What question did this study set out to answer?

To compare changes in coronary collateral function and their prognostic significance before and after percutaneous coronary intervention in patients with acute versus chronic total occlusions.

March 1, 2017JACC: Cardiovascular InterventionsOpen Access

Coronary Collaterals Function and Clinical Outcome Between Patients With Acute and Chronic Total Occlusion

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Why the study?

How do changes in collateral function before and after PCI compare between patients with acute and chronic total occlusions, and do they predict clinical outcomes?

Population

97 patients, comprising 23 with acute coronary syndrome and total or nearly total occlusions and 74 with…

Comparison

Percutaneous coronary intervention with… vs Comparison between ATO and CTO patients

Design

Cohort

Follow-up

1 year

Authors

JLJang Hoon LeeInterventional Cardiology CKChang-Yeon KimKyungpook National University Hospital NKNamkyun KimInterventional / Structural Cardiology

Discussion

Member takes

Implication

Post-PCI FFRmyo <0.90 and CPI <0.25 identify higher-risk CTO patients; hypothesis-generating, prospective trials needed before practice change.

Key Points

To compare changes in coronary collateral function and their prognostic significance before and after percutaneous coronary intervention in patients with acute versus chronic total occlusions.
Evaluated 23 patients with acute total or near-total occlusions (ATOs) and 74 patients with chronic total occlusions (CTOs).
Measured collateral pressure index (CPI), myocardial fractional flow reserve (FFRmyo), and coronary fractional flow reserve (FFRcor) during intravenous adenosine-induced maximum hyperemia at baseline, immediately post-PCI, and at 1 year.
FFRmyo and FFRcor increased significantly immediately after PCI in both groups (both p < 0.001), while CPI showed no significant immediate change.
In CTO patients, post-PCI FFRmyo <0.90 (p = 0.01) and post-PCI CPI <0.25 (p = 0.033) were independent predictors of clinical outcome.
CTO patients with high post-PCI CPI achieved better clinical outcomes if post-PCI FFRmyo was low (log-rank p = 0.009), but not if post-PCI FFRmyo was high (log-rank p = 0.492).

Structured PICO

How do changes in collateral function before and after PCI compare between patients with acute and chronic total occlusions, and do they predict clinical outcomes?

Population

97 patients, comprising 23 with acute coronary syndrome and total or nearly total occlusions (ATOs) and 74 with chronic total occlusions (CTOs)

Intervention

Percutaneous coronary intervention (PCI) with physiological assessment of collateral pressure index (CPI), myocardial fractional flow reserve (FFRmyo), and coronary fractional flow reserve (FFRcor) using intravenous adenosine

Comparator

Comparison between ATO and CTO patients

Outcome

Changes in collateral function (CPI, FFRmyo, FFRcor) at baseline, immediately after PCI, and at 1 year, and their association with clinical outcomessurrogate

Recruitable coronary collateral flow does not regress completely immediately after PCI in ATO or CTO patients, and aggressive reduction of ischemic burden may improve outcomes in CTO patients despite good collaterals.

Cite This Study

Lee et al. (2017) studied this question.

synapsesocial.com/papers/69fe7953d8476229fea35815 https://doi.org/10.1016/j.jcin.2016.12.009

Topics

Percutaneous coronary intervention Chronic total occlusion PCI

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Implication

Post-PCI FFRmyo <0.90 and CPI <0.25 identify higher-risk CTO patients; hypothesis-generating, prospective trials needed before practice change.

Coronary Collaterals Function and Clinical Outcome Between Patients With Acute and Chronic Total Occlusion

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Coronary Collaterals Function and Clinical Outcome Between Patients With Acute and Chronic Total Occlusion

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider