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Procedural and Long-Term Outcomes of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion

Lorenzo Azzalini1, Rustem Dautov2, Soledad Ojeda3

  • 1Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.

JACC. Cardiovascular Interventions
|April 17, 2017
PubMed

Insights

In-stent chronic total occlusion (IS-CTO) percutaneous coronary intervention (PCI) shows high procedural success but increased long-term adverse cardiac events, primarily driven by target-vessel revascularization.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO) has historically faced challenges with suboptimal success rates.
  • Understanding the long-term outcomes and predictors of adverse events in IS-CTO PCI is crucial for improving patient management.

Purpose of the Study:

  • To investigate the long-term outcomes and identify predictors of major adverse cardiac events (MACE) following PCI in patients with IS-CTO.
  • To compare the outcomes of IS-CTO PCI with de novo chronic total occlusion (CTO) PCI.

Main Methods:

  • A multicenter registry study involving 899 patients undergoing CTO PCI across three specialized centers.
  • Patients were categorized into IS-CTO (n=111) and de novo CTO (n=788) groups.
  • The primary endpoint was MACE, a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target-vessel revascularization (TVR), assessed via Cox regression analysis.

Main Results:

  • Procedural success rates were high and comparable between IS-CTO (86.5%) and de novo CTO (86.5%) groups.
  • At a median follow-up of 471 days, MACE occurred in 20.8% of IS-CTO patients versus 13.9% of de novo CTO patients (p=0.07).
  • TVR was significantly higher in the IS-CTO group (16.7% vs. 9.4%; p=0.03), and IS-CTO was an independent predictor of MACE (HR 2.16; p=0.01).

Conclusions:

  • While procedural success for IS-CTO PCI is similar to de novo CTO PCI, IS-CTO is an independent predictor of long-term MACE.
  • Target-vessel revascularization is the primary driver of increased MACE in the IS-CTO group.
  • Factors such as prior surgical revascularization, renal function, indication for acute coronary syndrome, number of diseased vessels, and the PROGRESS-CTO score also predict MACE.
Abstract

Keywords:
chronic total occlusionin-stent restenosispercutaneous coronary intervention

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