Procedural, clinical, and health status outcomes in chronic total coronary occlusion revascularization: Results from
David E Kandzari1, Nicholas J Lembo2, Harold D Carlson1
1Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia.
Insights
This study shows chronic total occlusion percutaneous coronary intervention (CTO PCI) has favorable outcomes. Zotarolimus-eluting stents (ZES) demonstrated significantly lower major adverse cardiac events (MACE) compared to performance goals.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Limited research exists on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) outcomes with independent adjudication.
- This study focuses on procedural, clinical, and patient-reported health status outcomes in CTO PCI.
- A specific emphasis is placed on outcomes using zotarolimus-eluting stents (ZES).
Purpose of the Study:
- To evaluate the procedural and clinical outcomes of CTO PCI.
- To assess patient-reported health status changes after CTO PCI.
- To compare the 1-year major adverse cardiac events (MACE) rate for zotarolimus-eluting stents (ZES) against a performance goal.
Main Methods:
- 500 consecutive patients undergoing attempted CTO PCI were analyzed for procedural and in-hospital outcomes.
- A 1-year composite endpoint of death, myocardial infarction, and target lesion revascularization (MACE) was examined.
- Health status was assessed at baseline and 1 year in 250 patients; ZES MACE was compared to a performance goal.
Main Results:
- Successful guidewire crossing was achieved in 90.9% of cases, with 94.3% clinical success.
- The 1-year MACE rate was 12.1% for the overall cohort.
- Successful CTO-PCI significantly improved patient health status (angina frequency). ZES treatment showed significantly lower 1-year MACE (18.2%) compared to the performance goal (25.2%).
Conclusions:
- CTO PCI demonstrates favorable procedural success and significant improvements in patient health status.
- Late-term clinical outcomes support the risk-benefit profile of CTO PCI in complex, indicated patients.
- Zotarolimus-eluting stents (ZES) show promising results in reducing MACE in CTO PCI procedures.
Background:
Limited research has detailed the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with independent core laboratory and event adjudication. This study examined procedural, clinical, and patient-reported health status outcomes among patients undergoing CTO PCI with specific focus on outcomes for those treated with zotarolimus-eluting stents (ZES).
Methods:
Among 500 consecutive patients undergoing attempted CTO PCI, procedural and in-hospital clinical outcomes were examined in addition to the 1-year composite endpoint of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events, MACE). In a pre-specified cohort of 250 patients, health status measures were ascertained at baseline and 1 year. A powered secondary endpoint was 1-year MACE among patients treated with ZES compared with a performance goal.
Results:
Demographic, lesion, and procedural characteristics for the overall population included prior bypass surgery, 29.8%; diabetes, 35.2%; occlusion length >20 mm, 71.3%; J-CTO score, 2.5 ± 1.1; and primary retrograde strategy, 30.8%. Overall guidewire crossing was 90.9%; clinical success following guidewire crossing, 94.3%; and 1-year MACE rate, 12.1%. One-year health status significantly improved from baseline with successful CTO-PCI (angina frequency, 72.7 ± 26.5 at baseline to 96.0 ± 10.8, p < .0001). Compared with a performance goal derived from prior CTO DES trials (1-year hierarchal MACE, 25.2%), treatment with ZES was associated with significantly lower MACE (18.2%, one-sided upper CI, 23.6%, p = .017).
Conclusions:
Favorable procedural success, health status improvements and late-term clinical outcomes inform the relative risks and benefits of CTO PCI when performed in a clinically indicated, complex patient population representative of those treated in clinical practice.
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