Long-Term Outcomes of Percutaneous Coronary Intervention for Patients With In-Stent Chronic Total Occlusion Versus De Novo Chronic Total Occlusion

Abstract

Limited data are available on long-term outcomes and health status in the treatment of in-stent coronary chronic total occlusion (IS-CTO) and de novo coronary chronic total occlusion (de novo CTO). This study compared the long-term clinical outcomes and health status of percutaneous coronary intervention (PCI) for patients with IS-CTO versus patients with de novo CTO in the drug-eluting stent era. We screened 483 consecutive patients with 1 CTO lesion, including 81 patients with IS-CTO and 402 patients with de novo CTO. Propensity score matching was used to balance baseline characteristics between the 2 groups. The clinical end point was major adverse cardiac events (MACE). The success rates of CTO lesion revascularization were similar in both groups. In the propensity score-matched patients, after a median follow-up of 36 months, MACE was observed in 32.8% of patients with IS-CTO versus 13.5% of the patients with de novo CTO ( P < .001), mainly driven by target-vessel revascularization (21.9% vs 6.7%; P < .01). Moreover, patients with IS-CTO had significantly worse Seattle Angina Questionnaire anginal stability scores than the patients with de novo CTO. In conclusion, patients with IS-CTO after PCI had a worse clinical outcome, mainly MACE, and a poorer anginal stability in the long term than patients with de novo CTO.

Influence of the Single Coronary Vessel on Acute Outcomes of In-Stent CTO Recanalization

“…Data by Guan et al [22] stressed that effectiveness and safety of this complex procedure are reasonable, but the risk of cardiac death and MI is higher among patients with IS-CTO. In another study including 81 patients, Gao et al [23] added that patients with IS-CTO had worse Seattle In-hospital death 0 (0.0%) 0 (0.0%) 0 (0.0%) 1.000 Hamatoma 0 (0.0%) 1 (12.5%) 1 (2.1%) 0.255 Stroke 0 (0.0%) 0 (0.0%) 0 (0.0%) 1.000 Perforation 0 (0.0%) 0 (0.0%) 0 (0.0%) 1.000 *Fisher's exact test; LAD, left anterior descending; LCX, left cir-cumflex; RCA, right coronary artery.…”

“…In another study including 81 patients, Gao et al . [ 23 ] added that patients with IS-CTO had worse Seattle Angina Questionnaire scores concerning anginal stabilities than the patients with de novo CTO.…”

Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion

“…Although previous stents can serve as a roadmap for intervention, tracking through the stented segment theoretically reduces the risk of dissection or injury during the procedure, further improving the procedure success rate [30]. In routine recanalization practice, however, conditions such as stent underexpansion or stent rupture often make wiring more difficult, and the complexity of the IS-CTO means presence of subintimal or extra-stent wire passage, difficulty in device delivery, and even crushing the occluded stent, which increases the risk of adverse events [28,49,50]. Recently, the IS-CTO score system was established to predict the technical success of IS-CTO PCI via antegrade approach, which reflects the academic circle's attention to this special type of coronary artery disease [50].…”

Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion

“…In the serve as a roadmap for intervention, tracking through the stented segment theoretically reduces the risk of dissection or injury during the procedure, further improving the procedure success rate [30]. In routine recanalization practice, however, conditions such as stent underexpansion or stent rupture often make wiring more di cult, and the complexity of the IS-CTO means presence of subintimal or extra-stent wire passage, di culty in device delivery, and even crushing the occluded stent, which increases the risk of adverse events [28, 49,50]. Recently, the IS-CTO score system was established to predict the technical success of IS-CTO PCI via antegrade approach, which re ects the academic circle's attention to this special type of coronary artery disease [50].…”