Azzalini, LorenzoDautov, RustemOjeda, SoledadBenincasa, SusannaBellini, BarbaraGiannini, FrancescoChavarria, JorgePan, ManuelCarlino, MauroColombo, AntonioRinfret, Stéphane2023-01-252023-01-252017-01-27Azzalini 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):892-902http://hdl.handle.net/10668/11096The 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.enChronic total occlusionIn-stent restenosisPercutaneous coronary interventionAgedChronic diseaseCoronary angiographyCoronary occlusionDisease-free survivalFemaleHumansItalyMaleMiddle agedMultivariate analysisPercutaneous coronary interventionProportional hazards modelsQuebecRegistriesRisk factorsSpainStentsTime factorsTreatment outcomeResearch article28412256open accessAncianoAngiografía coronariaEnfermedad crónicaFactores de riesgoIntervención coronaria percutáneaOclusión coronariaSistema de registrosSupervivencia sin enfermedad10.1016/j.jcin.2017.01.0471876-7605https://doi.org/10.1016/j.jcin.2017.01.047