Recommended
More Related Content
What's hot
What's hot (20)
Similar to A.Bufe - Session1 - Ischemia and Viability - How to select the right patient
Similar to A.Bufe - Session1 - Ischemia and Viability - How to select the right patient (20)
More from Euro CTO Club
More from Euro CTO Club (20)
Recently uploaded
Recently uploaded (20)
A.Bufe - Session1 - Ischemia and Viability - How to select the right patient
- 1. A. Bufe Helios Klinikum Krefeld - Heartcenter Dep. of Cardiology and Intensive Care Ischemia and Viability – How to select the right patient
- 2. A.Bufe - EuroCTO Club 2020 Berlin I DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation Disclosure Statement of Financial Interest
- 3. Why should we recanalize a CTO ? A.Bufe - EuroCTO Club 2020 Berlin
- 4. CTO-Patients are often severely symptomatic (exertional dyspnoe, angina pectoris, physical impairment) A.Bufe - EuroCTO Club 2020 Berlin
- 5. CTO-Patients often have a poor prognosis A.Bufe - EuroCTO Club 2020 Berlin
- 6. A.Bufe - EuroCTO Club 2020 Berlin
- 7. A.Bufe - EuroCTO Club 2020 Berlin 1 vessel disease Patient is severely symptomatic, AP CCS III Normal LV-function Do we really need ischaemia test?
- 8. n = 1000 Success rate 86% A.Bufe - EuroCTO Club 2020 Berlin Sapontis et al., JACC Cariovasc Intv 2017
- 9. EURO-CTO Study Success Failure Decision as per usual clinical care Medical Rx CABG Ongoing angina despite OMT* Clinically indicated interim PCI Repeat Exercice Tolerance Test (ETT) for objective assessment of ischaemia @ 12m and 36months Single-vessel disease CTO only Multivessel CAD including CTO Treat non-occlusive disease by PCI before CTO with DES Angina or angina- equivalent symptoms Randomisation 2:1 PCI with DES + OMT n=800 2 OMT to include: - Aspirin, - Statin, - ACE-inhibitor where tolerated - + up to 2 anti-anginal agents at max tolerated dose including rate- limiting agent where appropriate. Ischaemic symptoms should be confirmed with non-invasive test. OMT n=400 1 A.Bufe - EuroCTO Club 2020 Berlin Efficacy: Quality of Life @ 12 and 36 months Safety: Death, non-fatal myocardial infarction (ITT, PP) @ 36 months
- 10. A.Bufe - EuroCTO Club 2020 Berlin Werner et al., EHJ 2018
- 11. A.Bufe - EuroCTO Club 2020 Berlin
- 12. A.Bufe - EuroCTO Club 2020 Berlin Bangalore et al., Circulation 2020; 142:841-857
- 13. A.Bufe - EuroCTO Club 2020 Berlin
- 14. Werner et al., TCT 2019 A.Bufe - EuroCTO Club 2020 Berlin
- 15. Werner et al., TCT 2019 A.Bufe - EuroCTO Club 2020 Berlin
- 16. A.Bufe - EuroCTO Club 2020 Berlin Lee et al, Decision CTO Study, Circulation 2019;139:1674-1683
- 17. A.Bufe - EuroCTO Club 2020 Berlin
- 18. A.Bufe - EuroCTO Club 2020 Berlin n = 19088 Multicenter registry - propensity score - mulivariable analysis Azadani et al., JACC Cardiovac Img 2020 SPECT MPI
- 19. A.Bufe - EuroCTO Club 2020 Berlin ESC Guidelines 2018
- 20. A.Bufe - EuroCTO Club 2020 Berlin CTO LCX 1 vessel disease No symtoms
- 21. A.Bufe - EuroCTO Club 2020 Berlin Rest 30yg 20yg 40yg Dobutamin Stress-MRI
- 22. A.Bufe - EuroCTO Club 2020 Berlin 6.389 patients Revascularization was associated with a protective effect only in the subset of extensive CMR-related ischaemia Extensive ischaemic burden was related to a higher risc of long term mortality 516/516 matched patients
- 23. A.Bufe - EuroCTO Club 2020 Berlin LAD-Stenoses RCA-CTO RCA distal NSTEMI anterior wall Hypokinesia anterior and severe Hypokinesia inferior (EF 38%)
- 24. Claessen et al., EHJ 2012;33:768-775 A.Bufe - EuroCTO Club 2020 Berlin
- 25. A.Bufe - EuroCTO Club 2020 Berlin epicardial collaterals Stents septal collaterals
- 26. A.Bufe - EuroCTO Club 2020 Berlin reverse CART Subendocardial Scar inferior MRI for viability
- 27. A.Bufe - EuroCTO Club 2020 Berlin Complete Revascularization in viable myocardium
- 28. A.Bufe - EuroCTO Club 2020 Berlin Metha et al., NEJM 2019; 381:1411-1421
- 29. A.Bufe - EuroCTO Club 2020 Berlin
- 30. A.Bufe - EuroCTO Club 2020 Berlin Galassi, Mashajekhi et al., J Am Coll Cardiol Intv 2017 n = 839 PCI of CTO in patients with low EF
- 31. A.Bufe - EuroCTO Club 2020 Berlin n = 72 Galassi, Mashajekhi et al., J Am Coll Cardiol Intv 2017 PCI of CTO in patients with low EF
- 32. A.Bufe - EuroCTO Club 2020 Berlin Conclusion Galassi et al., EuroCTO Club consensus document, Eurointervention 2019
- 33. A.Bufe - EuroCTO Club 2020 Berlin Thank you
- 34. A.Bufe - EuroCTO Club 2020 Berlin Thank you