Abstract 2518: Clinical and Angiographic Outcomes after Percutaneous Revascularization of Chronic Total Occlusions with Bare-Metal and Drug-Eluting Stents: 3-year Follow-up Results from an International Multicenter CTO Registry
Background: Long-term outcomes after successful PCI of chronic total occlusions (CTO) with drug-eluting stents (DES) have not been clearly defined.
Methods: In a prospective PCI database, we analyzed clinical and angiographic data in 830 pts with 835 CTO who had successful PCI with either bare-metal stents (BMS) (n=270, 32.5%) or DES (n=560, 67.5%) between 2000 and 2007. The definite or probable stent thrombosis was defined based on the Academic Research Consortium criteria.
Results: Kaplan-Meier analysis of 3-year follow-up demonstrated no significant differences in mortality and MI between BMS and DES groups (figure⇓). Target vessel revascularization (TVR) and MACE rates were significantly lower in the DES group. Subgroup analysis between SES and PES showed no significant differences in mortality (2.8% vs. 1.8%; p=0.47), TVR (10.4% vs. 12.0%; p=0.46), and MACE (13.0% vs. 15.0%; p=0.53). Two pts had a stent thrombosis within 24 hours after PCI with SES and PES, requiring emergent PCI. Definite stent thrombosis occurred in 3 pts (0.6%) between 4 and 109 days after the index CTO procedure with SES. Repeat angiogram was performed in 334 pts (40%); In-stent restenosis (ISR) occurred more frequently in BMS group than in DES group (43.5% vs. 19.2%, p=0.001). There were no significant differences in ISR rate (17.9% vs. 21.6%; p=0.51) and quantitative angiographic parameters between SES and PES groups.
Conclusions: PCI of CTO with DES was associated with:
markedly lower ISR and TVR rates than with BMS;
no very late stent thrombosis;
no significant clinical and angiographic differences between SES and PES at 3 years.
These data support the use of DES in successfully recanalized CTO.