April 18, 2017
Study Evaluates PCI for In-Stent CTO
April 17, 2017—Lorenzo Azzalini, MD, et al conducted an investigation of procedural and long-term outcomes of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS CTO), which has traditionally been associated with suboptimal success. The findings are available online ahead of print in the Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.
The study was composed of a multicenter registry of consecutive patients undergoing CTO PCI at three specialized centers. Patients were divided into IS CTO and de novo CTO groups. 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.
As summarized in JACC: Cardiovascular Interventions, the investigators included 899 patients (IS CTO, n = 111; de novo CTO, n = 788). Baseline clinical and angiographic characteristics were balanced between the two groups.
The investigators reported that the overall mean Japanese CTO 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% of IS CTO and 48.1% of de novo CTO patients (P = .08). Procedural success was achieved in 86.5% of patients in both groups (P = .99).
After a median follow-up of 471 (interquartile range: 354 to 872) days, MACE rates in IS CTO and de novo CTO were 20.8% versus 13.9% (P = .07), driven by TVR (16.7% vs 9.4%; P = .03). IS CTO was an independent predictor of MACE (hazard ratio: 2.16; 95% confidence interval, 1.18 to 3.95; P = .01), together with previous surgical revascularization and renal function, CTO PCI indicated for acute coronary syndrome, number of diseased vessels, and PROGRESS CTO score.
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, concluded the investigators in JACC: Cardiovascular Interventions.