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• W2040187535 abstract "BackgroundCoronary chronic total occlusions (CTOs) are commonly encountered complex lesions. However, the true prevalence of CTOs in the current Canadian practice with the modern medical therapy remains unknown. In addition, CTOs remain the most powerful predictor of referral for coronary bypass surgery or medical therapy with an unchanged low CTO-percutaneous coronary intervention (PCI) attempt rate in the last years.MethodsWe aim to determine the prevalence, clinical characteristics and management of CTOs among all comers population referred for diagnostic coronary angiography. The rate of CTO attempt recanalization and procedure success were recorded. Therefore, we performed a systematic review of all coronary angiographies performed in a high volume Canadian university center between January and July 2010. Patients with at least one CTO (coronary obstruction with TIMI flow grade 0 - in the absence of a patent graft - with an estimated duration of ≥3 months) were included in our study. Patients with acute coronary syndrome or new onset angina involving the occluded artery territory were excluded. Detailed baseline clinical, angiographic, electrocardiographic, and revascularization data were collected.ResultsIn the study period, a total of 2087 coronary angiogram was performed with 371 patients (18%) met the selection criteria. The mean age was 67±11 years with 75% males, the mean left ventricular ejection fraction (LVEF) was 46±16% (with 47% of patients with a LVEF< 50%). Previous history of myocardial infarction was documented in 36% of CTOs patients with only one third of them having ECG evidence of a Q wave in the CTO territory. Ischemia in the CTO territory was documented prior to the coronary angiogram in 53% of cases. Almost half of CTOs were located in the right coronary artery, 24% in the circumflex and and 29% in the left anterior descending artery distribution. Only 10% of patients had a CTO-PCI attempt with a success rate of 78%. The majority of patients (79%) were treated medically and 11% were referred for coronary artery bypass graft (CABG) surgery.ConclusionChronic total occlusions remain common findings in the current practice with low rate of revascularization. New CTO-PCI techniques and dedicated operators could increase the rate of PCI success with potential long term clinical benefit. BackgroundCoronary chronic total occlusions (CTOs) are commonly encountered complex lesions. However, the true prevalence of CTOs in the current Canadian practice with the modern medical therapy remains unknown. In addition, CTOs remain the most powerful predictor of referral for coronary bypass surgery or medical therapy with an unchanged low CTO-percutaneous coronary intervention (PCI) attempt rate in the last years. Coronary chronic total occlusions (CTOs) are commonly encountered complex lesions. However, the true prevalence of CTOs in the current Canadian practice with the modern medical therapy remains unknown. In addition, CTOs remain the most powerful predictor of referral for coronary bypass surgery or medical therapy with an unchanged low CTO-percutaneous coronary intervention (PCI) attempt rate in the last years. MethodsWe aim to determine the prevalence, clinical characteristics and management of CTOs among all comers population referred for diagnostic coronary angiography. The rate of CTO attempt recanalization and procedure success were recorded. Therefore, we performed a systematic review of all coronary angiographies performed in a high volume Canadian university center between January and July 2010. Patients with at least one CTO (coronary obstruction with TIMI flow grade 0 - in the absence of a patent graft - with an estimated duration of ≥3 months) were included in our study. Patients with acute coronary syndrome or new onset angina involving the occluded artery territory were excluded. Detailed baseline clinical, angiographic, electrocardiographic, and revascularization data were collected. We aim to determine the prevalence, clinical characteristics and management of CTOs among all comers population referred for diagnostic coronary angiography. The rate of CTO attempt recanalization and procedure success were recorded. Therefore, we performed a systematic review of all coronary angiographies performed in a high volume Canadian university center between January and July 2010. Patients with at least one CTO (coronary obstruction with TIMI flow grade 0 - in the absence of a patent graft - with an estimated duration of ≥3 months) were included in our study. Patients with acute coronary syndrome or new onset angina involving the occluded artery territory were excluded. Detailed baseline clinical, angiographic, electrocardiographic, and revascularization data were collected. ResultsIn the study period, a total of 2087 coronary angiogram was performed with 371 patients (18%) met the selection criteria. The mean age was 67±11 years with 75% males, the mean left ventricular ejection fraction (LVEF) was 46±16% (with 47% of patients with a LVEF< 50%). Previous history of myocardial infarction was documented in 36% of CTOs patients with only one third of them having ECG evidence of a Q wave in the CTO territory. Ischemia in the CTO territory was documented prior to the coronary angiogram in 53% of cases. Almost half of CTOs were located in the right coronary artery, 24% in the circumflex and and 29% in the left anterior descending artery distribution. Only 10% of patients had a CTO-PCI attempt with a success rate of 78%. The majority of patients (79%) were treated medically and 11% were referred for coronary artery bypass graft (CABG) surgery. In the study period, a total of 2087 coronary angiogram was performed with 371 patients (18%) met the selection criteria. The mean age was 67±11 years with 75% males, the mean left ventricular ejection fraction (LVEF) was 46±16% (with 47% of patients with a LVEF< 50%). Previous history of myocardial infarction was documented in 36% of CTOs patients with only one third of them having ECG evidence of a Q wave in the CTO territory. Ischemia in the CTO territory was documented prior to the coronary angiogram in 53% of cases. Almost half of CTOs were located in the right coronary artery, 24% in the circumflex and and 29% in the left anterior descending artery distribution. Only 10% of patients had a CTO-PCI attempt with a success rate of 78%. The majority of patients (79%) were treated medically and 11% were referred for coronary artery bypass graft (CABG) surgery. ConclusionChronic total occlusions remain common findings in the current practice with low rate of revascularization. New CTO-PCI techniques and dedicated operators could increase the rate of PCI success with potential long term clinical benefit. Chronic total occlusions remain common findings in the current practice with low rate of revascularization. New CTO-PCI techniques and dedicated operators could increase the rate of PCI success with potential long term clinical benefit." @default.
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• W2040187535 date "2012-09-01" @default.
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• W2040187535 title "305 Prevalence, Clinical Characteristics and Management of Coronary Chronic Total Occlusions In Current Practice: A Canadian Single Center Experience" @default.
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