Title: The Demographic and Clinical Profile of Patients Undergoing Coronary Chronic total Occlusion (CTO) Intervention in a teaching hospital in Kerala
From the CTO Investigators- Kerala (CTOI-K) Group
Authors: Dr Gopakumar K S, Dr Mathew Iype, Prof Sunitha Viswanathan, Prof. George Koshy, Prof Prabha Nini Gupta, Prof V V Radhakrishnan
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.106
Abstract
Objectives: Coronary CTO interventions have become a common practice with a prevalence of 3.8-10 % in patients undergoing percutaneous coronary interventions (PCI). There are innumerable studies on CTO interventions. But studies on the patient demographics and background clinical presentations are lacking. This study, planned to bridge this gap.
Materials and Methods: This was a single center prospective study of a cohort of all patients undergoing percutaneous coronary intervention (PCI) as elective or adhoc procedure for CTO from august 2014 to june 2015.Only antegrade CTO interventions were included
Results: It was a prospective study of a cohort of all patients undergoing PCI as elective or adhoc procedure for CTO. A total of 210 (8.9% of total PCI (2353) during the study period) CTO patients were followed up. The mean age of the patients was 56.54 +/- 8.9 % with 63.3 %(n= 133) below the age of 60 .In the cohort females were only 19% (n= 40).Diabetes mellitus was seen in 33.8%(n= 71) , systemic hypertension in 52.4% (n=110) and 47.1% (n=99) were smokers. In the study 32.9% (n=69) had chronic stable angina(CSA), 22.9 %( n= 48) had UA/NSTEMI and 44.2% (n= 93) had STEMI. Left anterior descending coronary artery (LAD) was involved in 36.7% (n= 77), Right Coronary Artery (RCA) in 48.1% (n= 101), and Left Circumflex Coronary Artery (LCX) in 15.2% (n= 32). The J-CTO score in the cohort was J- CTO<1 in 13.3% (n=28) J- CTO = 2 in 50.5 % (n=106) and J- CTO > 3 in 36.2% (n= 76).
Conclusions: This is the first prospective CTO interventional study from Kerala state. Our data shows that Kerala has a relatively younger predominantly males, smokers and hypertensive population having coronary CTOs requiring revascularization. This points to a malignant atherosclerotic tendency in this population and calls for population preventive strategies.
References
1. Sianos G, Werner GS, Galassi AR.et al. Euro CTO Club. Recanalization of chronic total coronary occlusions: 2012 consensus document from the Euro CTO club. Euro Intervention 2012; 8:139–145.
2. Carlino M, Magri CJ, Uretsky BF et al. Treatment of the chronic total occlusion: a call to action for the interventional community. Catheter Cardiovasc. Interv. 2015; 85:771–778.
3. Jeroudi OM, Alomar ME, Michael TT et al.. Prevalence and management of coronary chronic total occlusions in a tertiary Veterans Affairs hospital. Catheter Cardiovasc Interv 2014; 84: 637–643.
4. Fefer P, Knudtson ML, Cheema AN et al.. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll. Cardiol. 2012; 59: 991–997.
5. Brilakis ES, Banerjee S, Karmpaliotis Det al. Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv 2015 Feb; 8(2):245-53
6. Borqui F, Viceconte N,Ali O et al Improved cardiac survival, freedom from MACE and angina-related quality of life after successful percutaneous recanaliz-ation of coronary artery chronic total occlusions. Int J Cardiol 2012 Nov 1; 161(1): 31-8
7. Hoebens LP, Claessen BE, Elias Jet al. Meta-analysis on the impact of percutaneous coronary intervention of chronic total occlusions on left ventricular function and clinical outcome. Int J Cardiol 2015; 187: 90-6
8. Khan MF, Wendel CS, Thai HM et al Effects of percutaneous revascularization of chronic total occlusions on clinical outcomes: a meta-analysis comparing successful versus failed percutaneous intervention for chronic total occlusion. Catheter Cardiovasc Interv.2013 Jul 1; 82(1):95-107
9. Pancholy SB, Boruah P, Ahmed I et al. Meta-analysis of effect on mortality of percutaneous recanalization of coronary chronic total occlusions using a stent-based strategy. Am J Cardiol 2013 Feb15: 111(4) : 521-5
10. Windecker S, Kolh P, Alfonso F. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. Heart J. 2014;35: 2541–2619.
11. Borqui F, Viceconte N,Ali O et al Improved cardiac survival, freedom from MACE and angina-related quality of life after successful percutaneous recanaliz-ation of coronary artery chronic total occlusions. Int J Cardiol 2012 Nov 1; 161(1): 31-8
12. Renato Valenti, Angela Migliorini, Umberto Signorini et al. Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion, Eur Heart J 2008 ; 29: 2336–2342
13. Brilakis ES, Banerjee S, Karmpaliotis et al. procedural Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention : A Report From the NCDR (National Cardiovascular Data Registry) JACC Cardio vascular interventions 2015 Feb ; 8(2) : 245-53
14. Claessen BE, Chieffo A, Dangas GD, et al.Gender differences in long-term clinical outcomes after percutaneous coronary intervention of chronic total occlusions. J Invasive Cardiol2002 Oct; 24(10):484-488.