- Email: [email protected]
TCTAP A-067 Treatment of Chronic Total Occlusions in Native Coronary Arteries by Drug-coated Balloons Without Stenting
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
TCTAP A-067 Treatment of Chronic Total Occlusions in Native Coronary Arteries by Drug-coated Balloons Without Stenting Philine Jascha Koeln,1 Bruno Scheller,2 Houng Bang Liew,3 Tuomas Rissanen,4 Wan Azman Wan Ahmad,5 Amin Ariff Nuruddin,6 Hee Hwa Ho,7 Antonia Schulz,8 Franz X. Kleber9 1 Charite - Universitaetsmedizin Berlin, Germany; 2University of Saarland, Germany; 3Queen Elizabeth Hospital II, Malaysia; 4Heart Center, Finland; 5University Malaya Medical Center, Malaysia; 6Institut Jantung Negara, Malaysia; 7Tan Tock Seng Hospital, Singapore; 8 Deutsches Herzzentrum Berlin, Germany; 9Cardio Centrum Berlin, Academic Teaching Institution of Charite - Universitaetsmedizin Berlin, Germany BACKGROUND Chronic total occlusions remain one of the biggest challenges for interventional cardiologists. Even though success rates and long-term outcome improved over the last decade, the higher risk of restenosis and stent thrombosis is still a major problem. Drugcoated balloons showed favorable results for the treatment of in-stent restenosis and other lesion types with a low incidence of restenosis and adverse cardiac events. The aim of this study was to evaluate the feasibility and short-term outcome of a drug-coated balloon only approach in patients with chronic total occlusion. METHODS We included 34 patients with a native chronic total occlusion treated only by drug-coated balloons without bail-out stenting. A visual residual stenosis of 30% or less without major dissection (type C or higher) was considered a satisfactory percutaneous intervention result according to the German Consensus Group recommendations and the criteria used in the CADDILAC study. Baseline clinical and procedural data as well as clinical data at follow-up were collected. Angiograms were conducted before and immediately after the procedure and at follow-up. Quantitative coronary analysis of all angiograms was performed by independent investigators and mean and minimal lumen diameter and late luminal gain were assessed. RESULTS The recanalization was considered satisfactory according to the German Consensus Group recommendations in 79.4% (n¼27). Restenosis occurred in 11.8% (n¼4) and reocclusion in 5.9% (n¼2). Out of the 27 patients with a satisfactory initial predilatation result 3.7% (n¼1) had reocclusion and 3.7% (n¼1) had restenosis. Major adverse cardiac events occurred in 17.6% (n¼6) of all patients and in 7.4% (n¼2) of patients with satisfactory predilatation results. Mean late luminal gain was 0.11 0.49 mm and mean angina class improved significantly from 2.45 1.02 before intervention to 1.39 0.92 at follow-up (p<0.001). There was no death and no myocardial infarction.
S37
S38
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
TCTAP A-173 Clinical Outcomes of Successful Chronic Total Occlusion Percutaneous Coronary Intervention Using the Retrograde Approach Osung Kwon,1 Do-Yoon Kang,1 Se Hun Kang,1 Pil Hyung Lee,1 Jung-Min Ahn,1 Duk-Woo Park,1 Soo-Jin Kang,1 Seung-Whan Lee,1 Young-Hak Kim,1 Cheol Whan Lee,1 Seong-Wook Park,1 Seung-Jung Park1 1 Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of) BACKGROUND Despite widespread use of the retrograde approach for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), the clinical outcomes have not been well established.
CONCLUSION Drug-coated balloon angioplasty without stenting is a feasible and well-tolerated treatment method in patients with chronic total occlusion if the predilatation result is sufficient according to the German Consensus Group recommendations.
METHODS Among 815 patients who underwent successful CTO PCI between January 2007 and June 2015, 187 (22.9%) who received retrograde approach were compared with 628 who received antegrade-only. The primary endpoint was target vessel failure (TVF) defined as a composite of cardiac death, target vessel myocardial infarction (TV-MI), or target vessel revascularization/reocclusion.
TCTAP A-068 Impact of Percutaneous Coronary Intervention for Chronic Total Occlusion Patients with Near-normal Left Ventricular Function Li Hu,1 Seung-Woon Rha,1 Byoung Geol Choi,1 Se Yeon Choi,1 Jae Kyeong Byun,1 Min Shim,1 Jun Hyuk Kang,1 Woo Hyeun Kim,1 Sung Hun Park,1 Eun Jin Park,1 Jah Yeon Choi,1 Sunki Lee,1 Jin Oh Na,1 Cheolung Choi,1 Hong Euy Lim,1 Jin Won Kim,1 Eung Ju Kim,1 Chang Gyu Park,1 Hong Seog Seo,1 Dong Joo Oh1 1 Korea University Guro Hospital, Korea (Republic of) BACKGROUND Left ventricular ejection fraction (LVEF) is a powerful predictor of prognosis in patients with coronary artery disease. The benefit of successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) patients with reduced EF has been investigated, however, there are very limited data regarding the benefit of PCI for CTO patients with near-normal left ventricular (LV) function. METHODS A total of 194 consecutive CTO patients with normal or near-normal LV function (EF>50%) underwent PCI or optimal medical therapy (OMT) were enrolled. The patients were divided into two groups according to treatment strategies; 1) the OMT group (n¼86) and 2) the PCI group (n¼108). To adjust for potential confounders, analysis was performed using the logistic regression model. Individual hard endpoints and major adverse cardiac events(MACE), defined as the composite of total death, myocardial infarction (MI), stroke and revascularization, were compared between the two groups up to 5 years. RESULTS Baseline clinical characteristics were similar between the two groups, Major clinical outcomes up to 5 years were significantly different between the two groups; Total major adverse cardiac events (MACE30.2% vs. 13.9%, p¼0.012), total death (11.6% vs. 1.9%, p¼0.009), cardiac death or MI (16.3% vs. 13.9%, p¼0.012). However, the incidence of target lesion and vessel revascularization (TLR)MACE (9.1% vs. 8.3%, p¼0.919) and target vessel revascularization (TVR)-MACE (9.1% vs. 8.3% p¼0.919) were similar in both groups (Table). CONCLUSION In this study, PCI for CTO patients even with normal or near-normal LVEF has a beneficial effect in reducing the incidence of individual and composite MACE up to 5 years.
RESULTS Compared with antegrade-only approach group, retrogradeattempt group had higher J-CTO score (2.5 1.0 vs. 1.8 1.0), longer lesion length (52.2 21.4 vs. 37.2 18.1 mm), and more CTOs located at left anterior descending artery (46.0 vs. 42.5%, all p<0.05) consequently requiring more and longer stent implantation. During a median of 4.3 years of follow-up, the cumulative incidence of TVF in the retrogradeattempt group was significantly higher than the antegrade-only approach group (12.9% vs. 6.0%, P¼0.01) mainly attributable to higher rates of target vessel revascularization/reocclusion (9.7 2.5 vs. 3.4 0.8, P¼0.01). The rates of cardiac death and TV-MI did not differ between groups. The higher risk of TVF (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.04–3.37, P¼0.04) and target-vessel revascularization/ reocclusion (HR 2.03,95% CI 1.07–3.85, P¼0.03) for retrograde attempt group remained significant after multivariable adjustment.
TCTAP A-067 Treatment of Chronic Total Occlusions in Native Coronary Arteries by Drug-coated Balloons Without Stenting Philine Jascha Koeln,1 Bruno Scheller,2 Houng Bang Liew,3 Tuomas Rissanen,4 Wan Azman Wan Ahmad,5 Amin Ariff Nuruddin,6 Hee Hwa Ho,7 Antonia Schulz,8 Franz X. Kleber9 1 Charite - Universitaetsmedizin Berlin, Germany; 2University of Saarland, Germany; 3Queen Elizabeth Hospital II, Malaysia; 4Heart Center, Finland; 5University Malaya Medical Center, Malaysia; 6Institut Jantung Negara, Malaysia; 7Tan Tock Seng Hospital, Singapore; 8 Deutsches Herzzentrum Berlin, Germany; 9Cardio Centrum Berlin, Academic Teaching Institution of Charite - Universitaetsmedizin Berlin, Germany BACKGROUND Chronic total occlusions remain one of the biggest challenges for interventional cardiologists. Even though success rates and long-term outcome improved over the last decade, the higher risk of restenosis and stent thrombosis is still a major problem. Drugcoated balloons showed favorable results for the treatment of in-stent restenosis and other lesion types with a low incidence of restenosis and adverse cardiac events. The aim of this study was to evaluate the feasibility and short-term outcome of a drug-coated balloon only approach in patients with chronic total occlusion. METHODS We included 34 patients with a native chronic total occlusion treated only by drug-coated balloons without bail-out stenting. A visual residual stenosis of 30% or less without major dissection (type C or higher) was considered a satisfactory percutaneous intervention result according to the German Consensus Group recommendations and the criteria used in the CADDILAC study. Baseline clinical and procedural data as well as clinical data at follow-up were collected. Angiograms were conducted before and immediately after the procedure and at follow-up. Quantitative coronary analysis of all angiograms was performed by independent investigators and mean and minimal lumen diameter and late luminal gain were assessed. RESULTS The recanalization was considered satisfactory according to the German Consensus Group recommendations in 79.4% (n¼27). Restenosis occurred in 11.8% (n¼4) and reocclusion in 5.9% (n¼2). Out of the 27 patients with a satisfactory initial predilatation result 3.7% (n¼1) had reocclusion and 3.7% (n¼1) had restenosis. Major adverse cardiac events occurred in 17.6% (n¼6) of all patients and in 7.4% (n¼2) of patients with satisfactory predilatation results. Mean late luminal gain was 0.11 0.49 mm and mean angina class improved significantly from 2.45 1.02 before intervention to 1.39 0.92 at follow-up (p<0.001). There was no death and no myocardial infarction.
S37
S38
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
TCTAP A-173 Clinical Outcomes of Successful Chronic Total Occlusion Percutaneous Coronary Intervention Using the Retrograde Approach Osung Kwon,1 Do-Yoon Kang,1 Se Hun Kang,1 Pil Hyung Lee,1 Jung-Min Ahn,1 Duk-Woo Park,1 Soo-Jin Kang,1 Seung-Whan Lee,1 Young-Hak Kim,1 Cheol Whan Lee,1 Seong-Wook Park,1 Seung-Jung Park1 1 Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of) BACKGROUND Despite widespread use of the retrograde approach for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), the clinical outcomes have not been well established.
CONCLUSION Drug-coated balloon angioplasty without stenting is a feasible and well-tolerated treatment method in patients with chronic total occlusion if the predilatation result is sufficient according to the German Consensus Group recommendations.
METHODS Among 815 patients who underwent successful CTO PCI between January 2007 and June 2015, 187 (22.9%) who received retrograde approach were compared with 628 who received antegrade-only. The primary endpoint was target vessel failure (TVF) defined as a composite of cardiac death, target vessel myocardial infarction (TV-MI), or target vessel revascularization/reocclusion.
TCTAP A-068 Impact of Percutaneous Coronary Intervention for Chronic Total Occlusion Patients with Near-normal Left Ventricular Function Li Hu,1 Seung-Woon Rha,1 Byoung Geol Choi,1 Se Yeon Choi,1 Jae Kyeong Byun,1 Min Shim,1 Jun Hyuk Kang,1 Woo Hyeun Kim,1 Sung Hun Park,1 Eun Jin Park,1 Jah Yeon Choi,1 Sunki Lee,1 Jin Oh Na,1 Cheolung Choi,1 Hong Euy Lim,1 Jin Won Kim,1 Eung Ju Kim,1 Chang Gyu Park,1 Hong Seog Seo,1 Dong Joo Oh1 1 Korea University Guro Hospital, Korea (Republic of) BACKGROUND Left ventricular ejection fraction (LVEF) is a powerful predictor of prognosis in patients with coronary artery disease. The benefit of successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) patients with reduced EF has been investigated, however, there are very limited data regarding the benefit of PCI for CTO patients with near-normal left ventricular (LV) function. METHODS A total of 194 consecutive CTO patients with normal or near-normal LV function (EF>50%) underwent PCI or optimal medical therapy (OMT) were enrolled. The patients were divided into two groups according to treatment strategies; 1) the OMT group (n¼86) and 2) the PCI group (n¼108). To adjust for potential confounders, analysis was performed using the logistic regression model. Individual hard endpoints and major adverse cardiac events(MACE), defined as the composite of total death, myocardial infarction (MI), stroke and revascularization, were compared between the two groups up to 5 years. RESULTS Baseline clinical characteristics were similar between the two groups, Major clinical outcomes up to 5 years were significantly different between the two groups; Total major adverse cardiac events (MACE30.2% vs. 13.9%, p¼0.012), total death (11.6% vs. 1.9%, p¼0.009), cardiac death or MI (16.3% vs. 13.9%, p¼0.012). However, the incidence of target lesion and vessel revascularization (TLR)MACE (9.1% vs. 8.3%, p¼0.919) and target vessel revascularization (TVR)-MACE (9.1% vs. 8.3% p¼0.919) were similar in both groups (Table). CONCLUSION In this study, PCI for CTO patients even with normal or near-normal LVEF has a beneficial effect in reducing the incidence of individual and composite MACE up to 5 years.
RESULTS Compared with antegrade-only approach group, retrogradeattempt group had higher J-CTO score (2.5 1.0 vs. 1.8 1.0), longer lesion length (52.2 21.4 vs. 37.2 18.1 mm), and more CTOs located at left anterior descending artery (46.0 vs. 42.5%, all p<0.05) consequently requiring more and longer stent implantation. During a median of 4.3 years of follow-up, the cumulative incidence of TVF in the retrogradeattempt group was significantly higher than the antegrade-only approach group (12.9% vs. 6.0%, P¼0.01) mainly attributable to higher rates of target vessel revascularization/reocclusion (9.7 2.5 vs. 3.4 0.8, P¼0.01). The rates of cardiac death and TV-MI did not differ between groups. The higher risk of TVF (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.04–3.37, P¼0.04) and target-vessel revascularization/ reocclusion (HR 2.03,95% CI 1.07–3.85, P¼0.03) for retrograde attempt group remained significant after multivariable adjustment.