Thirty‐day and 5‐year results of percutaneous coronary intervention for in‐stent restenotic chronic total occlusion lesions: Data from 2,659 consecutive patients

Abstract

Objectives: To investigate the procedure success rate and clinical outcomes of instent restenotic chronic total occlusion (ISR-CTO) percutaneous coronary intervention (PCI).Background: Few studies have reported the short-and long-term clinical outcomes of ISR-CTO PCI.Method: Patients who underwent ISR-CTO (n = 212) or de-novo CTO (n = 2,447) PCI at Fuwai Hospital from 2010 to 2013 were enrolled. Thirty-day and 5-year clinical outcomes were analyzed. The primary outcome was the incidence of all-cause death, myocardial infarction (MI), and heart failure at follow-up. The secondary outcome was the recanalization result (reasonable, suboptimal, or failed recanalization).Results: ISR-CTO PCI had a higher rate of suboptimal recanalization than de-novo CTO PCI (p < .01). The syntax score before PCI (odds ratio (OR): 1.06; 95% confidence interval (CI): 1.02-1.10; p = .002) and occlusion length ≥ 20 mm (OR: 2.70:95% CI: 1.46-4.98; p = .001) were predictors of suboptimal recanalization in ISR-CTO PCI. Cardiac death (p = .03) and 30-day all-cause mortality (p = .05) were higher among patients who underwent ISR-CTO PCI. The ISR-CTO group had a higher rate of MI (p = .07) at 5 years. Suboptimal recanalization (hazard ratio: 2.56; 95% CI: 1.13-5.83; p = .025) was an independent predictor of long-term major adverse events in ISR-CTO.Conclusions: Suboptimal recanalization, 30-day cardiac death, and long-term MI rates are higher for ISR-CTO PCI than de-novo CTO PCI. Suboptimal recanalization is an independent predictor of long-term major adverse events after ISR-CTO PCI.

Outcomes of Percutaneous Coronary Intervention for In‐Stent Restenosis Versus De Novo Lesions: A Meta‐Analysis

“…The final analysis included 12 studies published between 2011 to 2021, with a total of 708 391 patients: 71 353 patients underwent PCI for ISR, and 637 038 patients underwent PCI for de novo lesions. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 There was good interrater agreement between the 2 researchers performing study selection (κ=0.79; standard error=0.09) and data extraction (κ=0.81; standard error=0.06). The weighted follow‐up duration was 29.8 months.…”

“…Four of the included studies exclusively evaluated patients with PCI for CTO. 12 , 13 , 16 , 21 PCI with stenting was used in the ISR group in 46% to 49% of patients in 3 studies, 12 , 17 , 20 75% to 89% in 3 studies, 13 , 14 , 16 and 97% to 100% in the remaining studies. Stents used during PCI procedures were exclusively DES in 7 studies, 12 , 16 , 18 , 19 , 20 , 22 , 23 predominantly DES in 3 other studies, 14 , 17 , 21 and in 2 studies the types of stents were not reported.…”

“…Stents used during PCI procedures were exclusively DES in 7 studies, 12 , 16 , 18 , 19 , 20 , 22 , 23 predominantly DES in 3 other studies, 14 , 17 , 21 and in 2 studies the types of stents were not reported. 13 , 15 Baseline characteristics of included patients and procedural characteristics appear in Table 2 and Table 3 . The weighted mean age was 64.3 years and included predominantly men.…”

“…Based on the Newcastle‐Ottawa scale, all studies were considered to be of very good quality, except for 1 study, which was considered as good quality. 13 …”

Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions

“…In comparison with studies published previously in DES era, the incidence of TVR (11.3%) in our study seemed higher than that demonstrated in a retrospective study including 350 patients with 2-year follow up by Tang G, et al (7.6%), in which 79.4% of de novo CTO lesions were treated by DES [16]. Recently, another retrospective study including 1308 patients with de novo CTO lesion in which 73.9% of patients had stent implantation showed 6.3% TLR and 7.1% TVR in reasonable recanalization subgroup during 5-year follow up [17], which is similar to the 4-year follow up results in the DECISION-CTO trial, the randomized controlled trial (RCT) in CTO PCI [10]. The acute vessel closure, thrombosis after DCB treatment in de novo lesions are major safety concerns of DCBs and the occurrence has been shown to be very low.…”