Author + information
- Received October 7, 2016
- Revision received December 21, 2016
- Accepted January 27, 2017
- Published online May 1, 2017.
- Lorenzo Azzalini, MD, PhD, MSca,
- Rustem Dautov, MD, PhDb,c,
- Soledad Ojeda, MD, PhDd,
- Susanna Benincasa, MDa,
- Barbara Bellini, MDa,
- Francesco Giannini, MDa,
- Jorge Chavarría, MDd,
- Manuel Pan, MD, PhDd,
- Mauro Carlino, MDa,
- Antonio Colombo, MDa and
- Stéphane Rinfret, MD, SMb,c,∗ ()
- aDivision of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
- bDivision of Interventional Cardiology, McGill University Health Centre, Montreal, Canada
- cDivision of Interventional Cardiology, Quebec Heart and Lung Institute and Laval University, Quebec City, Canada
- dDivision of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
- ↵∗Address for correspondence:
Dr. Stéphane Rinfret, McGill University, Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, McGill University Health Centre, Royal Victoria Glen Site (B03.7200), 1001 Boulevard Décarie, Montreal (Québec) H4A 3J1, Canada.
Objectives 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).
Background IS-CTO PCI has traditionally been associated with suboptimal success rates.
Methods 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.
Results 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.
Conclusions 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.
Dr. Rinfret has served as a consultant for Boston Scientific and SoundBite medical; has received honoraria for proctorship and lectures for Boston Scientific, Abbott Vascular, and Terumo; and has received research funding from Medtronic and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 7, 2016.
- Revision received December 21, 2016.
- Accepted January 27, 2017.
- 2017 American College of Cardiology Foundation