James Sapontis1, Adam C Salisbury2, Robert W Yeh3, David J Cohen2, Taishi Hirai4, William Lombardi5, James M McCabe5, Dimitri Karmpaliotis6, Jeffrey Moses6, William J Nicholson7, Ashish Pershad8, R Michael Wyman9, Anthony Spaedy10, Stephen Cook11, Parag Doshi12, Robert Federici13, Craig R Thompson14, Steven P Marso15, Karen Nugent3, Kensey Gosch3, John A Spertus2, J Aaron Grantham16. 1. Monash Heart, Melbourne, Australia. 2. Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri Kansas City, Kansas City, Missouri. 3. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 4. Department of Medicine, Loyola University School of Medicine, Chicago, Illinois. 5. Department of Medicine, University of Washington, Seattle, Washington. 6. Department of Medicine, Columbia University, New York Presbyterian Hospital, New York, New York. 7. York Hospital, York, Pennsylvania. 8. Banner Good Samaritan Medical Center, Phoenix, Arizona; Banner Heart, Mesa, Arizona. 9. Torrance Medical Center, Torrance, California. 10. Boone County Hospital, Columbia, Missouri. 11. Peacehealth Sacred Heart Medical Center, Springfield, Oregon. 12. Alexian Brothers Medical Center, Chicago, Illinois. 13. Presbyterian Heart Center, Albuquerque, New Mexico. 14. Boston Scientific, Maple Grove, Minnesota. 15. Research Medical Center, Kansas City, Missouri. 16. Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri Kansas City, Kansas City, Missouri. Electronic address: jgrantham@saint-lukes.org.
Abstract
OBJECTIVES: This study sought to accurately describe the success rate, risks, and patient-reported benefits of contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: In light of the evolving techniques to successfully revascularize CTO lesions, there remains a compelling need to more accurately quantify the success rates, risks, and benefits of these complex procedures. METHODS: Using a uniquely comprehensive, core-lab adjudicated, single-arm, multicenter registry of 1,000 consecutive patients undergoing CTO PCI by the hybrid approach, we evaluated the technical success rates, complication rates, and raw and adjusted health status benefits at 1 month among successfully as compared to unsuccessfully treated patients. RESULTS: Technical success was high (86%). In-hospital and 1-month mortality was 0.9% and 1.3%, respectively, and perforations requiring treatment occurred in 48 patients (4.8%). Among those who survived and completed the 1-month interview (n = 947), mean ± SEM Seattle Angina Questionnaire quality of life scores improved from 49.4 ± 0.9 to 75.0 ± 0.7 (p < 0.01), mean Rose Dyspnea Scale scores improved (decreased) from 2.0 ± 0.1 to 1.1 ± 0.1 (p < 0.01), and physician health questionnaire (for depression) scores improved (decreased) from 6.2 ± 0.2 to 3.5 ± 0.1 (p < 0.01) at 1 month. After adjusting for baseline differences the mean group difference in Seattle Angina Questionnaire quality of life between successful and unsuccessful CTO PCI was 10.8 (95% confidence interval: 6.3 to 15.3; p < 0.001). CONCLUSIONS: Clarifying the success rates, risks, and benefits of CTO PCI will help to more accurately contextualize the informed consent process for these procedures so that patients with appropriate indications for CTO PCI can more effectively share in the decision to pursue this or other therapeutic options.
OBJECTIVES: This study sought to accurately describe the success rate, risks, and patient-reported benefits of contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: In light of the evolving techniques to successfully revascularize CTO lesions, there remains a compelling need to more accurately quantify the success rates, risks, and benefits of these complex procedures. METHODS: Using a uniquely comprehensive, core-lab adjudicated, single-arm, multicenter registry of 1,000 consecutive patients undergoing CTO PCI by the hybrid approach, we evaluated the technical success rates, complication rates, and raw and adjusted health status benefits at 1 month among successfully as compared to unsuccessfully treated patients. RESULTS: Technical success was high (86%). In-hospital and 1-month mortality was 0.9% and 1.3%, respectively, and perforations requiring treatment occurred in 48 patients (4.8%). Among those who survived and completed the 1-month interview (n = 947), mean ± SEM Seattle Angina Questionnaire quality of life scores improved from 49.4 ± 0.9 to 75.0 ± 0.7 (p < 0.01), mean Rose Dyspnea Scale scores improved (decreased) from 2.0 ± 0.1 to 1.1 ± 0.1 (p < 0.01), and physician health questionnaire (for depression) scores improved (decreased) from 6.2 ± 0.2 to 3.5 ± 0.1 (p < 0.01) at 1 month. After adjusting for baseline differences the mean group difference in Seattle Angina Questionnaire quality of life between successful and unsuccessful CTO PCI was 10.8 (95% confidence interval: 6.3 to 15.3; p < 0.001). CONCLUSIONS: Clarifying the success rates, risks, and benefits of CTO PCI will help to more accurately contextualize the informed consent process for these procedures so that patients with appropriate indications for CTO PCI can more effectively share in the decision to pursue this or other therapeutic options.
Authors: Mohammed Qintar; Taishi Hirai; Suzanne V Arnold; Justin Sheehy; James Sapontis; Phil Jones; Yuanyuan Tang; William Lombardi; Dimitri Karmpaliotis; Jeffery Moses; Christian Patterson; William J Nicholson; David J Cohen; John A Spertus; J Aaron Grantham; Adam C Salisbury Journal: Am Heart J Date: 2019-04-26 Impact factor: 4.749
Authors: Matthew T Finn; Darshan Doshi; Jacob Cleman; Lei Song; Akiko Maehara; Raja Hatem; Björn Redfors; Sanjog Kalra; Justin A Fried; Ming Liao; Candido Batres; Jeffery W Moses; Manish A Parikh; Michael B Collins; Tamim M Nazif; Khady N Fall; Phillip Green; Ajay J Kirtane; Ziad A Ali; Martin B Leon; Gary S Mintz; Dimitri Karmpaliotis Journal: Catheter Cardiovasc Interv Date: 2018-11-29 Impact factor: 2.692
Authors: Peter Tajti; Iosif Xenogiannis; Dimitris Karmpaliotis; Khaldoon Alaswad; Farouc A Jaffer; M Nicholas Burke; Imre Ungi; Emmanouil S Brilakis Journal: Curr Cardiol Rep Date: 2018-10-22 Impact factor: 2.931
Authors: Ali O Malik; John A Spertus; James A Grantham; Poghni Peri-Okonny; Kensey Gosch; James Sapontis; Jeffrey Moses; William Lombardi; Dimitri Karmpaliotis; William J Nicholson; Firas Al Badarin; Adam C Salisbury Journal: Am J Cardiol Date: 2020-01-08 Impact factor: 2.778