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Predictors of outcomes after PCI with incomplete revascularization: Impact of CTO and LAD vessel

Toshiki Kuno1,2,3, Giora Weisz4, Philippe Généreux5

  • 1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|July 15, 2024
PubMed

Insights

Incomplete revascularization (ICR) after percutaneous coronary intervention (PCI) involving the left anterior descending artery (LAD) showed similar outcomes to other coronary arteries. However, ICR in patients with chronic total occlusion (CTO) led to increased hospitalizations and myocardial infarctions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Incomplete revascularization (ICR) following percutaneous coronary intervention (PCI) is linked to adverse patient outcomes, including mortality and morbidity.
  • Understanding the specific impact of ICR in different coronary arteries and in the presence of chronic total occlusions (CTO) is crucial for risk stratification and treatment optimization.

Purpose of the Study:

  • To compare the clinical significance of ICR in the left anterior descending artery (LAD) versus the right coronary artery (RCA) or left circumflex artery (LCX).
  • To evaluate whether ICR in patients with a non-recanalized chronic total occlusion (CTO) carries a worse prognosis than in patients without a CTO.

Main Methods:

  • The study analyzed data from the RIVER-PCI trial, which enrolled 2651 patients with ICR after PCI, randomly assigned to ranolazine or placebo.
  • Angiographic assessments were performed in 2501 patients (94.3%) by an independent core laboratory.
  • The primary endpoint was a composite of ischemia-driven revascularization or hospitalization, with a median follow-up of 643 days.

Main Results:

  • ICR involving the LAD occurred in 66.5% of patients, while ICR limited to the RCA or LCX occurred in 33.5%. The primary endpoint rates were similar between these groups (26.9% vs. 26.5%).
  • A non-recanalized CTO was present in 34.1% of patients with ICR. The primary endpoint occurred slightly more often in patients with CTO (28.6% vs. 25.9%), though not statistically significant.
  • Patients with CTO experienced significantly higher rates of ischemia-driven hospitalization without revascularization (aHR: 1.27), heart failure hospitalization (aHR: 2.69), and myocardial infarction (aHR: 1.46) compared to those without CTO.

Conclusions:

  • The 2-year prognosis for patients with incomplete revascularization after PCI is similar regardless of whether the left anterior descending artery is involved.
  • Incomplete revascularization in patients with a co-existing chronic total occlusion is associated with a higher incidence of hospitalizations for ischemia and myocardial infarctions.
Abstract

Keywords:
chronic total occlusionincomplete revascularizationleft anterior descending coronary arterypercutaneous coronary interventionranolazine

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