Procedural and Long-Term Outcomes of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion

Lorenzo Azzalini, R Dautov, S Ojeda, S Benincasa, B Bellini, Francesco Giannini, J Chavarría, M Pan, M Carlino, A Colombo, S Rinfret

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Abstract

Objectives The study sought to investigate the long-term outcomes and predictors of adverse events of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO). Background IS-CTO PCI has traditionally been associated with suboptimal success rates. Methods We performed a multicenter registry of consecutive patients undergoing CTO PCI at 3 specialized centers. Patients were divided in IS-CTO and de novo CTO. The primary endpoint (major adverse cardiac events [MACE]) was a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target-vessel revascularization (TVR) on follow-up. Independent predictors of MACE were sought with Cox regression. Results We included 899 patients (n = 111 IS-CTO, n = 788 de novo CTO). Baseline clinical and angiographic characteristics were balanced between the 2 groups. Overall mean J-CTO (Japanese-Chronic Total Occlusion) score was 1.88 ± 1.24 and mean PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention-CTO) score was 1.04 ± 0.88. Antegrade wire escalation was used in 59.0% of IS-CTO and 48.1% of de novo CTO patients (p = 0.08). Procedural success was achieved in 86.5% in both groups (p = 0.99). After a median follow-up of 471 (interquartile range: 354 to 872) days, MACE were observed in 20.8% versus 13.9% in IS-CTO versus de novo CTO (p = 0.07), driven by TVR (16.7% vs. 9.4%; p = 0.03). IS-CTO was an independent predictor of MACE (hazard ratio: 2.16; 95% confidence interval: 1.18 to 3.95; p = 0.01), together with prior surgical revascularization and renal function, CTO PCI indicated for acute coronary syndrome, number of diseased vessels, and PROGRESS-CTO score. Conclusions Procedural success was high and similar in patients with IS-CTO, as compared with de novo CTO. However, IS-CTO was independently associated with MACE (driven by TVR) on follow-up. © 2017 American College of Cardiology Foundation
Original languageEnglish
Pages (from-to)892-902
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume10
Issue number9
DOIs
Publication statusPublished - 2017

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Stents
Percutaneous Coronary Intervention
Registries
Acute Coronary Syndrome
Myocardial Ischemia
Myocardial Infarction
Confidence Intervals
Kidney

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Procedural and Long-Term Outcomes of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion. / Azzalini, Lorenzo; Dautov, R; Ojeda, S; Benincasa, S; Bellini, B; Giannini, Francesco; Chavarría, J; Pan, M; Carlino, M; Colombo, A; Rinfret, S.

In: JACC: Cardiovascular Interventions, Vol. 10, No. 9, 2017, p. 892-902.

Research output: Contribution to journalArticle

Azzalini, L, Dautov, R, Ojeda, S, Benincasa, S, Bellini, B, Giannini, F, Chavarría, J, Pan, M, Carlino, M, Colombo, A & Rinfret, S 2017, 'Procedural and Long-Term Outcomes of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion', JACC: Cardiovascular Interventions, vol. 10, no. 9, pp. 892-902. https://doi.org/10.1016/j.jcin.2017.01.047
Azzalini, Lorenzo ; Dautov, R ; Ojeda, S ; Benincasa, S ; Bellini, B ; Giannini, Francesco ; Chavarría, J ; Pan, M ; Carlino, M ; Colombo, A ; Rinfret, S. / Procedural and Long-Term Outcomes of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion. In: JACC: Cardiovascular Interventions. 2017 ; Vol. 10, No. 9. pp. 892-902.
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abstract = "Objectives The study sought to investigate the long-term outcomes and predictors of adverse events of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO). Background IS-CTO PCI has traditionally been associated with suboptimal success rates. Methods We performed a multicenter registry of consecutive patients undergoing CTO PCI at 3 specialized centers. Patients were divided in IS-CTO and de novo CTO. The primary endpoint (major adverse cardiac events [MACE]) was a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target-vessel revascularization (TVR) on follow-up. Independent predictors of MACE were sought with Cox regression. Results We included 899 patients (n = 111 IS-CTO, n = 788 de novo CTO). Baseline clinical and angiographic characteristics were balanced between the 2 groups. Overall mean J-CTO (Japanese-Chronic Total Occlusion) score was 1.88 ± 1.24 and mean PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention-CTO) score was 1.04 ± 0.88. Antegrade wire escalation was used in 59.0{\%} of IS-CTO and 48.1{\%} of de novo CTO patients (p = 0.08). Procedural success was achieved in 86.5{\%} in both groups (p = 0.99). After a median follow-up of 471 (interquartile range: 354 to 872) days, MACE were observed in 20.8{\%} versus 13.9{\%} in IS-CTO versus de novo CTO (p = 0.07), driven by TVR (16.7{\%} vs. 9.4{\%}; p = 0.03). IS-CTO was an independent predictor of MACE (hazard ratio: 2.16; 95{\%} confidence interval: 1.18 to 3.95; p = 0.01), together with prior surgical revascularization and renal function, CTO PCI indicated for acute coronary syndrome, number of diseased vessels, and PROGRESS-CTO score. Conclusions Procedural success was high and similar in patients with IS-CTO, as compared with de novo CTO. However, IS-CTO was independently associated with MACE (driven by TVR) on follow-up. {\circledC} 2017 American College of Cardiology Foundation",
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T1 - Procedural and Long-Term Outcomes of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion

AU - Azzalini, Lorenzo

AU - Dautov, R

AU - Ojeda, S

AU - Benincasa, S

AU - Bellini, B

AU - Giannini, Francesco

AU - Chavarría, J

AU - Pan, M

AU - Carlino, M

AU - Colombo, A

AU - Rinfret, S

PY - 2017

Y1 - 2017

N2 - Objectives The study sought to investigate the long-term outcomes and predictors of adverse events of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO). Background IS-CTO PCI has traditionally been associated with suboptimal success rates. Methods We performed a multicenter registry of consecutive patients undergoing CTO PCI at 3 specialized centers. Patients were divided in IS-CTO and de novo CTO. The primary endpoint (major adverse cardiac events [MACE]) was a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target-vessel revascularization (TVR) on follow-up. Independent predictors of MACE were sought with Cox regression. Results We included 899 patients (n = 111 IS-CTO, n = 788 de novo CTO). Baseline clinical and angiographic characteristics were balanced between the 2 groups. Overall mean J-CTO (Japanese-Chronic Total Occlusion) score was 1.88 ± 1.24 and mean PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention-CTO) score was 1.04 ± 0.88. Antegrade wire escalation was used in 59.0% of IS-CTO and 48.1% of de novo CTO patients (p = 0.08). Procedural success was achieved in 86.5% in both groups (p = 0.99). After a median follow-up of 471 (interquartile range: 354 to 872) days, MACE were observed in 20.8% versus 13.9% in IS-CTO versus de novo CTO (p = 0.07), driven by TVR (16.7% vs. 9.4%; p = 0.03). IS-CTO was an independent predictor of MACE (hazard ratio: 2.16; 95% confidence interval: 1.18 to 3.95; p = 0.01), together with prior surgical revascularization and renal function, CTO PCI indicated for acute coronary syndrome, number of diseased vessels, and PROGRESS-CTO score. Conclusions Procedural success was high and similar in patients with IS-CTO, as compared with de novo CTO. However, IS-CTO was independently associated with MACE (driven by TVR) on follow-up. © 2017 American College of Cardiology Foundation

AB - Objectives The study sought to investigate the long-term outcomes and predictors of adverse events of percutaneous coronary intervention (PCI) for in-stent chronic total occlusion (IS-CTO). Background IS-CTO PCI has traditionally been associated with suboptimal success rates. Methods We performed a multicenter registry of consecutive patients undergoing CTO PCI at 3 specialized centers. Patients were divided in IS-CTO and de novo CTO. The primary endpoint (major adverse cardiac events [MACE]) was a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target-vessel revascularization (TVR) on follow-up. Independent predictors of MACE were sought with Cox regression. Results We included 899 patients (n = 111 IS-CTO, n = 788 de novo CTO). Baseline clinical and angiographic characteristics were balanced between the 2 groups. Overall mean J-CTO (Japanese-Chronic Total Occlusion) score was 1.88 ± 1.24 and mean PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention-CTO) score was 1.04 ± 0.88. Antegrade wire escalation was used in 59.0% of IS-CTO and 48.1% of de novo CTO patients (p = 0.08). Procedural success was achieved in 86.5% in both groups (p = 0.99). After a median follow-up of 471 (interquartile range: 354 to 872) days, MACE were observed in 20.8% versus 13.9% in IS-CTO versus de novo CTO (p = 0.07), driven by TVR (16.7% vs. 9.4%; p = 0.03). IS-CTO was an independent predictor of MACE (hazard ratio: 2.16; 95% confidence interval: 1.18 to 3.95; p = 0.01), together with prior surgical revascularization and renal function, CTO PCI indicated for acute coronary syndrome, number of diseased vessels, and PROGRESS-CTO score. Conclusions Procedural success was high and similar in patients with IS-CTO, as compared with de novo CTO. However, IS-CTO was independently associated with MACE (driven by TVR) on follow-up. © 2017 American College of Cardiology Foundation

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DO - 10.1016/j.jcin.2017.01.047

M3 - Article

VL - 10

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JO - JACC: Cardiovascular Interventions

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SN - 1936-8798

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