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RESEARCH PAPER
Analysis of risk factors for chronic total occlusion, multi-vessel and trunk of left coronary artery involvement in patients aged over 70 undergoing PCI
 
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1
Central Clinical Hospital, Warsaw / Medical University, Warsaw, Poland
 
2
University Clinical Hospital, Poznań, Poland
 
3
Międzyleski Specialist Hospital / Medical University, Warsaw, Poland
 
4
Southern Hospital, Warsaw-Ursynów, Poland
 
5
I Department and Clinic of Cardiology, Medical University, Warsaw, Poland
 
 
Corresponding author
Jakub Kuciński   

Central Clinical Hospital in Warsaw, Medical University, Warsaw, Poland
 
 
Med Og Nauk Zdr. 2023;29(4):283-289
 
KEYWORDS
TOPICS
ABSTRACT
Introduction and objective:
Percutaneous coronary intervention (PCI) is a non-surgical, invasive procedure used to unblock significantly narrowed coronary arteries in coronary artery disease. Elderly patients who require PCI are often burdened by a medical history. For these patients, percutaneous coronary intervention is a procedure with a significantly increased risk. In addition, several forms of coronary artery disease, such as multi-vessel disease, chronic total occlusion (CTO) or left coronary artery trunk disease, are considered ‘high-risk PCI’.

Material and methods:
An investigator-initiated, retrospective, single-centre study conducted between 11.2020–12.2021 in the 1st Department of Cardiology of the Medical University of Warsaw involving 150 patients over 70 years of age undergoing PCI. The performance of angioplasty, as recommended by the ESC guidelines, depended on the choice of the interventional cardiologist in the case of acute coronary syndrome, or on the decision of the Heart Group in the case of elective procedure, and subject to the patient’s informed consent. Exclusion criteria included age <70 years.

Results:
Comorbidities, such as diabetes, chronic kidney disease, high BMI and male gender, appear to be the main risk factors for complex PCI.

Conclusions:
The study showed that old age alone was not a significant risk factor for the need for a complex PCI procedure. There were no significant differences in the incidence of left coronary artery trunk disease, multi-vessel disease or chronic total occlusion between the age groups analysed. However, the group of patients who required ‘highrisk PCI’ had various co-morbidities, such as type 2 diabetes, chronic kidney disease or a higher BMI score.

REFERENCES (26)
1.
De Marzo V, D’amario D, Galli M, Vergallo R, Porto I. High-risk percutaneous coronary intervention: how to define it today? Minerva Cardioangiol. 2018 Oct;66(5):576–593.
 
2.
Bharath R, Nair KKM, Gupta D, Vijayan R. Assessment of Lewis negative phenotype as a risk factor for multivessel disease in patients with acute coronary syndrome. Transfus Clin Biol. 2022 May;29(2):129–133.
 
3.
Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. J Cell Physiol. 2019 Aug;234(10):16812–16823. doi: 10.1002/jcp.28350. Epub 2019 Feb 20.
 
4.
Hafeez Y, Varghese V. Chronic Total Occlusion Of The Coronary Artery. . In: StatPearls . Treasure Island (FL): StatPearls Publishing; 2023 Jan (access: 2023.02.05).
 
5.
Bryer E, Stein E, Goldberg S. Multivessel Coronary Artery Disease: The Limitations of a “One-Size-Fits-All” Approach. Mayo Clin Proc Innov Qual Outcomes. 2020 Nov 5;4(6):638–641.
 
6.
Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS Jr, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Jan 18;145(3):e4-e17. doi: 10.1161/CIR.0000000000001039. Epub 2021 Dec.Erratum in: Circulation. 2022 Mar 15;145(11):e771.
 
7.
Cantarelli MJC, Castello Jr HJ, Gonçalves R, Gioppato S, Guimarães JBF, Ribeiro EKP, Vardi JCF, Maksud D, Navarro EC. Independent predictors of multivessel coronary artery disease: results from Angiocardio Registry. Rev Bras Cardiol Invasiva (English Edition), 23(4), 266–270. October-December 2015.
 
8.
Bardají A, Rodriguez-López J, Torres-Sánchez M. Chronic total occlusion: To treat or not to treat. World J Cardiol. 2014 Jul 26;6(7):621–9.
 
9.
Chikwe J, Kim M, Goldstone AB, Fallahi A, Athanasiou T. Current diagnosis and management of left main coronary disease. Eur J Cardiothorac Surg. 2010 Oct;38(4):420–8.
 
10.
Zhang DQ, Xu YF, Dong YP, Yu SJ. Coronary computed tomography angiography study on the relationship between the Ramus Intermedius and Atherosclerosis in the bifurcation of the left main coronary artery. BMC Med Imaging. 2023 Apr 11;23(1):53.
 
11.
Kałużna-Oleksy M, Skorupski WJ, Grygier M, Araszkiewicz A, Skorupski W, Grajek S, Mitkowski P, Pyda M, Lesiak M. A Personalized Approach to Percutaneous Coronary Interventions in the Left Main Coronary Artery-Is the Female Gender Associated with Worse Outcomes? J Pers Med. 2021 Jun 20;11(6):581.
 
12.
Yildirimturk O, Cansel M, Erdim R, Ozen E, Demiroglu IC, Aytekin V. Coexistence of left main and right coronary artery ostial stenosis: demographic and angiographic features. Int J Angiol. 2011 Mar;20(1):33–8.
 
13.
Chiha J, Mitchell P, Gopinath B, Plant AJH, Kovoor P, Thiagalingam A. Gender differences in the severity and extent of coronary artery disease. Int J Cardiol Heart Vasc. 2015 Jul 30;8:161–166.
 
14.
Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary Artery Disease in Patients ≥80 Years of Age. J Am Coll Cardiol. 2018 May 8;71(18):2015–40.
 
15.
Gul F, Parekh A. Multivessel Disease. [Updated 2023 Feb 8]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
 
16.
Shamkhani W, Rashid M, Mamas M. Complex, high‐risk percutaneous coronary intervention types, trends, and in‐hospital outcomes among different age groups: An insight from a national registry. Catheter Cardiovasc Interv. 2022 Nov 1;100(5):711–720.
 
17.
Masafumi O, Serruys PW, Hara H, Kawashima H, Gao C, Wang R, Takahashi K, O’Leary N, Wykrzykowska JJ, Sharif F, Piek JJ, Garg S, Mack MJ, Holmes DR, Morice MC, Head SJ, Kappetein AP, Thuijs DJFM, Noack T, Davierwala PM, Mohr FW, Cohen DJ, Onuma Y. 10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease. Journal of the American College of Cardiology. 2021 Jun 8;77(22):2761–2773.
 
18.
Senior R, Reynolds HR, Min JK, Berman DS, Picard MH, Chaitman BR, Shaw LJ, Page CB, Govindan SC, Lopez-Sendon J, Peteiro J, Wander GS, Drozdz J, Marin-Neto J, Selvanayagam JB, Newman JD, Thuaire C, Christopher J, Jang JJ, Kwong RY, Bangalore S, Stone GW, O’Brien SM, Boden WE, Maron DJ, Hochman JS. Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial. J Am Coll Cardiol. 2022 Feb 22;79(7): 651–661.
 
19.
Su D, Zhang X, He K, Chen Y, Wu N. Individualized prediction of chronic kidney disease for the elderly in longevity areas in China: Machine learning approaches. Front Public Health. 2022 Oct 21;10:998549.
 
20.
Zhang HP, Ai H, Zhao Y, Li H, Tang GD, Zheng NX, Sun FC, Liu JH. Effect of Chronic Total Occlusion Percutaneous Coronary Interferon on Clinical Outcomes in Elderly Patients. Am J Med Sci. 2018 Feb;355(2):174–182.
 
21.
Toma A, Gebhard C, Gick M, Ademaj F, Stähli BE, Mashayekhi K, Ferenc M, Neumann FJ, Buettner HJ. Survival after percutaneous coronary intervention for chronic total occlusion in elderly patients. EuroIntervention. 2017 Jun 2;13(2):e228-e235.
 
22.
Cui C, Sheng Z. Outcomes of percutaneous coronary intervention for chronic total occlusions in the elderly: A systematic review and metaanalysis. Clin Cardiol. 2021 Jan;44(1): 27–35.
 
23.
Wang HY, Wang Y, Yin D, Gao RL, Yang YJ, Xu B, Dou KF. Percutaneous Coronary Intervention Complexity and Risk of Adverse Events in relation to High Bleeding Risk among Patients Receiving Drug-Eluting Stents: Insights from a Large Single-Center Cohort Study. J Interv Cardiol. 2020;2020: 2985435.
 
24.
Shoaib A, Rashid M, Kontopantelis E, Sharp A, Fahy EF, Nolan J, Townend J, Ludman P, Ratib K, Azam ZA, Ahmad A, McEntegart M, Mohamed M, Kinnaird T, Mamas MA. Clinical Characteristics and Outcomes From Percutaneous Coronary Intervention of Last Remaining Coronary Artery. Circulation: Cardiovascular Interventions. 2020 Sep;13(9).
 
25.
Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D, Belder Ad, Redwood S. Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. JAMA. 2010 Aug 25;304(8):867–74.
 
26.
Curtis JP, Rathore SS, Wang Y, Chen J, Nallamothu BK, Krumholz HM. Use and Effectiveness of Intra-Aortic Balloon Pumps Among Patients Undergoing High Risk Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry. Circulation: Cardiovascular Quality and Outcomes. 2012 Jan;5(1):21–30.
 
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