiency (serum creatinine > or = 1.5-4.0 mg/dl) and global ischemia (bilateral or solitary [single] kidney renal artery stenosis) There were 17 diabetic (DM) and 33 nondiabetic (NDM) patients. The endpoints included the follow-up measurements of renal function, blood pressure, and number of antihypertensive medications. RESULTS: After stent placement, at a mean follow-up of 42 +/- 18 months (range: 6-62 months), 79% NDM (N = 26), and 76% DM patients (N = 13) (P = NS) had improvement in the slope of the reciprocal of creatinine (1/SCr), indicating a beneficial effect in renal function in many patients. CONCLUSION: Renal artery stent placement appears to be equally beneficial in preserving renal function in DM and NDM patients with ischemic nephropathy and global renal ischemia.


Assuntos
Nefropatias Diabéticas/cirurgia , Isquemia/complicações , Rim/fisiopatologia , Obstrução da Artéria Renal/cirurgia , Insuficiência Renal Crônica/etiologia , Stents , Procedimentos Cirúrgicos Vasculares/instrumentação , Idoso , Azotemia/etiologia , Azotemia/fisiopatologia , Pressão Sanguínea , Creatinina/sangue , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/fisiopatologia , Feminino , Seguimentos , Humanos , Isquemia/sangue , Isquemia/etiologia , Isquemia/fisiopatologia , Isquemia/cirurgia , Rim/irrigação sanguínea , Testes de Função Renal , Masculino , Obstrução da Artéria Renal/sangue , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/fisiopatologia , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/cirurgia , Projetos de Pesquisa , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
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