EXPERT CTO Supports PCI for Highly Complex Lesions Using Contemporary Methods and EES

April 27, 2015—Results from the EXPERT CTO multicenter trial, which sought to evaluate procedural and clinical outcomes among patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using contemporary methods and the Xience coronary everolimus-eluting stents (EES; Abbott Vascular), were published by David E. Kandzari, MD, et al online ahead of print in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions. Specifically, EXPERT CTO evaluated the Xience Prime LL and Xience Nano EES.

As summarized in JACC: Cardiovascular Interventions, the study enrolled 250 consecutive patients for attempted CTO PCI at 20 centers. Procedural and in-hospital clinical outcomes were examined in addition to the 1-year primary endpoint of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events [MACE]). Demographic, lesion, and procedural characteristics included previous bypass surgery, 9.9%; diabetes, 40.1%; lesion length, 36.1 ± 18.5 mm; and stent length, 51.7 ± 27.2 mm. 

The investigators reported that procedural success, defined as guidewire recanalization with no in-hospital MACE, was 96.4%. Success with antegrade-only methods was 97.9% and 86.2% by retrograde/combined methods. Compared with a prespecified performance goal derived from six previous CTO drug-eluting stent trials (1-year MACE, 24.4%), treatment with EES was associated with significantly lower composite adverse events for both intent-to-treat (18.5%) and per-protocol populations (8.2%). Target lesion revascularization at 1 year was 6.3%. Dual-antiplatelet therapy adherence was 53.9% at 1 year, yet subacute definite stent thrombosis occurred in only two patients (0.9%), and late probable stent thrombosis occurred in one patient (0.5%).

The favorable procedural success and late-term clinical outcomes in EXPERT CTO support CTO PCI using contemporary methods and EES in a patient population with high lesion complexity, concluded the investigators in JACC: Cardiovascular Interventions.