TY - JOUR
T1 - Who Should Undergo Chronic Total Occlusions Percutaneous Coronary Intervention and When?
T2 - An Evidence-Based Approach to the Patient Referred for Percutaneous Coronary Intervention of Chronic Total Occlusion
AU - Soriano, Kevin
AU - Jiang, Ginger Y.
AU - Balkan, Lauren
AU - Tamez, Hector
AU - Yeh, Robert W.
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/9/15
Y1 - 2024/9/15
N2 - Chronic total occlusions (CTO) of the coronary arteries are common among patients presenting to the cardiac catheterization laboratory, and data suggests a worse overall prognosis in patients with CTOs. Percutaneous coronary intervention (PCI) of CTOs has been shown to improve anginal symptoms in observational studies and in a limited number of randomized trials. However, CTO PCI has not been shown to lead to a reduction in other important end points such as myocardial infarction or death. Furthermore, despite recent advances in the field, CTO PCI still carries higher risks and a lower likelihood of success compared with non-CTO PCI. Thus, determining which patients may be appropriate for CTO PCI is challenging and must involve a comprehensive risk-benefit analysis and discussion with the patient. Therefore, we review the currently available data regarding CTO PCI, including the clinical outcomes, the role of preprocedural ischemia testing, and various procedural success and risk stratification scores. Finally, we present our approach to the patient referred for CTO PCI.
AB - Chronic total occlusions (CTO) of the coronary arteries are common among patients presenting to the cardiac catheterization laboratory, and data suggests a worse overall prognosis in patients with CTOs. Percutaneous coronary intervention (PCI) of CTOs has been shown to improve anginal symptoms in observational studies and in a limited number of randomized trials. However, CTO PCI has not been shown to lead to a reduction in other important end points such as myocardial infarction or death. Furthermore, despite recent advances in the field, CTO PCI still carries higher risks and a lower likelihood of success compared with non-CTO PCI. Thus, determining which patients may be appropriate for CTO PCI is challenging and must involve a comprehensive risk-benefit analysis and discussion with the patient. Therefore, we review the currently available data regarding CTO PCI, including the clinical outcomes, the role of preprocedural ischemia testing, and various procedural success and risk stratification scores. Finally, we present our approach to the patient referred for CTO PCI.
KW - chronic total occlusion (CTO)
KW - percutaneous coronary intervention (PCI)
UR - http://www.scopus.com/inward/record.url?scp=85200476263&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2024.07.017
DO - 10.1016/j.amjcard.2024.07.017
M3 - Review article
C2 - 39032587
AN - SCOPUS:85200476263
SN - 0002-9149
VL - 227
SP - 18
EP - 28
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -