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Trends in the utilization and in-hospital outcomes when using mechanical circulatory support devices for stable chronic total occlusion treated with percutaneous coronary intervention

Published:September 17, 2018DOI:https://doi.org/10.1016/j.ejim.2018.09.008
      The treatment of chronic total occlusion (CTO) of coronary arteries is a challenge for physicians. In recent years, CTO treatment with percutaneous coronary intervention (PCI) has increased with procedural success rates as high as 70% [
      • Teramoto T.
      • Tsuchikane E.
      • Matsuo H.
      • Suzuki Y.
      • Ito T.
      • Ito T.
      • et al.
      Initial success rate of percutaneous coronary intervention for chronic total occlusion in a native coronary artery is decreased in patients who underwent previous coronary artery bypass graft surgery.
      ]. However, CTO-PCI treatment is questionable as a recent presentation of the DECISION-CTO trial demonstrated no clinical outcome benefit over maximum medical therapy. In contrast, the EURO-CTO trail demonstrated improved health status and functional class as compared to medical management. The ACC/AHA guidelines for CTO-PCI management carries a class IIa indication as the level of evidence is C [
      • Levine G.N.
      • Bates E.R.
      • Blankenship J.C.
      • Bailey S.R.
      • Bittl J.A.
      • Cercek B.
      • et al.
      ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.
      ]. Mechanical circulatory support (MCS) devices have increasingly been used for the treatment of coronary artery disease (CAD) undergoing percutaneous management [
      • Khera R.
      • Cram P.
      • Lu X.
      • Vyas A.
      • Gerke A.
      • Rosenthal G.E.
      • et al.
      Trends in the use of percutaneous ventricular assist devices: analysis of national inpatient sample data, 2007 through 2012.
      ]. There remains, however, a dearth of scientific evidence that directs the management of patients with stable CAD. This study demonstrates the utilization trends and in-hospital outcomes when using MCS for CTO-PCI hospitalizations presented with stable CAD.

      Keywords

      Abbreviations:

      CTO (chronic total occlusion), PCI (percutaneous coronary intervention)
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