Five-Year Outcomes of Coronary Stenting of CTOs Published

December 1, 2009—In Catheterization and Cardiovascular Interventions, Zhu Jun Shen, MD, et al published 5-year clinical outcomes after coronary stenting of chronic total occlusions (CTOs) using sirolimus-eluting stents (SES) in the RESEARCH (Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital) Registry (2009;74:979–986).

According to the investigators, the use of drug-eluting stents in patients with successfully recanalized CTOs has been associated with a significant decrease in the need for repeat revascularization and a favorable short-term clinical outcome when compared with the use of bare-metal stents (BMS). This group, however, has previously reported similar rates of target lesion revascularization (TLR) and major adverse cardiovascular events (MACE) at 3-year follow-up in patients with a successfully opened CTO who were treated with either SES or BMS. The objective of this report was to evaluate the outcomes of these patients at 5-year clinical follow-up.

The investigators reported that a total of 140 patients (64 BMS, 76 SES) with successfully opened CTOs were included. Seven patients died in the BMS group compared to nine patients who died in the SES group (P = .9). Noncardiac death was the major component of all-cause mortality (11 noncardiac deaths vs five cardiac deaths). There were two and three myocardial infarctions (MIs) in the BMS and SES groups, respectively (P = 1). The composite of death and MI occurred in seven (10.9%) and 11 (14.5%) patients in the BMS and SES groups, respectively (P = .53). Clinically driven TLR was performed in eight patients (12.5%) in the BMS group and in five (6.6%) in the SES group (P = .26). Non-TLR was performed in one patient in the BMS group and in four in the SES group (P = .37). The 5-year device-oriented cumulative MACE rate was 15.6% and 11.8% in the BMS and SES groups, respectively (P = .56).

The investigators concluded that in patients with successfully treated CTOs, clinical outcome after 5 years was similar between SES and BMS groups; however, clinically driven TLR was slightly higher in the BMS group.