Late (3 years) follow-up of successful versus unsuccessful revascularization in chronic total coronary occlusions treated by drug eluting stent

Giampaolo Niccoli, Francesco De Felice, Flavia Belloni, Rosario Fiorilli, Nicola Cosentino, Francesco Fracassi, Leonardo Cataneo, Francesco Burzotta, Carlo Trani, Italo Porto, Antonio Maria Leone, Carmine Musto, Roberto Violini, Filippo Crea

Research output: Contribution to journalArticle

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Abstract

The success rate of recanalization of coronary chronic total occlusion (CTO) has improved in recent years, but the clinical benefit associated with successful CTO recanalization in the drug-eluting stent (DES) era is not well known. A cohort of 317 consecutive patients (mean age 65 ± 10, 84% men) with CTOs (defined as Thrombolysis In Myocardial Infarction [TIMI] flow grade 0 and duration >3 months) of native coronary vessels in which percutaneous coronary intervention was attempted was enrolled from June 2005 to March 2009. All successful procedures (196 patients) were performed by DES implantation. The incidence of major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and repeat revascularization) was assessed during a mean follow-up period of 3 years. MACE predictors were assessed in clinical, angiographic, and procedural data, including procedural success. Patients with successful percutaneous coronary intervention experienced a significantly lower MACE rate compared to those with failed procedures (17 [9%] vs 32 [26%], p = 0.008). Patients with multivessel disease experienced MACEs more frequently than those with single-vessel disease (45 [22%] vs 4 [4%], p = 0.002). On multiple Cox regression analysis, the presence of multivessel disease and CTO opening failure were independent predictors of MACEs (hazard ratio 2.31, 95% confidence interval 1.17 to 4.96, p = 0.01, and hazard ratio 1.81, 95% confidence interval 1.33 to 4.12, p = 0.02, respectively). The worst prognosis was confined to patients with multivessel disease and failed procedures (hazard ratio 2.73, 95% confidence interval 1.21 to 3.92, p = 0.03). In conclusion, successful recanalization of CTOs with DES translates into a reduction of the 3-year MACE rate compared to failed procedures, and the worst prognosis is observed in patients with failed procedures and multivessel disease, a notion that might be taken into account in the management of patients with coronary CTOs.

Original languageEnglish
Pages (from-to)948-953
Number of pages6
JournalThe American Journal of Cardiology
Volume110
Issue number7
DOIs
Publication statusPublished - Oct 1 2012

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Drug-Eluting Stents
Coronary Occlusion
Confidence Intervals
Percutaneous Coronary Intervention
Myocardial Infarction
Coronary Vessels
Chronic Disease
Regression Analysis
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Late (3 years) follow-up of successful versus unsuccessful revascularization in chronic total coronary occlusions treated by drug eluting stent. / Niccoli, Giampaolo; De Felice, Francesco; Belloni, Flavia; Fiorilli, Rosario; Cosentino, Nicola; Fracassi, Francesco; Cataneo, Leonardo; Burzotta, Francesco; Trani, Carlo; Porto, Italo; Leone, Antonio Maria; Musto, Carmine; Violini, Roberto; Crea, Filippo.

In: The American Journal of Cardiology, Vol. 110, No. 7, 01.10.2012, p. 948-953.

Research output: Contribution to journalArticle

Niccoli, G, De Felice, F, Belloni, F, Fiorilli, R, Cosentino, N, Fracassi, F, Cataneo, L, Burzotta, F, Trani, C, Porto, I, Leone, AM, Musto, C, Violini, R & Crea, F 2012, 'Late (3 years) follow-up of successful versus unsuccessful revascularization in chronic total coronary occlusions treated by drug eluting stent', The American Journal of Cardiology, vol. 110, no. 7, pp. 948-953. https://doi.org/10.1016/j.amjcard.2012.05.025
Niccoli, Giampaolo ; De Felice, Francesco ; Belloni, Flavia ; Fiorilli, Rosario ; Cosentino, Nicola ; Fracassi, Francesco ; Cataneo, Leonardo ; Burzotta, Francesco ; Trani, Carlo ; Porto, Italo ; Leone, Antonio Maria ; Musto, Carmine ; Violini, Roberto ; Crea, Filippo. / Late (3 years) follow-up of successful versus unsuccessful revascularization in chronic total coronary occlusions treated by drug eluting stent. In: The American Journal of Cardiology. 2012 ; Vol. 110, No. 7. pp. 948-953.
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abstract = "The success rate of recanalization of coronary chronic total occlusion (CTO) has improved in recent years, but the clinical benefit associated with successful CTO recanalization in the drug-eluting stent (DES) era is not well known. A cohort of 317 consecutive patients (mean age 65 ± 10, 84{\%} men) with CTOs (defined as Thrombolysis In Myocardial Infarction [TIMI] flow grade 0 and duration >3 months) of native coronary vessels in which percutaneous coronary intervention was attempted was enrolled from June 2005 to March 2009. All successful procedures (196 patients) were performed by DES implantation. The incidence of major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and repeat revascularization) was assessed during a mean follow-up period of 3 years. MACE predictors were assessed in clinical, angiographic, and procedural data, including procedural success. Patients with successful percutaneous coronary intervention experienced a significantly lower MACE rate compared to those with failed procedures (17 [9{\%}] vs 32 [26{\%}], p = 0.008). Patients with multivessel disease experienced MACEs more frequently than those with single-vessel disease (45 [22{\%}] vs 4 [4{\%}], p = 0.002). On multiple Cox regression analysis, the presence of multivessel disease and CTO opening failure were independent predictors of MACEs (hazard ratio 2.31, 95{\%} confidence interval 1.17 to 4.96, p = 0.01, and hazard ratio 1.81, 95{\%} confidence interval 1.33 to 4.12, p = 0.02, respectively). The worst prognosis was confined to patients with multivessel disease and failed procedures (hazard ratio 2.73, 95{\%} confidence interval 1.21 to 3.92, p = 0.03). In conclusion, successful recanalization of CTOs with DES translates into a reduction of the 3-year MACE rate compared to failed procedures, and the worst prognosis is observed in patients with failed procedures and multivessel disease, a notion that might be taken into account in the management of patients with coronary CTOs.",
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AU - Fiorilli, Rosario

AU - Cosentino, Nicola

AU - Fracassi, Francesco

AU - Cataneo, Leonardo

AU - Burzotta, Francesco

AU - Trani, Carlo

AU - Porto, Italo

AU - Leone, Antonio Maria

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