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Percutaneous coronary revascularization of a chronic total occlusion: efficacy on symptoms, left ventricular ejection fraction and mid-term prognosis outcomes
6
Coronary heart disease
discharge treatment with DOA or VKA was a predictive factor of CMB progression 3 M after AMI:OR = 13.8 [1.11—173.5]. No significant differences between the two groups with regard to CRUSADE and BLEEDING Risk haemorrhage scores were noted. Neither ICH nor ischemic stroke were observed. Conclusion MRI-detected CMB was common and may even early increase after AMI. Our results highlight that the association of DOA or VKA with dual antiplatelet therapy at hospital discharge could be an independent risk factor of CMB progression. Larger population studies are needed to address antiplatelet therapy duration and dose of DOA as potential risk factors for CMB progression. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.003
Fig. 1 Angina pectoris symptoms evolution according to success or failure of CTO-PCI (median follow-up: 450 days).
038
Percutaneous coronary revascularization of a chronic total occlusion: efficacy on symptoms, left ventricular ejection fraction and mid-term prognosis outcomes H. Mesrar ∗ , L. Faroux , V. Heroguelle , T. Blanpain , P. Nazeyrollas , S. Tassan-Mangina , D. Metz Cardiologie et pathologies vasculaires, CHU de Reims, Hôpital Robert Debré, Reims, France ∗ Corresponding author. Adresse e-mail : [email protected] (H. Mesrar) Background The interest of coronary chronic total occlusion (CTO) revascularization by percutaneous angioplasty (PCI) remains debated. Purpose To study the effectiveness of CTO-PCI on angina pectoris symptoms as the primary endpoint, on LVEF evolution and mid-term prognosis outcomes as the secondary endpoints. Methods All patients who benefited from a CTO-PCI attempt in our center over a period of 48 months were included. The major adverse cardiovascular event (MACE) composite criteria included all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, and any new coronary revascularization (Table 1). Results One hundred and thirty-nine patients were included with a median follow-up of 450 days. A procedural success was obtained for 88% of the patients. A decrease in the proportion of patients with angina pectoris symptoms (P < 0.001) and an improvement in LVEF when it was impaired (P < 0.001) were demonstrated in the ‘‘Procedural success’’ group, unlike the ‘‘Procedural failure’’ group (respectively P = 1 and P = 0.07). Finally, there was a tendency to an improvement in the risk of MACE in the ‘‘Procedural success’’ group (HR = 0.60, 95% CI 0.23 to 1.56, P = 0.3) (Fig. 1). Conclusion A success of percutaneous CTO revascularization allowed in our study to decrease drastically the symptomatology of angina pectoris, and to improve the LVEF by on average 10 points, without a significant relationship between successful CTO-PCI and patient prognosis improvement. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.004
Table 1
Description of the study population. Study population (n = 139)
Age (years) Male, n(%) Diabete mellitus, n(%) Arterial hypertension, n(%) Smoking, n(%) Dyslipidaemia, n(%) Familial history of CVD, n(%) BMI (kg/m2 ) Previous MI, n(%) Angina pectoris, n(%) Multitroncular, n(%) Complete revascularization, n(%) RCA, n(%) Japenese-CTO Score Procedural success, n(%) LVEF initial
65 ± 10 118 (85) 51 (37) 84 (60) 103 (74) 92 (66) 59 (42) 28 ± 5 62 (45) 92 (66) 106 (76) 64 (46) 79 (57) 1,4 ± 1,2 123 (88) 53 ± 10
CVD: Cardiovascular disease; BMI: Body mass index; MI: Myocardial infarction; RCA: Right coronary artery; LVEF: Left ventricular ejection fraction.
183
Comparison of long-term outcomes between men and women after percutaneous coronary intervention N. Procopi ∗ , M. Zeitouni , M. Kerneis , N. Hammoudi , E. Berman , O. Barthélémy , R. Choussat , P. Guedeney , N. Braik , J. Silvain , C. Le Feuvre , G. Helft Cardiologie, Institut de Cardiolgie de la Pitié-Salpêtrière, Paris, France ∗ Corresponding author. Adresse e-mail : [email protected] (N. Procopi) Background Differences between long-term outcomes among women and men treated by percutaneous intervention (PCI) are unknown. Purpose To compare characteristics mortality and impact of gender on poor outcomes after PCI. Methods Consecutive men and women admitted for PCI between 2008 and 2011 were prospectively included and followed-up until January 2019. Major adverse cardiovascular and cerebrovascular events (MACCE) and causes of death were collected through consultations, calls and death certificates. The primary endpoint was all-cause mortality according to gender. Secondary endpoints were cardiovascular death, non-cardiovascular death and MACCEs. Results A total of 3524 patients including 2720 men (77.1%) and 804 women (22.8%) were followed-up for a median time of 7.0 years (IQ1: 5.4; IQ 3: 7.2) with a follow rate of 97.6%. At baseline, women
Coronary heart disease
discharge treatment with DOA or VKA was a predictive factor of CMB progression 3 M after AMI:OR = 13.8 [1.11—173.5]. No significant differences between the two groups with regard to CRUSADE and BLEEDING Risk haemorrhage scores were noted. Neither ICH nor ischemic stroke were observed. Conclusion MRI-detected CMB was common and may even early increase after AMI. Our results highlight that the association of DOA or VKA with dual antiplatelet therapy at hospital discharge could be an independent risk factor of CMB progression. Larger population studies are needed to address antiplatelet therapy duration and dose of DOA as potential risk factors for CMB progression. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.003
Fig. 1 Angina pectoris symptoms evolution according to success or failure of CTO-PCI (median follow-up: 450 days).
038
Percutaneous coronary revascularization of a chronic total occlusion: efficacy on symptoms, left ventricular ejection fraction and mid-term prognosis outcomes H. Mesrar ∗ , L. Faroux , V. Heroguelle , T. Blanpain , P. Nazeyrollas , S. Tassan-Mangina , D. Metz Cardiologie et pathologies vasculaires, CHU de Reims, Hôpital Robert Debré, Reims, France ∗ Corresponding author. Adresse e-mail : [email protected] (H. Mesrar) Background The interest of coronary chronic total occlusion (CTO) revascularization by percutaneous angioplasty (PCI) remains debated. Purpose To study the effectiveness of CTO-PCI on angina pectoris symptoms as the primary endpoint, on LVEF evolution and mid-term prognosis outcomes as the secondary endpoints. Methods All patients who benefited from a CTO-PCI attempt in our center over a period of 48 months were included. The major adverse cardiovascular event (MACE) composite criteria included all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, and any new coronary revascularization (Table 1). Results One hundred and thirty-nine patients were included with a median follow-up of 450 days. A procedural success was obtained for 88% of the patients. A decrease in the proportion of patients with angina pectoris symptoms (P < 0.001) and an improvement in LVEF when it was impaired (P < 0.001) were demonstrated in the ‘‘Procedural success’’ group, unlike the ‘‘Procedural failure’’ group (respectively P = 1 and P = 0.07). Finally, there was a tendency to an improvement in the risk of MACE in the ‘‘Procedural success’’ group (HR = 0.60, 95% CI 0.23 to 1.56, P = 0.3) (Fig. 1). Conclusion A success of percutaneous CTO revascularization allowed in our study to decrease drastically the symptomatology of angina pectoris, and to improve the LVEF by on average 10 points, without a significant relationship between successful CTO-PCI and patient prognosis improvement. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.004
Table 1
Description of the study population. Study population (n = 139)
Age (years) Male, n(%) Diabete mellitus, n(%) Arterial hypertension, n(%) Smoking, n(%) Dyslipidaemia, n(%) Familial history of CVD, n(%) BMI (kg/m2 ) Previous MI, n(%) Angina pectoris, n(%) Multitroncular, n(%) Complete revascularization, n(%) RCA, n(%) Japenese-CTO Score Procedural success, n(%) LVEF initial
65 ± 10 118 (85) 51 (37) 84 (60) 103 (74) 92 (66) 59 (42) 28 ± 5 62 (45) 92 (66) 106 (76) 64 (46) 79 (57) 1,4 ± 1,2 123 (88) 53 ± 10
CVD: Cardiovascular disease; BMI: Body mass index; MI: Myocardial infarction; RCA: Right coronary artery; LVEF: Left ventricular ejection fraction.
183
Comparison of long-term outcomes between men and women after percutaneous coronary intervention N. Procopi ∗ , M. Zeitouni , M. Kerneis , N. Hammoudi , E. Berman , O. Barthélémy , R. Choussat , P. Guedeney , N. Braik , J. Silvain , C. Le Feuvre , G. Helft Cardiologie, Institut de Cardiolgie de la Pitié-Salpêtrière, Paris, France ∗ Corresponding author. Adresse e-mail : [email protected] (N. Procopi) Background Differences between long-term outcomes among women and men treated by percutaneous intervention (PCI) are unknown. Purpose To compare characteristics mortality and impact of gender on poor outcomes after PCI. Methods Consecutive men and women admitted for PCI between 2008 and 2011 were prospectively included and followed-up until January 2019. Major adverse cardiovascular and cerebrovascular events (MACCE) and causes of death were collected through consultations, calls and death certificates. The primary endpoint was all-cause mortality according to gender. Secondary endpoints were cardiovascular death, non-cardiovascular death and MACCEs. Results A total of 3524 patients including 2720 men (77.1%) and 804 women (22.8%) were followed-up for a median time of 7.0 years (IQ1: 5.4; IQ 3: 7.2) with a follow rate of 97.6%. At baseline, women