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What is the Clinical Benefit of Coronary Chronic Total Occlusions Treatment by Percutaneous Coronary Intervention? 2-year experience in angiography laboratory.
Session:
Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker:
Hugo Costa
Congress:
CPC 2021
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters
FP Number:
---
Authors:
Hugo Alex Costa; Raquel Menezes Fernandes; Miguel Espírito Santo; Teresa Faria Da Mota; João De Sousa Bispo; Daniela Carvalho; Ana Marreiros; Hugo Palmeiro; João Pedro Moura Guedes; Hugo Vinhas; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Coronary chronic total occlusions (CTO) are relatively common findings in the context of coronary angiography. The indication for revascularization of this type of lesions remains controversial. The recommendations of international cardiology societies consider the treatment of CTO by percutaneous coronary intervention (PCI) in selected patients, but this technique is not yet widely used in this context.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives: </strong>Characterize the patient population undergoing CTO PCI and analyze its clinical benefit. Also, try to identify patient profiles according to the composite outcome (angina, heart failure symptoms (HF), myocardial infarction (MI) or death) in short and medium term (30 days (D) and 180D).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Observational and retrospective study with descriptive and comparative analysis of patients submitted to CTO PCI, between 1 January 2019 and 31 December 2020. A descriptive analysis was carried out. Chi-Square test was used for categorical variables and the T-Student test for numerical variables, with a significance level of 95%. CHIAD algorithm was applied to identify patient profiles, whose dependent variable was the presence or absence of the composite outcome (fixed 15 parent nodes- 5 children nodes). For statistical analysis, SPSS 24.0 was used.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> N177 patients were identified, with a mean age of 65.4 years (standard deviation of 11.1), 51% were female. The most frequent location of CTO was the right coronary artery in 41.2%. The composite outcome occurred in 23% (30D) and 16% (180D) of patients, regardless of past medical history. Angina was present in 9.4% (30D) and 5.3% (180D); HF symptoms in 12.3% (30D) and 5.3% (180D); MI in 2% (180D) mortality in 1.8% (30D) and 4.7% (180D). The complication rate was 5.1%, mostly cardio-respiratory arrest (2.5%) and vessel dissection (1.7%). In a logic of dependence and profiles, patients with LVEF>36% (80.1%-p=0.017), without HF symptoms (82.9%-p=0.007) and non-smokers/ ex-smokers (87.6%-p=0.043), were those with the greatest benefit at 30D. Patients with a history of non-ST segment elevation MI (24.5%-p=0.018) and chronic kidney diseade</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> (37.5%-p=0.048) were those with most occurrences presented at 180D.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>This analysis highlights the experience of the angiography laboratory. In this pool, the majority of patients experienced evident clinical improvement and recovered in short and medium term. The rate of serious events during and after the procedure was low. This analysis suggests that the greatest benefit were found in patients with LVEF>36%, who didn´t develop post-procedure HF symptoms and in non-smokers/ex-smokers.</span></span></p>
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