In-Stent CTO Percutaneous Coronary Intervention: Individual Patient Data Pooled Analysis of 4 Multicenter Registries.

Published on Jun 28, 2021in Jacc-cardiovascular Interventions8.432
· DOI :10.1016/J.JCIN.2021.04.003
Evangelia Vemmou6
Estimated H-index: 6
,
Alexandre Schaan de Quadros15
Estimated H-index: 15
+ 29 AuthorsLorenzo Azzalini22
Estimated H-index: 22
(VCU: Virginia Commonwealth University)
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Abstract
OBJECTIVES The authors sought to examine the outcomes of percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) chronic total occlusions (CTOs). BACKGROUND The outcomes of PCI for ISR CTOs have received limited study. METHODS The authors examined the clinical and angiographic characteristics and procedural outcomes of 11,961 CTO PCIs performed in 11,728 patients at 107 centers in Europe, North America, Latin America, and Asia between 2012 and 2020, pooling patient-level data from 4 multicenter registries. In-hospital major adverse cardiovascular events (MACE) included death, myocardial infarction, stroke, and tamponade. Long-term MACE were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization. RESULTS ISR represented 15% of the CTOs (n = 1,755). Patients with ISR CTOs had higher prevalence of diabetes (44% vs. 38%; p < 0.0001) and prior coronary artery bypass graft surgery (27% vs. 24%; p = 0.03). Mean J-CTO (Multicenter CTO Registry in Japan) score was 2.32 ± 1.27 in the ISR group and 2.22 ± 1.27 in the de novo group (p = 0.01). Technical (85% vs. 85%; p = 0.75) and procedural (84% vs. 84%; p = 0.82) success was similar for ISR and de novo CTOs, as was the incidence of in-hospital MACE (1.7% vs. 2.2%; p = 0.25). Antegrade wiring was the most common successful strategy, in 70% of ISR and 60% of de novo CTOs, followed by retrograde crossing (16% vs. 23%) and antegrade dissection and re-entry (15% vs. 16%; p < 0.0001). At 12 months, patients with ISR CTOs had a higher incidence of MACE (hazard ratio: 1.31; 95% confidence intervals: 1.01 to 1.70; p = 0.04). CONCLUSIONS ISR CTOs represent 15% of all CTO PCIs and can be recanalized with similar success and in-hospital MACE as de novo CTOs.
References24
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#2Lucio PadillaH-Index: 7
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OBJECTIVES: To inform about contemporary PCI practice of in-stent (IS) chronic total occlusions (CTO) from a large international registry in Latin America. BACKGROUND: IS-CTO represent a distinctive challenge for PCI, but literature is limited and restricted to high-resource regions of the world. METHODS: Patients undergoing CTO PCI enrolled in the LATAM CTO registry from 42 centers in eight countries were included. We analyzed demographics, angiographic, procedure technique, success and postpro...
1 CitationsSource
#1Issam D. Moussa (UIUC: University of Illinois at Urbana–Champaign)H-Index: 3
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Last. Chuck SimontonH-Index: 3
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Abstract Background There is a paucity of data on the burden of in-stent restenosis (ISR) in the United States as well as on its presentation and appropriate treatment strategies. Objectives This study aims to provide an analysis of the temporal trends, clinical presentation, treatment strategies, and in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) for ISR in the United States. Methods This study is a retrospective analysis of data collected in the Diagnostic...
9 CitationsSource
#1Evangelia VemmouH-Index: 6
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Percutaneous coronary intervention (PCI) of in-stent (IS) chronic total occlusions (CTOs) represents 5% to 25% of all CTO PCIs and has been associated with lower success rates in some studies ([1][1],[2][2]). We analyzed the clinical, angiographic, and procedural characteristics of 5,667 CTO PCIs
2 CitationsSource
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Background There have been little data about outcomes of percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) chronic total occlusion (CTO) in the drug eluting stent (DES) era. This study aimed to compare the procedural success rate and long-term clinical outcomes of ISR CTO and de novo CTO.
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#1Evan Shlofmitz (MedStar Washington Hospital Center)H-Index: 11
#2Rebecca Torguson (MedStar Washington Hospital Center)H-Index: 56
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Background Clinical data support the use of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) as being associated with improved outcomes. Nonetheless, global utilization of IVUS remains low. We hypothesize that in the revascularization of complex lesions, IVUS use is associated with improved outcomes. Methods All patients with complex lesions treated with PCI at a single center from 2003 to 2016 were stratified by use of IVUS. Complex lesions were defined as follows...
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#2Kambis MashayekhiH-Index: 14
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Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing...
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#1Peter Tajti (University of Szeged)H-Index: 10
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Background: We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG). Methods and Results: We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32% of total cohort) were older (67±9 versus 63±10 years; P<0.001) and had more comorbidities a...
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#1Peter Tajti (University of Szeged)H-Index: 10
#2Dimitri Karmpaliotis (Columbia University)H-Index: 36
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Abstract Objectives The aim of this study was to determine the techniques and outcomes of hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a diverse group of patients and operators on 2 continents. Background CTO PCI has been evolving with constant improvement of equipment and techniques. Methods Contemporary outcomes of CTO PCI were examined by analyzing the clinical, angiographic, and procedural characteristics of 3,122 CTO interventions performed in 3,055 patie...
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#1Ziyad Ghazzal (AUB: American University of Beirut)H-Index: 2
#2Fadi J. Sawaya (AUB: American University of Beirut)H-Index: 15
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