Improved Survival After Percutaneous Coronary Intervention of Chronic Total Occlusion Varies by Target Vessel
Mehdi H. Shishehbor, DO, MPH*,
Patrick L. Whitlow, MD
Safley et al. (1) conducted an important multivariable analysis to determine predictors of success in treating chronic total occlusion and clinical outcomes. As part of their conclusions, they stated that the use of glycoprotein IIb/IIIa was significantly associated with improved success (odds ratio: 2.27, 95% confidence interval: 1.36 to 4.80). However, we feel that the inclusion of glycoprotein IIb/IIIa in models to predict success and outcome is inappropriate, as glycoprotein IIb/IIIa is typically used after and not before the chronic total occlusion has been crossed with a guidewire with reasonable assurance that the wire is intraluminal distally. Therefore, we question whether glycoprotein IIb/IIIa use has any impact on chronic total occlusion success rates. Further, its inclusion in the models can potentially impact the point estimates of other important variables. More importantly, the use of glycoprotein IIb/IIIa before successful crossing of a chronic total occlusion may increase the risk of pericardial effusion or tamponade. It would be of interest to conduct the same analysis without the inclusion of glycoprotein IIb/IIIa to observe whether other important variables are predictive of success and outcome in this cohort.
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Footnotes
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Please note: Dr. Whitlow has received research grant support from Abbott Vascular, Boston Scientific, and Evalve Inc., and has received consulting fees from Medlogics and Icon International Systems Inc.
* Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, JJ40, Cleveland, Ohio 44195 (Email: shishem{at}gmail.com).
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REFERENCES
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- Safley DM, House JA, Marso SP, Grantham JA, Rutherford BD. Improvement in survival following successful percutaneous coronary intervention of chronic total occlusion: variability by target vessel J Am Coll Cardiol Intv 2008;1:295-302.[Abstract/Free Full Text]
Related Article
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- David M. Safley, Steven P. Marso, John A. House, J. Aaron Grantham, and Barry D. Rutherford
J. Am. Coll. Cardiol. Intv. 2008 1: 598.
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