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©2014 Baishideng Publishing Group Inc.
World J Cardiol. Jul 26, 2014; 6(7): 621-629
Published online Jul 26, 2014. doi: 10.4330/wjc.v6.i7.621
Published online Jul 26, 2014. doi: 10.4330/wjc.v6.i7.621
Table 1 Chronic total occlusion prevalence, location and treatment applied in different studies n (%)
Ref. | Type of study | Population | CTO prevalence | CTO location | Medical treatment | PCI | CABG | ||
RCA | LAD | LCA | |||||||
Kahn et al[2], 1993 | Retrospective | 333 Coronary disease (stenoses ≥ 50%) | 101 (35) | 58% | 18% | 24% | - | - | - |
Christofferson et al[3], 2005 | Retrospective | 6581 Underwent coronarography because of suspected CD | 1612 (25) | 49.4% | 22% | 28.60% | 49% | 11% | 40% |
3087 Coronary disease (stenoses ≥ 70%) | 1612 (52) | ||||||||
Srinivas et al[4], 2002 | Retrospective | 1761 Multivessel disease | 545 (31) | - | - | - | - | 14.50% | - |
Yamamoto et al[5], 2013 | Prospective | 15263 First revascularization procedure | 2491 (19) | 44.9% | 41.10% | 28.50% | - | 61.18% | - |
Fefer et al[6], 2012 | Prospective | 14439 Underwent coronariography because of suspected CD | 2630 (18.2) | 46.9% | 19.86% | 15.43% | 64% | 10% | 26% |
Jeroudi et al[7], 2013 | Prospective | 1015 Coronary disease (stenoses ≥ 50%) | 319 (31.34) | - | - | - | 19% (61) | 50% (161) | 30% (97) |
Table 2 Specific recommendations on the treatment of chronic total occlusion in the American and European Practice Guidelines
Society | Guideline | Specific recommendation on the treatment of CTO |
EUROPEAN | 2010 Guidelines of myocardial revascularization[9] | “Revascularization of CTO may be considered in the presence of angina or ischemia related to the corresponding territory” |
2013 ESC guidelines on the management of stable coronary artery disease[1] | “Revascularization needs to be discussed in patients with symptoms of occlusion or large ischemic areas” | |
AMERICAN | 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery[10] | Not mentioned |
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention[11] | Recommendation IIa. Evidence level B. PCI of a CTO in patients with appropriate clinical indications and suitable anatomy is reasonable when performed by operators with appropriate expertise “The decision to try PCI for a CTO (vs continued medical therapy or surgical revascularization) requires an individualized risk-benefit analysis encompassing clinical, angiographic, and technical considerations” | |
2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease[12] | Not mentioned |
Table 3 Specific recommendations on the treatment of chronic total occlusion in the 2012 ACCF/SCAI/STS/AATS/ASNC/HFSA/SCCT Appropriate Use Criteria for Coronary Revascularization Focused Update[14]
ANGINA | ||||||||
Asymptomatic | I | II | III | IV | ||||
Risk in the ischemia test | High | Uncertain | Appropriate | Appropriate | Appropriate | Appropriate | Max | Treatment level |
Uncertain | Uncertain | Uncertain | Appropriate | Appropriate | Med | |||
Uncertain | Uncertain | Uncertain | Appropriate | Appropriate | Min | |||
Medium | Uncertain | Uncertain | Uncertain | Appropriate | Appropriate | Max | ||
Inappropriate | Uncertain | Uncertain | Uncertain | Uncertain | Med | |||
Inappropriate | Uncertain | Uncertain | Uncertain | Uncertain | Min | |||
Low | Inappropriate | Inappropriate | Inappropriate | Uncertain | Uncertain | Max | ||
Inappropriate | Inappropriate | Inappropriate | Inappropriate | Inappropriate | Med | |||
Inappropriate | Inappropriate | Inappropriate | Inappropriate | Inappropriate | Min |
Table 4 Findings on left ventricular ejection fraction and regional wall motion variations after percutaneous coronary intervention treatment of chronic total occlusion
Type of study | Population | LVEF estimation | Follow up | Results | |||||
LVEF | Regional wall motion | Symptoms | Collateral function | Ventricular remodeling | |||||
1994-1995 Sirnes et al[30] | Prospective | 95 CTOs treated with PCI | Ventriculography | Angiography 6 mo | LVEF increase (from 0.62 ± 0.13 to 0.67 ± 0.12) P < 0.001 | Increase in regional radial shortening (from 0.279 ± 0.106 to 0.319 ± 0.107) P < 0.001 | Improvement in angina class | Not mentioned | Not mentioned |
1999-2003 Werner et al[31] | Prospective | 126 CTOs treated with PCI | Ventriculography | Angiography | LVEF increase (from 0.60 ± 0.19 to 0.67 ± 0.16) P < 0.001 | Increase in wall motion severity index (from -1.92 ± 1.32 to -1.30 ± 1.28) P < 0.001 | Not mentioned | No changes in collateral function | Not mentioned |
2008 Kirschbaum et al[32] | Prospective | 21 CTOs treated with PCI | NMR | NMR 5 mo and 3 yr | LVEF increase (from 60% ± 9% to 63% ± 11%) P = 0.11 | Increase in segmental wall thickening. From 19% ± 21% to 31% ± 30% at 5 mo (P < 0.001) and 47% ± 46% at 3 yr (P = 0.04) | Not mentioned | Not mentioned | Less ventricular remodeling in NMR at 3 yr |
Table 5 Baseline characteristics of clinical and angiographic variables in studies included on Joyal meta-analisis[42]
Ref. | Age (yr) | Male sex (%) | Multivessel disease(%) | Diabetes (%) | LVEF (%) | NYHA class 3-4 (%) | Renal dysfunction(%) | Occlusion length (mm) | Calcified vessel (%) | Ischemic burden | ||||||||||
Success | Failure | Success | Failure | Success | Failure | Success | Failure | Success | Failure | Success | Failure | Success | Failure | Success | Failure | Success | Failure | Success | Failure | |
Finci et al[42], 1990 | 55 ± 11 | 55 ± 12 | 93 | 88 | 24 | 23 | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d |
Warren et al[43], 1990 | 54 | 55 | 53 | 47 | 48 | 52 | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d |
Ivanhoe et al[44], 1992 | 55 ± 10 | 56 ± 11 | 81 | 82 | 30 | 54 (0.0001) | 10 | 15 | 55 ± 10 | 56 ± 11 | 3 | 3 | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d |
Angioï[45], 2000 | 55 ± 10 | 56 ± 11 | 52 | 88 | 37 | 45 | 10 | 11 | 59 ± 14 | 59 ± 14 | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d |
Noguchi et al[46], 2000 | 61 ± 9 | 61 ± 11 | 78 | 80 | 47 | 67 (0.01) | 26 | 32 | 56 ± 12 | 54 ± 9 | n/d | n/d | n/d | n/d | 11.3 ± 8.3 | 14.1 ± 8.1 (< 0.05) | 37 | 56 (< 0.01) | n/d | n/d |
Suero et al[47], 2001 | 60 ± 11 | 61 ± 12 | 78 | 80 | 73 | 82 (0.001) | 21 | 20 | 51 ± 14 | 52 ± 14 | n/d | n/d | 8.2 | 7.1 | n/d | n/d | n/d | n/d | n/d | n/d |
Olivari et al[48], 2003 | 58 ± 10 | 59 ± 11 | 86 | 85 | 45 | 60 (0.014) | 17 | 20 | 56 ± 10 | 56 ± 10 | 9 | 7 | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d |
Hoye et al[49], 2005 | 60 ± 11 | 61 ± 10 | 74 | 72 | 54 | 67(0.03) | 12 | 9.1 | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d |
Drozd et al[50], 2006 | 57 ± 10 | 58 ± 10 | 81 | 80 | 46 | 53 | 11 | 11 | n/d | n/d | 14.4 | 18 (NYHA ≥ 2) | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d |
Aziz et al[51], 2007 | 59 | 59 | 76 | 81 | 50 | 40 (0.006) | 14 | 9 | 53 | 53 | 12.2 | 15.7 | 0.3 | 1.8 | n/d | n/d | n/d | n/d | n/d | n/d |
Prasad et al[52], 2007 | 63 ± 11 | 64 ± 11 | 76 | 75 | 70 | 74 | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d | n/d |
Valenti et al[53], 2008 | 67 ± 11 | 70 ± 11 | 81 | 83 | 85 | 87 | 24 | 21 | 42 ± 13 | 41 ± 14 | n/d | n/d | n/d | n/d | 25 (15-52.5) | 28 (21-47.5) | n/d | n/d | n/d | n/d |
de Labriolle et al[54], 2008 | 61 ± 12 | 64 ± 10 | 72 | 87 | 45 | 66 (0.002) | 19 | 40.5 (0.005) | 50 ± 12 | 48 ± 15 | n/d | n/d | 9.1 | 6.3 | n/d | n/d | n/d | n/d | n/d | n/d |
- Citation: Bardají A, Rodriguez-López J, Torres-Sánchez M. Chronic total occlusion: To treat or not to treat. World J Cardiol 2014; 6(7): 621-629
- URL: https://www.wjgnet.com/1949-8462/full/v6/i7/621.htm
- DOI: https://dx.doi.org/10.4330/wjc.v6.i7.621