Relentless Angina of a Scarred Heart

Eslam Abbas; Ahmed Mahdy; Shady Mansy

doi:doi:10.11648/j.ccr.20240804.11

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Relentless Angina of a Scarred Heart

Eslam Abbas^*, Ahmed Mahdy, Shady Mansy

Published in Cardiology and Cardiovascular Research (Volume 8, Issue 4)

Received: 28 August 2021 Accepted: 12 October 2021 Published: 7 December 2024

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Abstract

Refractory anginal pain affects nearly 5-10% of stable coronary artery disease patients, and maximizing the anti-ischemic medical therapy is the standard first-line treatment. The presence of a scarred myocardial territory of the epicardial coronary chronic total occlusion (CTO) limits the implementation of other modalities, such as angioplasty and surgical bypass. Accordingly, this subset of patients, who show poor response to medical treatment with the absence of considerable reversible ischemia, bears an additional burden of persistent angina besides the structural and functional complications resulting from their scarred hearts. In this report, a patient, with compensated ischemic cardiomyopathy, complaining of disabling stable angina was indicated for diagnostic coronary angiography that showed a chronic total occlusion (CTO) at the mid-segment of the left anterior descending coronary artery (LAD) and otherwise no significant stenoses in the epicardial coronary tree. After the failure of maximized anti-ischemic medical therapy, the patient underwent elective percutaneous intervention (PCI) to the left anterior descending coronary artery (LAD) chronic total occlusion (CTO) with 2 overlapping drug-eluting stents that yielded a favorable outcome on patient follow-up even though a myocardial perfusion imaging failed to show considerable reversible ischemia at the left anterior descending coronary artery (LAD) territory. The report points out that elective chronic total occlusion (CTO) revascularization may alleviate anginal pain, despite the absence of a considerable macroscopic ischemia, after failure of a maximized anti-ischemic medical regimen.

Published in	Cardiology and Cardiovascular Research (Volume 8, Issue 4)
DOI	10.11648/j.ccr.20240804.11
Page(s)	92-95
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Chest Pain, Refractory Angina, Elective PCI, CTO, Revascularization, Myocardial Ischemia

References

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[2]	Davies A, Fox K, Galassi AR, Banai S, Ylä-Herttuala S, Lüscher TF. Management of refractory angina: an update. Eur Heart J. 2021; 42(3): 269–83.
[3]	Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; 62(16): e147–239.
[4]	Berkhout T, Claessen BE, Dirksen MT. Advances in percutaneous coronary intervention for chronic total occlusions: current antegrade dissection and reentry techniques and updated algorithm. Netherlands Hear J. 2021; 29(1): 52–9.
[5]	Maeremans J, Knaapen P, Stuijfzand WJ, Kayaert P, Pereira B, Barbato E, Dens J. Antegrade wire escalation for chronic total occlusions in coronary arteries: simple algorithms as a key to success. J Cardiovasc Med. 2016; 17(9): 680–6.
[6]	Thomas M, Jones PG, Arnold S V, Spertus JA. Interpretation of the Seattle Angina Questionnaire as an Outcome Measure in Clinical Trials and Clinical Care A Review. JAMA Cardiol. 2021; 6(5): 593–9.
[7]	Bardají A, Rodriguez-López J, Torres-Sánchez M. Chronic total occlusion: to treat or not to treat. World J Cardiol. 2014; 6(7): 621.
[8]	Werner GS, Martin-Yuste V, Hildick-Smith D, Boudou N, Sianos G, Gelev V, Rumoroso JR, Erglis A, Christiansen EH, Escaned J. A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. Eur Heart J. 2018; 39(26): 2484–93.
[9]	Obedinskiy AA, Kretov EI, Boukhris M, Kurbatov VP, Osiev AG, Ibn Elhadj Z, Obedinskaya NR, Kasbaoui S, Grazhdankin IO, Prokhorikhin AA, et al. The IMPACTOR-CTO Trial. JACC Cardiovasc Interv. 2018 Jul; 11(13): 1309–11.
[10]	Sapontis J, Salisbury AC, Yeh RW, Cohen DJ, Hirai T, Lombardi W, McCabe JM, Karmpaliotis D, Moses J, Nicholson WJ. Early procedural and health status outcomes after chronic total occlusion angioplasty: a report from the OPEN-CTO registry (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures). JACC Cardiovasc Interv. 2017; 10(15): 1523–34.
[11]	Windecker S, Kolh P, Alfonso F, Collet J-P, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ. 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2014 Oct 1; 35(37): 2541–619.
[12]	Schumacher SP, Stuijfzand WJ, Opolski MP, van Rossum AC, Nap A, Knaapen P. Percutaneous coronary intervention of chronic total occlusions: when and how to treat. Cardiovasc Revascularization Med. 2019; 20(6): 513–22.
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APA Style

Abbas, E., Mahdy, A., Mansy, S. (2024). Relentless Angina of a Scarred Heart. Cardiology and Cardiovascular Research, 8(4), 92-95. https://doi.org/10.11648/j.ccr.20240804.11

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ACS Style

Abbas, E.; Mahdy, A.; Mansy, S. Relentless Angina of a Scarred Heart. Cardiol. Cardiovasc. Res. 2024, 8(4), 92-95. doi: 10.11648/j.ccr.20240804.11

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AMA Style

Abbas E, Mahdy A, Mansy S. Relentless Angina of a Scarred Heart. Cardiol Cardiovasc Res. 2024;8(4):92-95. doi: 10.11648/j.ccr.20240804.11

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@article{10.11648/j.ccr.20240804.11,
  author = {Eslam Abbas and Ahmed Mahdy and Shady Mansy},
  title = {Relentless Angina of a Scarred Heart
},
  journal = {Cardiology and Cardiovascular Research},
  volume = {8},
  number = {4},
  pages = {92-95},
  doi = {10.11648/j.ccr.20240804.11},
  url = {https://doi.org/10.11648/j.ccr.20240804.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20240804.11},
  abstract = {Refractory anginal pain affects nearly 5-10% of stable coronary artery disease patients, and maximizing the anti-ischemic medical therapy is the standard first-line treatment. The presence of a scarred myocardial territory of the epicardial coronary chronic total occlusion (CTO) limits the implementation of other modalities, such as angioplasty and surgical bypass. Accordingly, this subset of patients, who show poor response to medical treatment with the absence of considerable reversible ischemia, bears an additional burden of persistent angina besides the structural and functional complications resulting from their scarred hearts. In this report, a patient, with compensated ischemic cardiomyopathy, complaining of disabling stable angina was indicated for diagnostic coronary angiography that showed a chronic total occlusion (CTO) at the mid-segment of the left anterior descending coronary artery (LAD) and otherwise no significant stenoses in the epicardial coronary tree. After the failure of maximized anti-ischemic medical therapy, the patient underwent elective percutaneous intervention (PCI) to the left anterior descending coronary artery (LAD) chronic total occlusion (CTO) with 2 overlapping drug-eluting stents that yielded a favorable outcome on patient follow-up even though a myocardial perfusion imaging failed to show considerable reversible ischemia at the left anterior descending coronary artery (LAD) territory. The report points out that elective chronic total occlusion (CTO) revascularization may alleviate anginal pain, despite the absence of a considerable macroscopic ischemia, after failure of a maximized anti-ischemic medical regimen.
},
 year = {2024}
}

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TY  - JOUR
T1  - Relentless Angina of a Scarred Heart

AU  - Eslam Abbas
AU  - Ahmed Mahdy
AU  - Shady Mansy
Y1  - 2024/12/07
PY  - 2024
N1  - https://doi.org/10.11648/j.ccr.20240804.11
DO  - 10.11648/j.ccr.20240804.11
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 92
EP  - 95
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20240804.11
AB  - Refractory anginal pain affects nearly 5-10% of stable coronary artery disease patients, and maximizing the anti-ischemic medical therapy is the standard first-line treatment. The presence of a scarred myocardial territory of the epicardial coronary chronic total occlusion (CTO) limits the implementation of other modalities, such as angioplasty and surgical bypass. Accordingly, this subset of patients, who show poor response to medical treatment with the absence of considerable reversible ischemia, bears an additional burden of persistent angina besides the structural and functional complications resulting from their scarred hearts. In this report, a patient, with compensated ischemic cardiomyopathy, complaining of disabling stable angina was indicated for diagnostic coronary angiography that showed a chronic total occlusion (CTO) at the mid-segment of the left anterior descending coronary artery (LAD) and otherwise no significant stenoses in the epicardial coronary tree. After the failure of maximized anti-ischemic medical therapy, the patient underwent elective percutaneous intervention (PCI) to the left anterior descending coronary artery (LAD) chronic total occlusion (CTO) with 2 overlapping drug-eluting stents that yielded a favorable outcome on patient follow-up even though a myocardial perfusion imaging failed to show considerable reversible ischemia at the left anterior descending coronary artery (LAD) territory. The report points out that elective chronic total occlusion (CTO) revascularization may alleviate anginal pain, despite the absence of a considerable macroscopic ischemia, after failure of a maximized anti-ischemic medical regimen.

VL  - 8
IS  - 4
ER  -

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Author Information

Eslam Abbas

Department of Cardiology, Arab Contractors Medical Center (ACMC), Cairo, Egypt

Contact Email
Ahmed Mahdy

Department of Cardiology, Jaber Al-Ahmad Armed Forces Hospital, Kuwait City, Kuwait;Department of Cardiology, Al Mokattam Insurance Hospital, Cairo, Egypt
Shady Mansy

Department of Cardiology, Al Mokattam Insurance Hospital, Cairo, Egypt

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Plain Text BibTeX RIS

APA Style

Abbas, E., Mahdy, A., Mansy, S. (2024). Relentless Angina of a Scarred Heart. Cardiology and Cardiovascular Research, 8(4), 92-95. https://doi.org/10.11648/j.ccr.20240804.11

Copy | Download

ACS Style

Abbas, E.; Mahdy, A.; Mansy, S. Relentless Angina of a Scarred Heart. Cardiol. Cardiovasc. Res. 2024, 8(4), 92-95. doi: 10.11648/j.ccr.20240804.11

Copy | Download

AMA Style

Abbas E, Mahdy A, Mansy S. Relentless Angina of a Scarred Heart. Cardiol Cardiovasc Res. 2024;8(4):92-95. doi: 10.11648/j.ccr.20240804.11

Copy | Download

@article{10.11648/j.ccr.20240804.11,
  author = {Eslam Abbas and Ahmed Mahdy and Shady Mansy},
  title = {Relentless Angina of a Scarred Heart
},
  journal = {Cardiology and Cardiovascular Research},
  volume = {8},
  number = {4},
  pages = {92-95},
  doi = {10.11648/j.ccr.20240804.11},
  url = {https://doi.org/10.11648/j.ccr.20240804.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20240804.11},
  abstract = {Refractory anginal pain affects nearly 5-10% of stable coronary artery disease patients, and maximizing the anti-ischemic medical therapy is the standard first-line treatment. The presence of a scarred myocardial territory of the epicardial coronary chronic total occlusion (CTO) limits the implementation of other modalities, such as angioplasty and surgical bypass. Accordingly, this subset of patients, who show poor response to medical treatment with the absence of considerable reversible ischemia, bears an additional burden of persistent angina besides the structural and functional complications resulting from their scarred hearts. In this report, a patient, with compensated ischemic cardiomyopathy, complaining of disabling stable angina was indicated for diagnostic coronary angiography that showed a chronic total occlusion (CTO) at the mid-segment of the left anterior descending coronary artery (LAD) and otherwise no significant stenoses in the epicardial coronary tree. After the failure of maximized anti-ischemic medical therapy, the patient underwent elective percutaneous intervention (PCI) to the left anterior descending coronary artery (LAD) chronic total occlusion (CTO) with 2 overlapping drug-eluting stents that yielded a favorable outcome on patient follow-up even though a myocardial perfusion imaging failed to show considerable reversible ischemia at the left anterior descending coronary artery (LAD) territory. The report points out that elective chronic total occlusion (CTO) revascularization may alleviate anginal pain, despite the absence of a considerable macroscopic ischemia, after failure of a maximized anti-ischemic medical regimen.
},
 year = {2024}
}

Copy | Download

TY  - JOUR
T1  - Relentless Angina of a Scarred Heart

AU  - Eslam Abbas
AU  - Ahmed Mahdy
AU  - Shady Mansy
Y1  - 2024/12/07
PY  - 2024
N1  - https://doi.org/10.11648/j.ccr.20240804.11
DO  - 10.11648/j.ccr.20240804.11
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 92
EP  - 95
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20240804.11
AB  - Refractory anginal pain affects nearly 5-10% of stable coronary artery disease patients, and maximizing the anti-ischemic medical therapy is the standard first-line treatment. The presence of a scarred myocardial territory of the epicardial coronary chronic total occlusion (CTO) limits the implementation of other modalities, such as angioplasty and surgical bypass. Accordingly, this subset of patients, who show poor response to medical treatment with the absence of considerable reversible ischemia, bears an additional burden of persistent angina besides the structural and functional complications resulting from their scarred hearts. In this report, a patient, with compensated ischemic cardiomyopathy, complaining of disabling stable angina was indicated for diagnostic coronary angiography that showed a chronic total occlusion (CTO) at the mid-segment of the left anterior descending coronary artery (LAD) and otherwise no significant stenoses in the epicardial coronary tree. After the failure of maximized anti-ischemic medical therapy, the patient underwent elective percutaneous intervention (PCI) to the left anterior descending coronary artery (LAD) chronic total occlusion (CTO) with 2 overlapping drug-eluting stents that yielded a favorable outcome on patient follow-up even though a myocardial perfusion imaging failed to show considerable reversible ischemia at the left anterior descending coronary artery (LAD) territory. The report points out that elective chronic total occlusion (CTO) revascularization may alleviate anginal pain, despite the absence of a considerable macroscopic ischemia, after failure of a maximized anti-ischemic medical regimen.

VL  - 8
IS  - 4
ER  -

Copy | Download