Procedural and Long-Term Outcomes of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion

Lorenzo Azzalini; Rustem Dautov; Soledad Ojeda; Susanna Benincasa; Barbara Bellini; Francesco Giannini; Jorge Chavarría; Manuel Pan; Mauro Carlino; Antonio Colombo; Stéphane Rinfret

doi:10.1016/j.jcin.2017.01.047

Procedural and Long-Term Outcomes of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion

JACC Cardiovasc Interv. 2017 May 8;10(9):892-902. doi: 10.1016/j.jcin.2017.01.047. Epub 2017 Apr 12.

Affiliations

¹ Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
² Division of Interventional Cardiology, McGill University Health Centre, Montreal, Canada; Division of Interventional Cardiology, Quebec Heart and Lung Institute and Laval University, Quebec City, Canada.
³ Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain.
⁴ Division of Interventional Cardiology, McGill University Health Centre, Montreal, Canada; Division of Interventional Cardiology, Quebec Heart and Lung Institute and Laval University, Quebec City, Canada. Electronic address: [email protected].

PMID: 28412256
DOI: 10.1016/j.jcin.2017.01.047

Abstract

Objectives: The study sought to investigate the long-term outcomes and predictors of adverse events of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO).

Background: IS-CTO PCI has traditionally been associated with suboptimal success rates.

Methods: We performed a multicenter registry of consecutive patients undergoing CTO PCI at 3 specialized centers. Patients were divided in IS-CTO and de novo CTO. The primary endpoint (major adverse cardiac events [MACE]) was a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target-vessel revascularization (TVR) on follow-up. Independent predictors of MACE were sought with Cox regression.

Results: We included 899 patients (n = 111 IS-CTO, n = 788 de novo CTO). Baseline clinical and angiographic characteristics were balanced between the 2 groups. Overall mean J-CTO (Japanese-Chronic Total Occlusion) score was 1.88 ± 1.24 and mean PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention-CTO) score was 1.04 ± 0.88. Antegrade wire escalation was used in 59.0% of IS-CTO and 48.1% of de novo CTO patients (p = 0.08). Procedural success was achieved in 86.5% in both groups (p = 0.99). After a median follow-up of 471 (interquartile range: 354 to 872) days, MACE were observed in 20.8% versus 13.9% in IS-CTO versus de novo CTO (p = 0.07), driven by TVR (16.7% vs. 9.4%; p = 0.03). IS-CTO was an independent predictor of MACE (hazard ratio: 2.16; 95% confidence interval: 1.18 to 3.95; p = 0.01), together with prior surgical revascularization and renal function, CTO PCI indicated for acute coronary syndrome, number of diseased vessels, and PROGRESS-CTO score.

Conclusions: Procedural success was high and similar in patients with IS-CTO, as compared with de novo CTO. However, IS-CTO was independently associated with MACE (driven by TVR) on follow-up.

Keywords: chronic total occlusion; in-stent restenosis; percutaneous coronary intervention.

Publication types

Comparative Study
Multicenter Study
Observational Study

MeSH terms

Aged
Chronic Disease
Coronary Angiography
Coronary Occlusion / diagnostic imaging
Coronary Occlusion / etiology
Coronary Occlusion / mortality
Coronary Occlusion / therapy*
Disease-Free Survival
Female
Humans
Italy
Male
Middle Aged
Multivariate Analysis
Percutaneous Coronary Intervention / adverse effects
Percutaneous Coronary Intervention / instrumentation*
Percutaneous Coronary Intervention / mortality
Proportional Hazards Models
Quebec
Registries
Risk Factors
Spain
Stents*
Time Factors
Treatment Outcome