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Comparison of Percutaneous Coronary Intervention-Related Adverse Cardiac Outcomes in Patients With in-stent vs de
Anthony Lyonga Ngonge1, Nso Nso2, Yolanda Mbome3
1Department of Medicine, Howard University Hospital, Washington, DC.
Insights
Percutaneous coronary intervention for in-stent chronic total occlusion (IS CTO PCI) is linked to higher rates of major adverse cardiac events (MACE) and target-vessel myocardial infarction compared to de novo CTO PCI. However, IS CTO PCI showed a lower incidence of bleeding requiring transfusion.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease.
- Chronic total occlusions (CTOs) present unique challenges in PCI.
- Existing literature suggests varying cardiac complication rates for different CTO PCI approaches.
Conclusions:
- Patients undergoing IS CTO PCI exhibit a higher predisposition for MACE, ischemia-driven target-vessel revascularization, and target-vessel MI compared to those undergoing de novo CTO PCI.
- A lower incidence of bleeding requiring transfusion was observed in the IS CTO PCI group.
- Further investigation with randomized controlled trials is warranted to confirm these prognostic outcomes in CTO PCI cases.
Abstract:
Contemporary literature reveals a range of cardiac complications in patients who receive the percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study compared the adverse cardiac outcomes and procedural/technical success rates between the patients groups of in-stent (IS) CTO PCI and de novo CTO PCI. This systematic review and meta-analysis compared odds for primary (all-cause mortality, MACE, cardiac death post PCI, stroke) and secondary (bleeding requiring blood transfusion, ischemia-driven target-vessel revascularization, PCI procedural success, PCI technical success, and target-vessel MI) endpoints between 2734 patients who received PCI for IS CTO and 17,808 for de novo CTO. Odds ratios for outcome variables were calculated within 95% confidence intervals (CIs) via the Mantel-Haenszel method. The pooled analysis was undertaken for observational (retrospective/prospective) single- and multicentered studies published between January 2005 and December 2021. We found 57% higher, 166% higher, 129% higher, and 57% lower odds for MACE (OR: 1.57, 95% CI 1.31, 1.89, P < 0.001), ischemia-driven target-vessel revascularization (OR: 2.66, 95% CI 2.01, 3.53, P < 0.001), target-vessel myocardial infarction (MI) (OR: 2.29, 95% CI 1.70, 3.10, P < 0.001), and bleeding requiring blood transfusion (OR: 0.43, 95% CI 0.19, 1.00, P = 0.05), respectively, in patients with IS CTO PCI as compared to that of the de novo CTO PCI. No statistically significant differences between the study groups were recorded for the other primary/secondary outcome variables. The findings from this study indicated a high predisposition for MACE, ischemia-driven target-vessel revascularization, target vessel MI, and a lower incidence of bleeding episodes among IS CTO PCI patients as compared to those with de novo CTO PCI. The prognostic outcomes in CTO PCI cases require further investigation with randomized controlled trials.
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