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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Early procedural results and outcomes after chronic total occlusion angioplasty: experience of atreatment program
Session:
Posters 1 - Écran 2 - Doença Coronária
Speaker:
Ana Vera Marinho
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.4 Coronary Artery Disease – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Ana Vera Marinho; Joana M. Ribeiro; Luís Graça Santos; Célia Domingues; Patrícia M. Alves; Manuel Oliveira Santos; Luís Candal Leite; Luis Paiva; Hilário Oliveira; Francisco Gonçalves; Elisabete Jorge; Joana Delgado Silva; Vitor Azevedo Matos; Marco Costa; Lino Gonçalves
Abstract
<p><strong>BACKGROUND:</strong> Coronary chronic total occlusions (CTOs) are routinely found in patients undergoing coronary angiography. In recent years, the success rate of CTO intervention have increased, driven by advances in material and interventional techniques, without compromising patent safety. We aimed to describe the characteristics, procedural aspects and clinical outcomes of a structured CTO program.</p> <p><strong>METHODS:</strong> We conducted a prospective, cohort study including all consecutive patients enrolled in our CTO program from December, 2013 to November, 2018. Angiographic data included the number of diseased vessels, the SYNTAX score and the Japanese CTO (J-CTO) score. We defined a co-primary safety outcome (procedure-related complications) and a co-primary efficacy outcome (procedural success). A follow-up with a mean duration of 470 ± 420 days was conducted. Secondary, exploratory endpoints included death, myocardial infarction (MI) and target lesion revascularization (TVR); CCS and NYHA class assessment; and impact on left ventricular ejection fraction (LVEF) on follow-up.</p> <p><strong>RESULTS:</strong> A total of 195 patients (mean age 66±10 years, 81% male) with 202 CTO lesions were included. Most patients were hypertensive (79.3%), had dyslipidemia (82.4%) and a BMI > 25.kg.m<sup>-2</sup> (87.1%); 35.6% were diabetic, 32.6% were smokers and a third had a prior history of MI. The indication for a CTO procedure was angina in 78.0%, viable heart failure in 9.2% and ventricular arrhythmias in 1.2%. The mean J-CTO score was 2.0±0.8 and 54.5% of patients had multivessel disease. Regarding the technical procedure, 89.7% were performed via the anterograde wire-escalation technique and 10.3% performed as variants of the retrograde technique. Bilateral injection was used in 51.3% of patients. The primary efficacy co-endpoint (procedure success rate) occurred in 92.8% of patients (in 91.7% at the first 1 attempt). The primary safety co-endpoint occurred in (n=9) 4.0% of patients and included: stroke in peri procedural period in 1 patient, perforation in 3 pts (these 1 needed of pericardicocentesis), local heamatoma in2 pts and distal embolization/important side branch occlusion in 3 pts in 1 patient. Secondary endpoints incidence during follow-up included 7 (4.6%) mortality events, 2 of them cardiovascular deaths (not-procedure related). Admissions for ACS occurred in 1.5% (3 pts). TVR occurred in 5 patients (2.6%). CCS class decreased following a successful CTO treatment in 90.3% of patients (2.1 ±0.9 vs 0.6±0.6, p<0.01). Regarding LVEF variation after a successful CTO intervention, we found a significant increase (48% vs. 52%, p =0.01).</p> <p><strong>CONCLUSIONS: </strong>In this large cohort of CTO patients, we found a high success rate (93%) with a low complication rate. A successful CTO PCI was associated with important symptomatic relief and a significant increase in LVEF.</p>
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