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Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length
Ahmad Shoaib1,2, James C Spratt3, Nick Curzen4
1Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK.
Insights
Percutaneous coronary intervention (PCI) for long chronic total occlusions (CTO) increases procedural complications and major adverse cardiac events (MACE). However, mortality risk remains similar compared to shorter CTO lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Long lesions are associated with poorer outcomes in percutaneous coronary intervention (PCI).
- Limited data exist on the impact of lesion length on PCI outcomes specifically in chronic total occlusions (CTO).
Purpose of the Study:
- To assess the association between treated lesion length and clinical outcomes in patients undergoing PCI for CTO.
- To evaluate risks of procedural complications and adverse events based on CTO lesion length.
Main Methods:
- A longitudinal cohort of 27,205 stable angina patients undergoing PCI for CTO (2006-2018) from the British Cardiovascular Intervention Society (BCIS) database was analyzed.
- Patients were stratified into three groups based on treated segment length: <30 mm, 30-59 mm, and ≥60 mm.
- Multivariable analysis was used to compare in-patient death, 1-year death, in-patient MACE, and procedural complications across groups.
Main Results:
- Patients with longer CTO lesions (≥60 mm) had significantly higher rates of in-patient procedural complications (OR: 1.61) and in-patient MACE (OR: 1.52) compared to shorter lesions (<30 mm).
- No significant differences in in-patient or 1-year mortality were observed across lesion length groups.
- Each 10 mm increase in lesion length was associated with increased risk of procedural complications and coronary perforation, but not MACE or death.
Conclusions:
- Very long CTO lesions treated with PCI carry an elevated risk of procedural complications and in-patient MACE.
- Despite increased procedural risks, mortality rates at short and long-term follow-up are comparable between long and short CTO lesions.
Background:
Long lesions are known to have worse outcomes following percutaneous coronary intervention (PCI), but there are limited data assessing the association between lesion length and clinical outcomes in PCI procedures undertaken in chronic total occlusions (CTO).
Methods And Results:
We formed a longitudinal cohort (2006-2018, n = 27,205) of stable angina patients who underwent PCI to CTO in the British Cardiovascular Intervention Society (BCIS) database. Clinical, demographical, procedural, and outcome data were analyzed in three groups by treated segment length, < 30 mm (n = 11,782), 30-59 mm (n = 10,415), ≥ 60 mm (n = 5008). Prevalence of previous myocardial infarction and PCI were higher in patients in 30-59 mm group or ≥ 60 mm group compared with < 30 mm group. Following multivariable analysis, no significant difference was observed in in-patient death (OR = 30-59 mm group = 1.10, CI:0.55-2.19, p = 0.78) (OR ≥ 60 mm group = 0.82, CI: 0.33-2.05, p = 0.67), and 1-year death (OR = 30-59 mm group = 1.06, CI: 0.81-1.37, p = 0.69) (OR ≥ 60 mm group =1.01, CI: 0.70-1.43, p = 0.99) (< 30 mm group = reference) but in-patient MACE was higher in > = 60 mm group (OR: 1.52, CI: 1.15-2.01, p = 0.06) but similar in 30-59 mm group (OR: 1.16, CI: 0.91-1.48, p = 0.22) compared with < 30 mm group. The adjusted rates of procedural complications were higher in ≥ 60 mm group (OR: 1.61, CI: 1.40-1.85, p < 0.001) but were similar in 30-59 mm group (OR: 1.06, CI: 0.94-1.20, p < 0.31) compared with < 30 mm group. For every 10 mm increase, there was an increased adjusted risk of in-patient procedural complications and coronary perforation but not in-patient MACE or death.
Conclusion:
Patients with very long CTO lesions have higher risk of procedural complications and in-patient MACE but similar risk of short or long-term mortality compared with short CTO lesions.
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