RT Journal Article
T1 Procedural and Long-Term Outcomes of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion.
A1 Azzalini, Lorenzo
A1 Dautov, Rustem
A1 Ojeda, Soledad
A1 Benincasa, Susanna
A1 Bellini, Barbara
A1 Giannini, Francesco
A1 Chavarria, Jorge
A1 Pan, Manuel
A1 Carlino, Mauro
A1 Colombo, Antonio
A1 Rinfret, Stéphane
K1 Chronic total occlusion
K1 In-stent restenosis
K1 Percutaneous coronary intervention
AB 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). IS-CTO PCI has traditionally been associated with suboptimal success rates. 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. 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. 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.
PB American College of Cardiology
YR 2017
FD 2017-01-27
LK http://hdl.handle.net/10668/11096
UL http://hdl.handle.net/10668/11096
LA en
NO Azzalini L, Dautov R, Ojeda S, Benincasa S, Bellini B, Giannini F, et al. 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
DS RISalud
RD Apr 5, 2025