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Published on: September 14, 2009
[Five-year clinical outcomes of patients with in-stent chronic total occlusion undergoing percutaneous coronary
1Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO) is safe and effective, but carries a higher long-term risk of cardiac death and myocardial infarction (MI) compared to de novo CTO lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Context:
- In-stent chronic total occlusion (IS-CTO) presents unique challenges in coronary artery disease management.
- Percutaneous coronary intervention (PCI) is a key revascularization strategy for CTO lesions.
- Long-term outcomes of PCI in IS-CTO compared to primary CTO require further elucidation.
Purpose:
- To evaluate the safety and long-term clinical efficacy of PCI in patients with IS-CTO.
- To compare PCI outcomes between IS-CTO and de novo chronic total occlusion (CTO) lesions.
- To assess the 5-year incidence of major adverse cardiac events following PCI in these patient groups.
Summary:
- A retrospective analysis compared 212 IS-CTO patients with 212 de novo CTO patients undergoing PCI.
- PCI success rates and complication incidence were similar between IS-CTO and de novo CTO groups.
- The 5-year incidence of the primary endpoint (cardiac death and myocardial infarction) was significantly higher in the IS-CTO group (10.8% vs. 4.7%).
Impact:
- PCI is an acceptable treatment for IS-CTO, demonstrating similar acute safety and efficacy to de novo CTO PCI.
- Patients with IS-CTO face a significantly higher risk of long-term adverse cardiac events, particularly myocardial infarction.
- These findings highlight the need for vigilant long-term monitoring and risk management in patients treated for IS-CTO.
Abstract:
Objective: To evaluate the safety and long-term clinical efficacy of percutaneous coronary intervention (PCI) in patients with in-stent chronic total occlusion (IS-CTO) lesions. Metheds: This is a retrospective analysis. Patients with IS-CTO who underwent PCI in Fuwai hospital from January 2010 to December 2013 were enrolled. A total of 212 patients who met the inclusion criteria were included in the IS-CTO group, 212 matched patients with primary CTO lesions were included in the de novo CTO group. The incidence of complications and the success rate of PCI were compared between the two groups. Successful PCI was defined as successfully implantation of stent(s) at target CTO lesions. The primary endpoint was defined as a composite event of cardiac death and myocardial infarction (MI). Secondary endpoints including PCI success, all-cause death, cardiac death, MI, target vessel related MI, revascularization, target vessel revascularization, heart failure for rehospitalization. The patients were followed up for 5 years after PCI. Results: A total of 424 cases were included. The mean age was (57.8±10.5) years, there were 364 males in this cohort. The left ventricular ejection fraction was significantly lower ((58.7±9.2)% vs. (61.0±7.7)%, P=0.01) and the SYNTAX scores was significantly higher (19.4±8.3 vs. 15.3±10.0, P<0.01) in IS-CTO group than that in de novo CTO group. The proportion of patients with target CTO lesions in left anterior descending artery was significantly higher (42.9% (50/212) vs. 23.6% (91/212), P<0.01) in IS-CTO group than that in de novo CTO group. The rate of successful PCI (71.7% (152/212) vs. 69.8% (148/212), P=0.70) and complication (40.6% (86/212) vs. 36.3% (77/212), P=0.37) was similar between the two groups. The incidence of primary endpoint at 5 years was significantly higher in IS-CTO group (10.8% (23/212) vs. 4.7% (10/212), P=0.02), which was driven by higher incidence of MI (9.0% (19/212) vs. 4.2% (9/212), P=0.05). There were a trend of higher secondary endpoints in IS-CTO group (all P>0.05). Conclusion: The safety and effectiveness of PCI are acceptable in patients with IS-CTO, but the risk of long-term cardiac death and MI is higher among patients with IS-CTO as compared to patients with primary CTO lesions.
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