CTO in MVD
- 1. Klinik für Innere Medizin I / Kardiologie CTO and MVD 12th Experts Live CTO 11. - 12.09.2019 Prof. Dr. Bernward Lauer Ltd. Oberarzt der Klinik für Innere Medizin I Universitätsklinikum Jena
- 2. CTO and MVD in acute coronary syndroms CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD
- 3. CTO and MVD in acute coronary syndroms CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD Ariza-Solé A et al. Rev Esp Cardiol 2014; 67(5): 359-366; Choi IJ et al. Am J Cardiol 2016;117:1039-1046; Hoebers LPC et al. Eur J Heart Fail 2013 15(4) 425-432; Lesiak M et al. Cardiol J 2017 24(2) 117-124; Mizuguchi Y et al. Int J Cardiol 2014 176(3) 1139-1141; Tajstra M et al. Am J Cardiol 2012 109(2) 208-213; Valenti Ret al. Am J Cardiol 2014 114(12) 1794-1800; Wanatanabe H et al. Eurointervention 2017 12(15) e1874- e1882 Year ACS Region Study population MVD CTO Ariza-Solé 2013 STEMI Spain 1176 125 (10,6%) Choi 2016 STEMI Korea 4748 324 (6,8%) Hoebers 2013 NSTEMI Netherlands 5018 1819 (36,3%) 666 (13,3%) Lesiak 2017 STEMI Poland 836 437 (52,3%) 146 (17,5%) Miziguchi 2013 AMI Japan 417 35 (8,0%) Tajstra 2012 STEMI Poland 1658 666 (40,2%) 204 (12,3%) Valenti 2012 AMI Italy 1911 169 (8,8%) Wanatanabe 2017 STEMI Korea 5429 2045 (37,7%) 383 (7,1%) Total 21193 2052 (9,7%)
- 4. Infarct size CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Saad et al. (2018) Int J Cardiol; 265; 251 - 255
- 5. LV - EF CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Saad et al. (2018) Int J Cardiol; 265; 251 - 255
- 6. event rate CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Saad et al. (2018) Int J Cardiol; 265; 251 - 255
- 7. prognosis CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Claessen et al.; Eur Heart J. 2012 33(6) 768-775 HORIZONS-AMI
- 8. prognosis CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Claessen et al.; Eur Heart J. 2012 33(6) 768-775 HORIZONS-AMI
- 9. prognosis CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432 single vs multiple CTOs
- 10. prognosis CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Saad M et al. (2018) Eurointervention 14; e306-e314 in cardiogenic shock
- 11. prognosis CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432 IRA localisation
- 12. prognosis CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Hoebers LP et al. Eur J Heart Fail. 2013 15(4) 425-432 CTO localisation
- 13. prognosis CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Fujii T et al Int J Cardiol. 2017 (230) 346-352 CTO collateral quality
- 14. prognosis CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Fujii T et al. Int J Cardiol. 2016 (218) 158-163 CTO collateral donor
- 15. CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Higher mortality with a CTO vs. no CTO more than one CTO in cardiogenic shock LAD as IRA poor collaterals Collaterals from IRA
- 16. CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Henriques JP et al. J Am Coll Cardiol. 2016 Oct 11;68(15):1622- 1632 RCT: EXPLORE trial
- 17. CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Henriques JP et al. J Am Coll Cardiol. 2016 Oct 11;68(15):1622- 1632 RCT: EXPLORE trial
- 18. CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Choi IJ et al. Am J Cardiol. 2016 117(7) 1039-1046 Prognosis with/without successful recanalisation of CTO
- 19. CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN ACS Valenti R et al. Am J Cardiol. 2014 114(12) 1794-1800 Prognosis with/without successful recanalisation of CTO After an ACS, a successful CTO - PCI seems to be associated with increased survival
- 20. CTO and MVD in chronic coronary syndroms CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD
- 21. Prevalence of a CTO: • ACS: 10 % • elective coronary angiography: 15 - 25 % • after CABG: 90 % CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN CCS
- 22. Prevalence of a CTO: • ACS: 10 % • elective coronary angiography: 15 - 25 % • after CABG: 90 % • in MVD (Syntax study): ≈ 35,7 % ! CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN CCS
- 23. How is the treatment of a CTO in MVD in CCS ? CTO and MVD EuroCTO - Meeting Berlin 2020 1262 4337 3075 12751800 903897 1981077 24,3% 217 pat 22,2% 200 pat 56,6% 610 pat 36,5% 72 patCTO CTO AND MVD IN CCS numbers calculated and extrapolated from: Serruys et al, NEJM 2009 Syntax Trial
- 24. Syntax Score calculation CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN CCS CTO proximal LAD, unknown age: SyntaxScore: 18,5 Probably due to the fact, that the EuroCTO club was founded only in 2006 (after the Syntax Score has been introduced) ESC Guidelienes myocardial revascularization 2018
- 25. Revascularisation in MVD with CTO CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD IN CCS ESC Guidelienes myocardial revascularization 2018 Which lesion first ? • no CRT !! • which leaves you with „EBM“ („eminence based medicine“) • Factors to consider: • antegrade or retrograde approach • area at risk by non-CTO lesion(s) • complexity of the non-CTO lesion(s) • regional LV function • lesion in a collateral donor vessel ? • others • individual decision
- 26. Thank you for your attention CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD
- 27. Thank you for your attention CTO and MVD EuroCTO - Meeting Berlin 2020 CTO AND MVD