Use of Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention.

Autor: Karacsonyi J; Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota., Deffenbacher K; Interventional Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois., Benzuly KH; Interventional Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois., Flaherty JD; Interventional Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois., Alaswad K; Interventional Cardiology, Henry Ford Hospital, Detroit, Michigan., Basir M; Interventional Cardiology, Henry Ford Hospital, Detroit, Michigan., Megaly MS; Interventional Cardiology, Henry Ford Hospital, Detroit, Michigan., Jaffer F; Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts., Doshi D; Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts., Poommipanit P; Cardiac Catheterization Laboratory, University Hospitals, Case Western Reserve University, Cleveland, Ohio., Khatri J; Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Patel M; Interventional Cardiology, VA San Diego Healthcare System and University of California San Diego, San Diego, California., Riley R; Cardiology, Overlake Medical Center, Bellevue, Washington., Sheikh A; Cardiovascular Medicine, Wellstar Health System, Marietta, Georgia., Wollmuth JR; Interventional Cardiology, Providence Heart Institute, Portland, Oregon., Korngold E; Interventional Cardiology, Providence Heart Institute, Portland, Oregon., Uretsky BF; Interventional Cardiology, Central Arkansas Veterans Healthcare System, and University of Arkansas for Medical Sciences, Little Rock, Arkansas., Yeh RW; Medicine Department, Beth Israe, Deaconess Medical Center, Boston, Massachusetts., Chandwaney RH; Interventional Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma., Elguindy AM; Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt., Tammam K; Interventional Cardiology, International Medical Center, Jeddah, Saudi Arabia., AbiRafeh N; Cardiology, North Oaks Health System, Hammond, Louisiana., Schmidt CW; Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota., Okeson B; Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota., Kostantinis S; Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota., Simsek B; Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota., Rangan BV; Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota., Brilakis ES; Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota., Schimmel DR; Interventional Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: dschimme@nm.org.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2023 Feb 15; Vol. 189, pp. 76-85. Date of Electronic Publication: 2022 Dec 10.
DOI: 10.1016/j.amjcard.2022.10.049
Abstrakt: The use of mechanical circulatory support (MCS) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We analyzed the clinical and angiographic characteristics, and procedural outcomes of 7,171 CTO PCIs performed between 2012 and 2021 at 35 international centers. Mean age was 64.5 ± 10 years, mean left ventricular ejection fraction was 50 ± 13%. MCS was used in 4.5%, prophylactically in 78.7%, and urgently in 21.3%. The most common type of MCS overall was Impella CP (Abiomed) (55.5%), followed by intra-aortic balloon pump (14.8%) and TandemHeart (LivaNova Inc.) (10.0%). Prophylactic MCS patients were more likely to have diabetes mellitus (55% vs 42%, p <0.001) and had more complex lesions compared with cases without prophylactic MCS (Japan-CTO score: 2.80 ± 1.22 vs 2.39 ± 1.27, p <0.001). Cases with prophylactic MCS had similar technical (86% vs 87%, p = 0.643) but lower procedural (80% vs 86%, p = 0.028) success rates and higher rates of periprocedural major cardiac adverse events compared with no prophylactic MCS use (6.55% vs 1.68%, p <0.001). Urgent MCS use was associated with lower technical (68% vs 87%, p <0.001) and procedural (39% vs 86%, p <0.001) success rates and higher major cardiac adverse events compared with no-MCS use (32.26% vs 1.68%, p <0.001). The differences persisted in multivariable analyses. In summary, in this contemporary multicenter registry, MCS was used in 4.5% of CTO PCIs, mostly prophylactically (78.7%). Elective MCS cases had similar technical success but a higher risk of complications. Urgent MCS cases had lower technical and procedural success and higher periprocedural major complication rates.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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