• Chronic total occlusion
• Multivessel disease
• Myocardial infarction
• Percutaneous coronary intervention

• Humans
• Male
• Female
• Coronary Occlusion/diagnosis
• Coronary Occlusion/mortality
• Coronary Occlusion/surgery
• Middle Aged
• Aged
• Myocardial Infarction/mortality
• Myocardial Infarction/diagnosis
• Chronic Disease
• Follow-Up Studies
• Retrospective Studies
• Percutaneous Coronary Intervention/methods
• Survival Rate/trends
• Coronary Artery Disease/mortality
• Coronary Artery Disease/diagnosis
• Coronary Artery Disease/surgery
• Cohort Studies
• Propensity Score

• acute coronary syndromes
• chronic total occlusion
• major adverse cardiac event
• non-infarct-related artery
• percutaneous coronary intervention

• Humans
• Acute Coronary Syndrome/mortality
• Acute Coronary Syndrome/therapy
• Chronic Disease
• Coronary Angiography
• Coronary Occlusion/complications
• Coronary Occlusion/diagnosis
• Coronary Occlusion/epidemiology
• Percutaneous Coronary Intervention/methods

• CTO
• NSTEMI
• Revascularisation

• Humans
• Male
• Female
• Coronary Occlusion/mortality
• Coronary Occlusion/therapy
• Coronary Occlusion/diagnostic imaging
• Aged
• Percutaneous Coronary Intervention/adverse effects
• Percutaneous Coronary Intervention/mortality
• Retrospective Studies
• Non-ST Elevated Myocardial Infarction/mortality
• Non-ST Elevated Myocardial Infarction/therapy
• Non-ST Elevated Myocardial Infarction/diagnosis
• Non-ST Elevated Myocardial Infarction/diagnostic imaging
• Middle Aged
• Time Factors
• Treatment Outcome
• Registries
• Chronic Disease
• Risk Assessment
• Risk Factors
• Aged, 80 and over
• United Kingdom/epidemiology

• chronic total occlusion
• clinical outcome
• percutaneous coronary intervention
• randomized controlled trial

• Humans
• Male
• Female
• Percutaneous Coronary Intervention/adverse effects
• Percutaneous Coronary Intervention/methods
• Coronary Occlusion/therapy
• Coronary Occlusion/mortality
• Coronary Occlusion/complications
• Middle Aged
• ST Elevation Myocardial Infarction/therapy
• ST Elevation Myocardial Infarction/mortality
• ST Elevation Myocardial Infarction/complications
• Aged
• Treatment Outcome
• Chronic Disease
• Time Factors
• Follow-Up Studies
• Risk Factors

• chronic total occlusion
• diabetes
• medical therapy
• percutaneous coronary intervention

• Humans
• Percutaneous Coronary Intervention/adverse effects
• Coronary Occlusion/complications
• Coronary Occlusion/therapy
• Diabetes Mellitus
• Coronary Vessels
• Chronic Disease
• Treatment Outcome
• Risk Factors
• Coronary Angiography
• Registries

• chronic total occlusion
• obstructive CAD
• revascularization

• Humans
• Coronary Occlusion/diagnosis
• Coronary Occlusion/surgery
• Coronary Occlusion/complications
• Risk Factors
• Coronary Angiography/adverse effects
• Coronary Artery Disease/complications
• Myocardial Infarction
• Coronary Stenosis/complications
• Chronic Disease
• Percutaneous Coronary Intervention/adverse effects
• Treatment Outcome

• U54 AG062334 NIA NIH HHS
• P01 HL154996 NHLBI NIH HHS
• R33 HL138657 NHLBI NIH HHS
• T32 HL130025 NHLBI NIH HHS
• P30 DK111024 NIDDK NIH HHS
• R01 HL109413 NHLBI NIH HHS
• R01 HL166004 NHLBI NIH HHS
• R61 HL154116 NHLBI NIH HHS

• Humans
• Shock, Cardiogenic/etiology
• Shock, Cardiogenic/therapy
• ST Elevation Myocardial Infarction/complications
• ST Elevation Myocardial Infarction/surgery
• Percutaneous Coronary Intervention/adverse effects
• Coronary Occlusion/complications
• Coronary Occlusion/surgery
• Myocardial Infarction/complications
• Coronary Vessels
• Treatment Outcome
• Chronic Disease
• Risk Factors

• Contrast-associated nephropathy
• ST-segment elevation myocardial infarction
• chronic total occlusion
• non-infarct-related artery
• primary percutaneous coronary intervention

• Multivessel disease
• ST-segment elevation myocardial infarction (STEMI)
• chronic total occlusion (CTO)
• complete revascularization
• infarct-related artery
• percutaneous coronary intervention (PCI)

Catheter ablation of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) is an effective tool to prevent VT recurrences. Chronic total occlusion (CTO) represents a clinically relevant entity in ICM patients and is an independent predictor of ventricular arrhythmia and mortality. The effects of CTO on the outcome of VT ablation are not well-studied.

This analysis aimed to identify the impact of CTO, revascularized, or not revascularized, on the outcome of VT ablation.

Of 385 consecutive subjects with ICM-VT who underwent catheter VT ablation for monomorphic VT at Heart Center Leipzig between 2008 and 2017, 108 patients without CTO and 191 patients with CTO were included in the analysis. Within a median follow-up time of 557 days (IQR 149, 1095), VT recurred in 77 (40%) patients in the CTO and 40 (37.0%) in the non-CTO cohort (p = 0.62). In a multivariable model, a 10% stepwise change in LVEF as well as ICD on admission was associated with VT recurrence (HR_adj 1.82, 95% CI 1.04–3.18 and HR_adj 1.35, 95% CI 1.23–1.61, respectively). Of the CTO cohort before ablation, 45% had received revascularization, which was independently associated with a higher risk for VT recurrence (HR 2.12, 95% CI 1.35–3.34) as compared to nonrevascularized CTO.

In ICM patients with and without CTO, VT ablation was associated with equal effectiveness with regard to VT recurrence. However, in revascularized CTO patients, the risk of recurrence of VT after ablation was significantly increased.

• acute coronary syndrome
• myocardial infarction
• percutaneous coronary intervention

• Acute Coronary Syndrome/surgery
• Coronary Artery Disease
• Humans
• Percutaneous Coronary Intervention
• Treatment Outcome

Treatment of coronary chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) has rapidly increased during the past decades. Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success. The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently, has led to an exponential increase in the number of CTO-PCI procedures, even if are still underutilized. It has been widely demonstrated that complete coronary revascularization, achieved by either coronary artery bypass graft or PCI, is associated with prognostic improvement, in terms of increased survival and reduction of major adverse cardiovascular events. The application of “contemporary” strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit, even in high-risk patients or complex coronary anatomy with CTO. The increasing success of CTO-PCI, allowing a complete or reasonable incomplete coronary revascularization, is enabling to overcome the last great challenge of interventional cardiology, adding a “complex” piece to “complete” the puzzle.

• Chronic total occlusion
• Percutaneous coronary intervention
• Complete revascularization
• Prognosis
• Coronary artery disease

• acute myocardial infarction
• chronic total occlusion
• percutaneous coronary intervention

• Aged
• Arteries
• Chronic Disease
• Coronary Occlusion/diagnosis
• Coronary Occlusion/surgery
• Humans
• Myocardial Infarction/therapy
• Percutaneous Coronary Intervention/adverse effects
• Retrospective Studies
• Risk Factors
• Treatment Outcome

• 2019YFC0120203 National Key R&D Program of China
• SHDC12018X05 Clinical Science and Technology Innovation Project of Shanghai Shenkang Hospital Development Center
• 81570315 National Natural Science Foundation of China
• National Natural Science Foundation of China

• coronary artery disease
• heart failure
• mortality
• percutaneous coronary intervention
• registries

• CTO
• MPI
• Myocardial ischaemia
• Prognosis
• SPECT

• Coronary Angiography
• Coronary Artery Disease/diagnostic imaging
• Coronary Occlusion/diagnostic imaging
• Humans
• Myocardial Perfusion Imaging/methods
• Percutaneous Coronary Intervention
• Tomography, Emission-Computed, Single-Photon/methods

• CTO
• Chronic total occlusion
• PCI
• Percutaneous coronary intervention

The right ventricle (RV) is frequently involved in ST-segment elevation myocardial infarction (STEMI) when the culprit or concurrent chronic total occlusion (CTO) is located in the right coronary artery (RCA). We investigated RV function recovery in STEMI-patients with concurrent CTO. In EXPLORE, STEMI-patients with concurrent CTO were randomized to CTO percutaneous coronary intervention (PCI) or no CTO-PCI. We analyzed 174 EXPLORE patients with serial cardiovascular magnetic resonance imaging RV data (baseline and 4-month follow-up), divided into three groups: CTO-RCA (CTO in RCA, culprit in non-RCA; n = 89), IRA-RCA (infarct related artery [IRA] in RCA, CTO in non-RCA; n = 56), and no-RCA (culprit and CTO not in RCA; n = 29). Tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (RVEF), RV global longitudinal strain (GLS) and free wall longitudinal strain (FWLS) were measured. We found that RV strain and TAPSE improved in IRA-RCA and CTO-RCA (irrespective of CTO-PCI) at follow-up, but not in no-RCA. Only RV FWLS was different among groups at baseline, which was lower in IRA-RCA than no-RCA (− 26.0 ± 8.3% versus − 31.0 ± 6.4%, p = 0.006). Baseline RVEF, RV end-diastolic volume and TAPSE were associated with RVEF at 4 months. RV function parameters were not predictive of 4 year mortality, although RV GLS showed additional predictive value for New York Heart Association Classification > 1 at 4 months. In conclusion, RV parameters significantly improved in patients with acute or chronic RCA occlusion, but not in no-RCA patients. RV FWLS was the only RV parameter able to discriminate between acute ischemic and non-ischemic myocardium. Moreover, RV GLS was independently predictive for functional status.

• Cardiovascular magnetic resonance
• Chronic total occlusion
• Right ventricle
• ST-segment elevation myocardial infarction
• Strain analysis

The benefit of revascularizing chronically occluded coronary arteries remains debatable, and available long-term outcome reports are sparse. Current guidelines recommend revascularization of chronically occluded arteries only in patients with myocardial ischemia and/or symptoms associated with angina. We investigated outcome of patients with total chronic occlusion of the right coronary artery (RCA) receiving coronary artery bypass grafting (CABG) surgery with and without revascularization of the RCA.

We retrospectively analyzed all patients with chronically occluded RCAs receiving CABG with (group 1 = RCA-CABG; n = 487) and without (group 2 = No-RCA-CABG; n = 100) revascularization of the RCA. In total, 587 patients with complete follow-up of a minimum of 6 years were included (92%).

In total, 82% in group 1 versus 86% in group 2 were male (P = .38). European System for Cardiac Operative Risk Evaluation II was comparable between both groups (4.35 ± 7.09% vs 4.80 ± 5.77%, P = .56) with no major differences regarding preoperative characteristics between groups. Patients in group 1 received 3.24 ± 0.79 distal anastomoses, whereas group 2 received 2.45 ± 0.83 distal anastomoses (P < .001). Although in-hospital mortality was comparable (2.9% in group 1 vs 5.0% in group 2, P = .27), long-term survival was significantly better in group 1 (P = .002). No difference in the incidence of further major adverse cardiac and cerebrovascular events was found.

Patients with a chronically occluded RCA undergoing CABG who did not receive an RCA graft showed a significantly reduced long-term survival. Given the herein presented data, revascularization of chronically occluded right arteries during CABG should be recommended whenever technically feasible.

• Medicare
• coronary artery disease
• death
• myocardial infarction
• percutaneous coronary intervention

We sought to assess the relative merits of different revascularization strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease complicated by cardiogenic shock or chronic total occlusion (CTO).

Recent randomized trials and meta-analysis have suggested that multivessel percutaneous coronary intervention (PCI) is associated with better outcomes in patients with STEMI and multivessel coronary artery disease, however, patients complicated by cardiogenic shock or CTO were excluded.

Studies that compared multivessel PCI (immediate or staged) with culprit-only PCI in patients with STEMI and multivessel coronary artery disease complicated by cardiogenic shock or CTO were included. Random odd ratio (OR) and 95% confidence interval (CI) were conducted.

Sixteen studies with 8695 patients complicated by cardiogenic shock and eight studies with 2259 patients complicated by CTO were included. In patients complicated by cardiogenic shock, a strategy of CO-PCI was associated with lower risk for short-term renal failure (OR: 0.75; 95% CI: 0.61–0.93; I² = 0.0%), with no significant difference in MACE, all-cause mortality, re-infarction, revascularization, cardiac death, heart failure, major bleeding, or stroke compared with an immediate MV-PCI strategy. In patients complicated by CTO, a strategy of CO-PCI was associated with higher risk for long-term MACE (OR: 2.06; 95% CI: 1.39–3.06; I² = 54.0%), all-cause mortality (OR: 2.89; 95% CI: 2.09–4.00; I² = 0.0%), cardiac death (OR: 3.12; 95% CI: 2.05–4.75; I² = 16.8%), heart failure (OR: 1.99; 95% CI: 1.22–3.24; I² = 0.0%), and stroke (OR: 2.80; 95% CI: 1.04–7.53; I² = 0.0%) compared with a staged MV-PCI strategy, without any difference in re-infarction, revascularization, or major bleeding.

For patients with STEMI and multivessel coronary artery disease complicated by cardiogenic shock, an immediate multivessel PCI was not advocated due to a higher risk for short-term renal failure, whereas for patients complicated by CTO, a staged multivessel PCI was advocated due to reduced risks for long-term MACE, all-cause mortality, cardiac death, heart failure, and stroke.

• Cardiogenic shock
• Chronic total occlusion
• Multivessel disease
• Percutaneous coronary intervention
• ST-segment elevation myocardial infarction

• Myocardial infarction
• Percutaneous coronary intervention

• CMR
• CTO
• ECG
• PCI
• STEMI

• Acute myocardial infarction
• Chronic total occlusion
• Left ventricular ejection fraction
• Prognosis

• Chronic total occlusion (CTO)
• Coronary artery disease (CAD)
• J CTO Score
• Percutaneous coronary intervention (PCI)

• Acute ST segment elevation myocardial infarction
• Chronic total occlusion
• Percutaneous coronary intervention
• Prognosis

• Age Factors
• Aged
• Chronic Disease
• Coronary Occlusion/diagnostic imaging
• Coronary Occlusion/mortality
• Coronary Occlusion/physiopathology
• Female
• Humans
• Male
• Middle Aged
• Peptic Ulcer Hemorrhage/mortality
• Percutaneous Coronary Intervention/adverse effects
• Percutaneous Coronary Intervention/mortality
• Renal Insufficiency/mortality
• Retrospective Studies
• Risk Assessment
• Risk Factors
• ST Elevation Myocardial Infarction/diagnostic imaging
• ST Elevation Myocardial Infarction/mortality
• ST Elevation Myocardial Infarction/physiopathology
• ST Elevation Myocardial Infarction/therapy
• Time Factors
• Treatment Outcome

• xxz0607 Sub-program of the key project of Digestive Collaborative Development Center of Gastroenterology, Beijing Hospital Administration Center
• Sub-program of the key project of Digestive Collaborative Development Center of Gastroenterology, Beijing Hospital Administration Center

• acute myocardial infarction
• chronic total occlusion
• percutaneous coronary intervention
• periprocedural myocardial infarction

Patients with chronic total coronary occlusions (CTO) are at increased risk for poor clinical outcomes. We aimed to determine the incidence of CTO percutaneous coronary intervention (PCI) and to identify CTO patients at risk for cardiac events in the nationwide Netherlands Heart Registration (NHR).

We included all PCI procedures with ≥1 CTO registered in the NHR from January 2015 to December 2018, excluding acute interventions. We used multivariable logistic regression of baseline characteristics to calculate the risk for events as odds ratios (OR) with 95% confidence intervals (CI).

Of the PCIs performed during the study period, 6.3% (8,343/133,042) were for CTOs, with the percentage increasing significantly over time from 5.9% in 2015 to 6.6% in 2018 (p < 0.001). Coronary artery bypass grafting <24 h was carried out in 0.3%, and the only significant predictor was diabetes mellitus (OR 2.97, 95% CI 1.04–8.49, p = 0.042). Myocardial infarction (MI) <30 days occurred in 0.5%, and renal insufficiency (i.e. estimated glomerular filtration rate <30 ml/min per 1.73 m²) was identified as an independent predictor (OR 4.70, 95% CI 1.07–20.61, p = 0.040). Among patients undergoing CTO-PCI, 1‑year mortality was 3.7%, and independent predictors included renal insufficiency (OR 5.59, 95% CI 3.25–9.59, p < 0.001), left ventricular ejection fraction <30% (OR 3.43, 95% CI 2.00–5.90, p < 0.001), previous MI (OR 1.62, 95% CI 1.14–2.31, p = 0.007) and age (OR 1.06 per year increment, 95% CI 1.04–1.07, p < 0.001). Target-vessel revascularisation <1 year occurred in 11.3%.

CTO-PCI is still infrequently performed in the Netherlands. The most important predictor of mortality after CTO-PCI was renal insufficiency. Identification of patients at risk may help improve the prognosis of CTO patients in the future.

The online version of this article (10.1007/s12471-020-01521-y) contains supplementary material, which is available to authorized users.

• Chronic total occlusion
• Mortality
• Percutaneous coronary intervention
• Renal insufficiency

• Antegrade approach
• BridgePoint device
• Chronic total occlusions
• Dissection/reentry
• Percutaneous coronary intervention

• CTO
• Coronary chronic total occlusion
• Mortality
• Sudden cardiac death
• Ventricular fibrillation
• Ventricular tachyarrhythmias
• Ventricular tachycardia

• Chronic coronary total occlusion
• Multiple vessel disease
• Percutaneous coronary intervention

• cardiac function
• cardiovascular magnetic resonance
• chronic total coronary artery occlusion
• coronary artery disease
• multi-vessel coronary artery disease
• percutaneous coronary intervention

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Chronic Disease
• Coronary Angiography
• Coronary Occlusion/diagnosis
• Coronary Occlusion/surgery
• Coronary Vessels/diagnostic imaging
• Coronary Vessels/surgery
• Female
• Humans
• Male
• Middle Aged
• Myocardial Contraction/physiology
• Percutaneous Coronary Intervention/methods
• Prospective Studies
• Treatment Outcome
• Ventricular Function, Left/physiology
• Young Adult

• Concurrent chronic total occlusion
• Long-term outcome
• ST-segment elevation myocardial infarction
• Staged recanalization

• Coronary chronic total occlusion
• Outcomes
• Transcatheter aortic valve replacement