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Published on: September 14, 2009
Comparison of Percutaneous Coronary Intervention Outcomes for in-Stent vs de Novo Chronic Total Occlusions: A
Qiongya Mao1, Lili Xie1, Jun Wu2
1Nursing Department, Ningbo Municipal Hospital of Traditional Chinese Medicine, Affiliated to Zhejiang Chinese Medical University, Ningbo City, Zhejiang Province, 315010, People's Republic of China.
Insights
Percutaneous coronary intervention for chronic coronary total occlusion (CTO) shows similar success rates for in-stent CTO and de novo CTO. While short-term outcomes are comparable, in-stent CTO PCI increases the long-term risk of major adverse cardiovascular events and myocardial infarction, primarily due to target vessel revascularization needs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic coronary total occlusion (CTO) presents a significant challenge in interventional cardiology.
- CTO can occur in previously implanted stents (in-stent CTO) or in non-stented native vessels (de novo CTO).
Purpose of the Study:
- To compare the outcomes of percutaneous coronary intervention (PCI) between patients with in-stent CTO and de novo CTO.
- To conduct a systematic review and meta-analysis of existing comparative studies.
Main Methods:
- A comprehensive literature search was performed across PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases.
- Comparative studies published up to September 20, 2025, were included.
- A random effects model was utilized for meta-analysis to calculate odds ratios (OR).
Main Results:
- Nineteen studies involving 73,945 patients with in-stent CTO and 651,961 patients with de novo CTO were analyzed.
- No significant difference in technical success was observed between in-stent CTO and de novo CTO PCI (OR, 0.97; 95% CI, 0.87, 1.08).
- Early outcomes, including all-cause mortality, MACE, MI, stent thrombosis, and tamponade, showed no significant differences. Long-term mortality also did not differ significantly. However, in-stent CTO patients had a significantly increased long-term risk of MACE, MI, and TVR.
Conclusions:
- In-stent CTO-PCI demonstrates success rates comparable to de novo CTO-PCI.
- Short-term adverse outcomes are similar between the two groups.
- Patients undergoing in-stent CTO PCI face an elevated long-term risk of MACE and MI, largely attributed to a higher need for TVR.
Background:
Chronic coronary total occlusion (CTO) represents a formidable challenge in interventional cardiology, occurring either within previously implanted stents (in-stent CTO) or in non-stented native vessels (de novo CTO). We aimed to compare the outcomes of percutaneous coronary intervention (PCI) between patients with in-stent and de novo CTO through a systematic review and meta-analysis.
Methods:
PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched for comparative studies published up to 20th September 20, 2025. A meta-analysis was conducted to calculate the odds ratios (OR) using a random effects model.
Results:
Nineteen studies that compared 73,945 patients with in-stent CTO and 651,961 patients with de novo CTO were included. There was no statistically significant difference in technical success between the two groups (OR, 0.97; 95% CI, 0.87, 1.08; I2=0%; p=0.67). Pooled analysis of early outcomes demonstrated no statistically significant difference in the risk of all-cause mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), stent thrombosis, or tamponade between the two groups. We also noted no statistically significant differences in long-term all-cause or cardiac mortality between the two groups. However, a meta-analysis of long-term data indicated that patients with in-stent CTO have a statistically significantly increased risk of MACE, MI, and target vessel revascularization (TVR) compared to those with de novo CTO.
Conclusion:
Our results indicate that in-stent CTO-PCI has success rates similar to those of de novo CTO-PCI. There was no difference in short-term adverse outcomes between the two groups; however, patients undergoing in-stent CTO PCI had an increased risk of MACE and MI, mainly driven by the significantly increased need for TVR.
