MedicalResearch.com Interview with:
Emmanouil S. Brilakis, MD, PhD
Director, Center for Advanced Coronary Interventions
Minneapolis Heart Institute
Minneapolis, Minnesota 55407
Adjunct Professor of Medicine
University of Texas Southwestern Medical School at Dallas
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Calcification in the coronary arteries might hinder lesion crossing, equipment delivery and stent expansion and contribute to higher rates of in-stent restenosis, as well as stent thrombosis. In this project we sought to examine the impact of calcific deposits on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a contemporary, multicenter registry.
We analyzed the outcomes of 1,476 consecutive CTO PCIs performed in 1,453 patients between 2012 and 2016 at 11 US centers. Data collection was performed in a dedicated online database (PROGRESS CTO: Prospective Global Registry for the Study of Chronic Total Occlusion Intervention, Clinicaltrials.gov Identifier: NCT02061436).
MedicalResearch.com: What are the main findings?
Response: The main findings of our study are that moderate/severe calcific deposits are common (they were present in 58% of attempted CTO lesions) and was associated with higher use of the retrograde approach (54% vs. 30%, p<0.001), lower technical (86.6% vs. 93.8%, p<0.001) and procedural (84.4% vs. 92.7%, p<0.001) success rates and higher incidence of major adverse cardiac events (3.7% vs. 1.8%, p=0.033).
On the other hand, on multivariable analysis the amount of calcium was not independently associated with technical success. Additionally, the procedure times, contrast use and radiation exposure were greater among lesions with moderate/severe calcific deposits.
MedicalResearch.com: What should readers take away from your report?
Response: Our study provides a comprehensive overview of the impact of coronary calcification on the outcomes of CTO PCI. In a contemporary, multicenter registry, moderate or severe calcification was present in more than half of the attempted CTO lesions and was associated with higher use of the retrograde approach, lower success and higher complication rates, an important finding for operators performing procedures in patients with calcified coronary lesions. We believe that these findings would be of great interest to physicians treating patients with such lesions and could help to facilitate procedural planning.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Novel devices and techniques that are easy to use and carry low risk are needed to treat severely calcified lesions.
MedicalResearch.com: Is there anything else you would like to add?
Response: We hope that our study will be implanted to clinical practice and we provided an important finding for operators performing PCIs in patients with calcified coronary lesions.
Dr Brilakis receives consulting/speaker honoraria from Abbott Vascular, Asahi, Scientific, Cardinal Health, Elsevier, and GE Healthcare; and research support from Boston Scientific and InfraRedx. His spouse is employee of Medtronic.
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Impact of Calcium on Chronic Total Occlusion Percutaneous Coronary Interventions
The American Journal of Cardiology
Available online 13 April 2017
Judit Karacsonyi, MD1, 2, Dimitri Karmpaliotis, MD3, Khaldoon Alaswad, MD4, Farouc A. Jaffer, MD, PhD5,Robert W. Yeh, MD6, Mitul Patel, MD7, Ehtisham Mahmud, MD7, William Lombardi, MD8, et al
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