scholarly journals Causal Models for the Result of Percutaneous Coronary Intervention in Coronary Chronic Total Occlusions

2021 ◽  
Vol 11 (19) ◽  
pp. 9258
Author(s):  
Maria Ganopoulou ◽  
Ioannis Kangelidis ◽  
Georgios Sianos ◽  
Lefteris Angelis
Keyword(s):  
Predictive Model ◽  
Causal Structure ◽  
Model Development ◽  
Coronary Intervention ◽  
Causal Models ◽  
Percutaneous Coronary Interventions ◽  
Graph Structure ◽  
Chronic Total Occlusions ◽  
Operator Experience ◽  
Percutaneous Coronary

Background: Patients undergoing coronary angiography very frequently exhibit coronary chronic total occlusions (CTOs). Over the last decade, there has been an increasing acceptance of the percutaneous coronary interventions (PCI) in CTOs due to, among else, rising operator experience and advances in technology. This study is an effort to address the problem of identifying important factors related to the success or failure of the PCI. Methods: The analysis is based on the EuroCTO Registry, which is the largest database available worldwide, consisting of 164 variables and 29,995 cases for the period 2008–2018. The aim is to assess the dynamics of causal models and causal discovery, using observational data, in predicting the result of the PCI. Causal models use graph structure to assess the cause–effect relationships between variables. In this study, the constrained-based algorithm PC was employed. The focus was to find the local causal structure around the PCI result and use it as a feature selection tool for building a predictive model. Results: The model developed was compared with other modeling approaches from the literature, and it was found to perform equally well or better. Conclusions: The analysis showcased the potential of employing local causal structure in predictive model development.

scholarly journals Procedural Success Prediction Scoring Systems Used in Percutaneous Coronary Interventions for Chronic Total Occlusions: A Systematic Evaluation

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 1033
Author(s):  
Crischentian Brinza ◽  
Iolanda Valentina Popa ◽  
Alexandru Basarab ◽  
Radu Crisan-Dabija ◽  
Alexandru Burlacu
Keyword(s):  
Complex Interventions ◽  
Real Life ◽  
Scoring Systems ◽  
Predictive Performance ◽  
Coronary Intervention ◽  
Systematic Evaluation ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Operator Experience ◽  
Percutaneous Coronary

(1) Background: Data suggest that patients with coronary chronic total occlusion (CTO) managed with percutaneous coronary intervention (PCI) could have better outcomes than those treated with optimal medical therapy alone. We aimed to systematically review dedicated scoring systems used to predict successful PCI in patients with CTO. (2) Methods: Electronic databases of MEDLINE (PubMed), Embase, and Cochrane were searched. (3) Results: 32 studies were included. We provided insights into all available predictive models of PCI success in CTO including predictive performance, validations, and comparisons between different scores and models’ limitations. Considering the differences in the population included, coronary lesions, and techniques applied across clinical studies, the most used scores displayed a modest to good predictive value, as follows: J-CTO (AUC, 0.55–0.868), PROGRESS-CTO (AUC, 0.557–0.788), CL (AUC, 0.624–0.800), CASTLE (AUC, 0.633–0.68), and KCCT (AUC, 0.703–0.776). As PCI for CTO is one of the most complex interventions, using dedicated scoring systems could ensure an adequate case selection as well as preparation for an appropriate recanalization technique in order to increase chances of successful procedure. (4) Conclusion: Clinical models appear to be valuable tools for the prediction of PCI success in CTO patients. Clinicians should be aware of the limitations of each model and should be able to correctly select the most appropriate score according to real-life case particularities such as lesion complexity and operator experience in order to maximize success and achieve the best patients’ outcomes.

scholarly journals Common and Uncommon CTO complications

2018 ◽  
Vol 13 (3) ◽  
pp. 121 ◽  
Author(s):  
Johannes Rigger ◽  
Colm G. Hanratty ◽  
Simon J Walsh ◽  
◽  
◽  
...  
Keyword(s):  
Interventional Cardiology ◽  
Haemodynamic Instability ◽  
Percutaneous Coronary Interventions ◽  
Efficient Manner ◽  
Chronic Total Occlusions ◽  
Operator Experience ◽  
Percutaneous Coronary ◽  
Timely Fashion ◽  
Ongoing Development ◽  
Artery Disease

Despite the ongoing development of technical skills, increasing operator experience and improvements in medical devices, percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) are still the most challenging procedures in interventional cardiology for coronary artery disease. Due to the complexity of the procedury have a higher complication rate than PCI interventions for the treatment of non-occlusive disease. This may significantly increase procedural morbidity and potentially mortality. CTO-PCI related complications include all the usual complications that are seen in routine PCI in addition to unique issues such as inadvertent occlusion of donor vessels or injury of collateral channels causing haemodynamic instability or ischaemia. To minimise the morbidity associated with these procedures, it is important to be aware of potential complications and recognise them in a timely fashion. Should they arise, operators should be able to deal with them in a safe and efficient manner.

scholarly journals TCTAP A-054 Percutaneous Coronary Intervention in Nonagenarians: A Single Operator Experience

2021 ◽  
Vol 77 (14) ◽  
pp. S33
Author(s):  
Harinder K. Bali ◽  
Amreen Dhindsa ◽  
Kapil K. Chattree ◽  
Gagandip Singh ◽  
Navdeep Singh Sidhu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Operator Experience ◽  
Percutaneous Coronary ◽  
Single Operator

P5.21 PERCUTANEOUS CORONARY INTERVENTIONS OF CHRONIC TOTAL OCCLUSIONS: GENDER DIFFERENCES – SINGLE CENTER EXPERIENCE

2015 ◽  
Vol 12 (C) ◽  
pp. 24
Author(s):  
Leszek Bryniarski* ◽  
Slawomir Surowiec ◽  
Lukasz Klima ◽  
Michal Terlecki ◽  
Piotr Jankowski ◽  
...  
Keyword(s):  
Gender Differences ◽  
Percutaneous Coronary Interventions ◽  
Single Center ◽  
Chronic Total Occlusions ◽  
Coronary Interventions ◽  
Single Center Experience ◽  
Percutaneous Coronary

The impact of gender on outcomes in patients with chronic total coronary occlusions undergoing percutaneous coronary intervention: results from a Dutch nationwide registry including 7560 patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Van Veelen ◽  
J Elias ◽  
I.M Van Dongen ◽  
J.P.S Henriques ◽  
P Knaapen
Keyword(s):  
Cardiovascular Disease ◽  
Percutaneous Coronary Intervention ◽  
Survival Curve ◽  
Coronary Intervention ◽  
Chronic Total Occlusions ◽  
Nationwide Registry ◽  
Percutaneous Coronary ◽  
Baseline Characteristics ◽  
Gender Based ◽  
The Impact

Abstract Background Females comprise a minority of patients with chronic total occlusions (CTO). It is known that men have a greater benefit from CTO percutaneous coronary intervention (PCI) than women. We aimed to determine gender-based differences in baseline characteristics and outcomes after PCI in patients with CTO. Methods The Netherlands Heart Registration (NHR) is a nationwide registry that registers outcomes of cardiac interventions. For the purpose of this analysis, the data of all patients undergoing PCI from inception of the NHR to December 2018 were selected, that included PCI with at least one CTO in one of the treated coronary arteries. We compared baseline characteristics and the outcomes 1 year mortality, 30 day myocardial infarction (MI) and target vessel revascularization (TVR) <1 year between men and women. Results A total of 7560 patients were identified that underwent PCI between January 1, 2015 and December 31, 2018 with at least 1 CTO in the treated vessel. A total of 5850 was male (77.4%) and 1710 was female (22.6%). Women were older (68.5±10.6 versus 64.7±10.6 years old, p<0.001), and more frequently had diabetes (29.4% [n=529] versus 25.0% [n=1602], p<0.001) and kidney disease (4.5% [n=529] versus 2.2% [n=142], p<0.001). However, men had more extensive cardiovascular disease, i.e. multi-vessel disease (56.0% [n=3584] versus 50.4% [n=912], p<0.001), previous MI (39.7% [n=2527] versus 31.0% [n=555], p<0.001), previous PCI (48.2% [n=1967] versus 40.2% [n=455], p<0.001) and previous coronary artery bypass grafting (16.8% [n=1085] versus 10.5% [n=191], p<0.001) and more frequently presented with an out-of-hospital cardiac arrest, compared to women (2.1% [n=136] versus 1.1% [n=20], p=0.004). The 1-year mortality was higher in women (10.3% versus 7.5%, p<0.001), as well as the 30-day MI (0.9% versus 0.4%, p=0.043), but men had higher risk for TVR<1 year (11.7% versus 9.5%, p=0.044). Corrected for age and comorbidities, female gender was an independent predictor for mortality (Figure 1; odds ratio 1.83, 95% confidence interval 1.08–3.11, p=0.025). Conclusion In this nationwide registry comprising 7560 CTO patients undergoing PCI, significant gender-based differences were found. Males were found to have more extensive cardiovascular disease. However, females were at higher risk of mortality, possibly due to higher age and higher prevalence of concomitant comorbidities. Figure 1. Survival curve Funding Acknowledgement Type of funding source: None

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