Evidence map›Paper›PMID 33914092›Full record

ArticleHeart and vessels2021

Both surgical and percutaneous revascularization improve prognosis in patients with a coronary chronic total occlusion (CTO) irrespective of collateral robustness.

Usaid K Allahwala, Hosen Kiat, Avedis Ekmejian, Nadeem Mughal, Levi Bassin, Michael Ward, James C Weaver, Ravinay Bhindi

Abstract read
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In one paragraph

Article in Heart and vessels, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.8field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Usaid K AllahwalaDepartment of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia. usaid.allahwala@sydney.edu.au.ORCID http://orcid.org/0000-0001-7178-4744
Hosen KiatFaculty of Medicine and Health Sciences, Macquarie University, Marsfield, Australia.
Avedis EkmejianDepartment of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia.
Nadeem MughalDepartment of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia.
Levi BassinDepartment of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia.
Michael WardDepartment of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia.
James C WeaverThe University of Sydney, Sydney, Australia.
Ravinay BhindiDepartment of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia.
The University of Sydney · AURoyal North Shore Hospital · AUUNSW Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The impact of surgical or percutaneous coronary revascularization on prognosis in patients with a chronic total occlusion (CTO) remains uncertain. Particularly, whether revascularization of those with robust coronary collaterals improves prognosis is unknown. The objective of this study was to determine the predictors and prognostic impact of revascularization of a CTO, and to determine the clinical impact of robust coronary collaterals. Patients with a CTO diagnosed on coronary angiography between Jul 2010 and Dec 2019 were included in this study. Management strategy of the CTO was defined as percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or medical management. The degree of collateral robustness was determined by the Rentrop grading classification. Demographic, angiographic and clinical outcomes were recorded. A total of 954 patients were included in the study, of which 186 (19.5%) patients underwent CTO PCI, 296 (31.0%) patients underwent CABG and 472 (49.5%) patients underwent medical management of the CTO. 166 patients (17.4%) had Rentrop grade zero or one collaterals, 577 (60.5%) patients had Rentrop grade two and 211 (22.1%) had Rentrop grade three collaterals. The independent predictors of medical management of the CTO were older age, greater stenosis in the donor vessel, an emergent indication for angiography, a non-LAD CTO and female sex. The degree of collateral robustness was not associated with long-term mortality, while patients who were revascularized either through CABG or PCI had a significantly lower mortality compared to medical management alone (p < 0.0001). In patients with a CTO, the presence of robust collaterals is not associated with prognosis, while both surgical and percutaneous revascularization is associated with improved prognosis. Further research into the optimal revascularization strategy for a CTO is required.

Indexed as

Coronary OcclusionPercutaneous Coronary InterventionAgedChronic DiseaseCollateral CirculationCoronary AngiographyFemaleHumansPrognosisTreatment OutcomeChronic total occlusionCoronary artery bypass graftingCoronary collateralsCTOMortalityPercutaneous coronary interventionRevascularization

Identifiers

PMID33914092
OpenAlexW3157941227

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.