Publications by authors named "James W Choi"
Background: Proximal vessel tortuosity can hinder wiring and equipment delivery during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Aims: We sought to examine the association of proximal vessel tortuosity with the short and long-term outcomes of patients undergoing CTO PCI.
Methods: We examined the association of proximal vessel tortuosity with clinical outcomes in patients who underwent CTO PCI at 50 US and non-US centers between 2012 and 2024.
Outcomes of Left Main Chronic Total Occlusion Percutaneous Coronary Interventions.
Catheter Cardiovasc Interv
November 2024
Article Synopsis
- The study looked at the outcomes of patients undergoing percutaneous coronary intervention (PCI) for left main (LM) chronic total occlusions (CTO) compared to non-LM CTOs across multiple centers from 2012 to 2024.
- Out of over 15,000 CTO PCIs, only 85 involved LM CTOs, which were associated with older patients who commonly had higher rates of health issues like heart failure and previous bypass surgeries.
- Despite higher complications and angiographic complexity in LM CTO cases, the technical success rates were similar to non-LM PCIs, indicating that they can be performed safely despite their challenges.
Background: The J-CTO investigators recently developed angiographic difficulty scores for each of the three major coronary arteries in patients undergoing first-attempt chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in de novo occlusions.
Methods: We examined the performance of the individual J-CTO scores in a large multicenter registry.
Results: The CTO lesion location was as follows: right coronary artery (RCA) 3,805 (54%), left anterior descending artery (LAD) 2,303 (33%), and left circumflex (LCX) 935 (13%).
Background: Drug-eluting stents (DESs) with controlled antiproliferative drug release reduce restenosis risk, but durable polymers can delay healing and inhibit reendothelialization. The Firehawk biodegradable polymer sirolimus-eluting stent (BP-SES) has a fully biodegradable sirolimus-containing polymer coating localized to recessed abluminal grooves on the stent surface and delivers roughly one-third the drug dose of other DESs.
Objectives: We report the primary results of the TARGET-IV NA (Firehawk Rapamycin Target Eluting Coronary Stent North American Trial) randomized controlled trial comparing clinical outcomes with BP-SES vs currently used second-generation DESs.
There are limited comparative data on the use of plaque modification devices during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared intravascular lithotripsy (IVL) with rotational atherectomy (RA) for lesion preparation in patients who underwent CTO PCI across 50 US and non-US centers from 2019 to 2024. Of 15,690 patients who underwent CTO PCI during the study period, 436 (2.
View Article and Find Full Text PDFArticle Synopsis
- A study analyzed the outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) specifically in patients with anomalous coronary arteries (ACA) from a large dataset of over 14,000 patients between 2012 and 2023.
- Among 14,470 CTO procedures, only 36 (0.24%) were performed on patients with ACA, who displayed similar baseline characteristics to those without ACA, but had more complicated lesions, requiring longer procedures and greater contrast volume.
- Despite the increased complexity, ACA patients achieved similar procedural success rates to non-ACA patients, with no major adverse cardiac events reported in the ACA group, indicating a favorable outcome for CTO PCI in
Background: The impact of peripheral artery disease (PAD) on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is not well studied.
Methods: We analyzed the association of PAD with CTO-PCI outcomes using data from the PROGRESS-CTO registry of procedures performed at 47 centers between 2012 and 2023.
Results: The prevalence of PAD among 12 961 patients who underwent CTO PCI during the study period was 13.
Article Synopsis
- A study was conducted to create and validate a machine learning model to predict the success of chronic total occlusion crossing through primary antegrade wiring, using a large dataset from 12,136 cases in the PROGRESS CTO registry.
- The extreme gradient boosting model showed the best performance with an area under the receiver-operating characteristic curve of around 0.78, indicating its effectiveness.
- Key factors influencing the success included occlusion length and vessel characteristics, while aorto-ostial lesion location had minimal impact; a web application for predicting outcomes is available online.
Background: There is variability in clinical and lesion characteristics as well as techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: We analyzed patient and lesion characteristics, techniques, and outcomes in 11 503 CTO-PCI procedures performed in North America (NA) and in the combined regions of Europe, Asia, and Africa from 2017 to 2023 as documented in the PROGRESS-CTO registry.
Results: Eight thousand four hundred seventy-nine (74%) procedures were performed in NA.
Article Synopsis
- Some doctors suggest giving patients with a high bleeding risk a shorter treatment of medication after getting a special type of heart stent.
- This study looked at how safe and effective 1 month of this medication is compared to 3 months for patients who also had a type of heart problem or not.
- They found that 1-month treatment had the same chance of serious heart issues as the 3-month treatment, but it caused less bleeding after a year.
Ranolazine is an anti-anginal medication given to patients with chronic angina and persistent symptoms despite medical therapy. We examined 11 491 chronic total occlusion (CTO) percutaneous coronary interventions (PCI) that were performed at 41 US and non-US centers between 2012 and 2023 in the PROGRESS-CTO Registry. Patients on ranolazine at baseline had more comorbidities, more complex lesions, lower procedural and technical success (based on univariable but not multivariable analysis), and higher incidence of major adverse cardiac events (MACE) (on both univariable and multivariable analysis).
View Article and Find Full Text PDFBackground: The complex high-risk indicated percutaneous coronary intervention (CHIP) score is a tool developed using the British Cardiovascular Intervention Society (BCIS) database to define CHIP cases and predict in-hospital major adverse cardiac or cerebrovascular events (MACCE).
Aim: To assess the validity of the CHIP score in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: We evaluated the performance of the CHIP score on 8341 CTO PCIs from the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) performed at 44 centers between 2012 and 2023.
Background: Catheter-based renal sympathetic denervation (RDN) reduced blood pressure (BP) in multiple randomized sham-controlled trials of patients with uncontrolled hypertension (HTN). We tested proof-of-concept for a more selective treatment strategy, exclusively targeting these areas to improve the efficiency of the procedure.
Methods: The SPYRAL DYSTAL Pilot study was designed to mirror the SPYRAL HTN-OFF MED Pivotal study, enabling comparison with a propensity score adjusted active-control group.
Background: There is limited data on retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) via ipsilateral epicardial collaterals (IEC).
Aims: To compare the clinical and angiographic characteristics, and outcomes of retrograde CTO PCI via IEC versus other collaterals in a large multicenter registry.
Methods: Observational cohort study from the Prospective Global registry for the study of Chronic Total Occlusion Intervention (PROGRESS-CTO).
Article Synopsis
- Plaque modification microcatheters (PM), specifically Tornus and Turnpike Gold, are specialized devices used to treat chronic total occlusion (CTO) in coronary artery interventions.
- In a study analyzing their use across multiple centers, PMs were employed in 242 cases, representing only 1.6% of total procedures, with usage declining over time.
- The results showed that both types of microcatheters had similar success rates and complication levels, indicating that while they are seldom used, they are effective and safe in CTO interventions.
Background: Antegrade wiring is the most commonly used chronic total occlusion (CTO) crossing technique.
Methods: Using data from the PROGRESS CTO registry (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; Clinicaltrials.gov identifier: NCT02061436), we examined the clinical and angiographic characteristics and procedural outcomes of CTO percutaneous coronary interventions (PCIs) performed using a primary antegrade wiring strategy.
Objectives: There is limited data on race and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The authors sought to evaluate CTO PCI techniques and outcomes in different racial groups.
Methods: We examined the baseline characteristics and procedural outcomes of 11 806 CTO PCIs performed at 44 US and non-US centers between 2012 and March 2023.
Background: Emergency coronary artery bypass surgery (eCABG) is a serious complication of chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI).
Methods: We examined the incidence and outcomes eCABG among 14,512 CTO PCIs performed between 2012 and 2023 in a large multicenter registry.
Results: The incidence of eCABG was 0.
Background: There is limited data on equipment loss or entrapment during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: We analyzed the baseline clinical and angiographic characteristics and outcomes of equipment loss/entrapment at 43 US and non-US centers between 2017 and 2023.
Results: Equipment loss/entrapment was reported in 40 (0.
There is significant variation in wire utilization patterns for chronic total occlusion (CTO) percutaneous coronary intervention. This study aimed to compare the outcomes of polymer-jacketed wires (PJWs) versus non-PJWs in anterograde procedures. We analyzed clinical and angiographic characteristics, and procedural outcomes of 7,575 anterograde CTO percutaneous coronary interventions that were performed at 47 centers between 2012 and 2023.
View Article and Find Full Text PDFArticle Synopsis
- The analysis evaluated the impact of 1-month versus 3-month dual antiplatelet therapy (DAPT) in older patients after percutaneous coronary intervention (PCI), focusing on those with high bleeding risk.
- In a study of 3,364 patients, they found similar rates of all-cause death or myocardial infarction for both therapy durations, regardless of whether patients were ≥75 years or <75 years old.
- However, patients aged ≥75 experienced significantly less bleeding with the 1-month DAPT compared to the 3-month treatment, suggesting a clearer benefit in reducing bleeding risk without increasing heart-related complications.
Article Synopsis
- A study assessed the relationship between activated clotting time (ACT) and in-hospital outcomes for patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- Out of 4,377 patients, it was found that low (<200 seconds) and high (>400 seconds) ACT levels were linked to higher risks of net adverse cardiovascular events (NACE), compared to the ideal range of 200 to 400 seconds.
- The findings suggest that an optimal ACT range is crucial as low ACT increases ischemic events while high ACT leads to more bleeding complications during CTO PCI.
Article Synopsis
- Retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has lower success rates and higher complications compared to the antegrade method, yet its outcomes and techniques were evaluated in this study involving over 4,000 cases.
- The study found that retrograde crossing was successful in about 60.5% of cases, with technical success rates of 78.7% and a 3.5% rate of major adverse cardiac events (MACE) during hospitalization.
- Among various retrograde techniques, retrograde true lumen puncture showed the best safety profile, but overall there is room for improvement in both the efficacy and safety of retrograde CTO PCI procedures.*