Imperial College London
Alternate

DrMilesDalby

Faculty of Medicine, National Heart & Lung Institute

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

miles.dalby

 
 
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Location

 

Guy Scadding BuildingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Jones:2018:10.1097/MCA.0000000000000644,
author = {Jones, DA and Rathod, KS and Pavlidis, AN and Gallagher, SM and Astroulakis, Z and Lim, P and Sirker, A and Knight, CJ and Dalby, MC and Malik, IS and Mathur, A and Rakhit, R and Redwood, S and MacCarthy, PA and Baker, C and Desilva, R and Di, Mario C and Weerackody, R and Hill, J and Wragg, A and Smith, EJ},
doi = {10.1097/MCA.0000000000000644},
journal = {Coron Artery Dis},
title = {Outcomes after chronic total occlusion percutaneous coronary interventions: an observational study of 5496 patients from the Pan-London CTO Cohort.},
url = {http://dx.doi.org/10.1097/MCA.0000000000000644},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: Chronic total occlusions (CTO) are commonly encountered in patients undergoing coronary angiography; however, percutaneous coronary intervention (PCI) is infrequently performed owing to technical difficulty, the perceived risk of complications and a lack of randomized data. The aim of this study was to analyse the frequency and outcomes of CTO-PCI procedures in a large contemporary cohort of successive patients. PATIENTS AND METHODS: We undertook an observational cohort study of 48 234 patients with stable angina of which 5496 (11.4%) procedures were performed for CTOs between 2005 and 2015 at nine tertiary cardiac centres across London, UK. Outcome was assessed by in-hospital major adverse cardiac events and all-cause mortality at a median follow-up of 4.8 years (interquartile range: 2.2-6.4 years). RESULTS: Over time, there was an increase in the proportion of elective PCI procedures performed for CTOs, but no increase in the absolute number. Overall success rates increased over time (74.3% in 2005 to 81.5% in 2015; P=0.0003) despite an increase in case complexity (previous myocardial infarction, diabetes, renal failure, previous coronary artery bypass grafting, peripheral vascular disease and left ventricular impairment) that correlated with procedural advancements. Successful CTO PCI was associated with lower mortality [9.5%, 95% confidence interval (CI): 8.1-11.6 vs. 15.3%, 95% CI: 13.7-20.6, P<0.0001] that persisted after multivariate cox analysis (hazard ratio: 0.37, 95% CI: 0.25-0.62) and propensity matching (hazard ratio=0.36, 95% CI: 0.18-0.73, P=0.0005). CONCLUSION: Successful procedures were associated with lower mortality suggesting that the greater uptake of CTO PCI may improve clinical outcomes in a wider population than are currently being offered therapy.
AU  - Jones,DA
AU  - Rathod,KS
AU  - Pavlidis,AN
AU  - Gallagher,SM
AU  - Astroulakis,Z
AU  - Lim,P
AU  - Sirker,A
AU  - Knight,CJ
AU  - Dalby,MC
AU  - Malik,IS
AU  - Mathur,A
AU  - Rakhit,R
AU  - Redwood,S
AU  - MacCarthy,PA
AU  - Baker,C
AU  - Desilva,R
AU  - Di,Mario C
AU  - Weerackody,R
AU  - Hill,J
AU  - Wragg,A
AU  - Smith,EJ
DO  - 10.1097/MCA.0000000000000644
PY  - 2018///
TI  - Outcomes after chronic total occlusion percutaneous coronary interventions: an observational study of 5496 patients from the Pan-London CTO Cohort.
T2  - Coron Artery Dis
UR  - http://dx.doi.org/10.1097/MCA.0000000000000644
UR  - https://www.ncbi.nlm.nih.gov/pubmed/29985189
ER  -
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