Abstract 17948: Effect of the Procedural Difficulty on Long-Term Clinical outcomes After Drug-Eluting Stent Implantation for Chronic Total Occlusion
Background: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) still remains the technical challenge for the procedural difficulty. We expect to achieve both procedural success and long-term patency before the procedure. However, there are few studies which have evaluated the influence of the procedural difficulty on long-term patency after CTO recanalization.
Methods: Between August 2004 and April 2008, we performed PCI in 697 patients with 748 CTO lesions excluding in-stent reocclusion. Overall procedural success rate was 83.8%. Of these, 439 patients with 476 lesions underwent successful CTO recanalization with only drug-eluting stent implantation. Major adverse cardiac events were composed of cardiac death, myocardial infarction, and target lesion revascularization (TLR). A stratified analysis of TLR at five years was performed based on the patient, lesion, and procedural factors.
Results: The median follow-up duration was 5.4 years (interquartile range, 4.8-6.3 years). On univariate analysis, diabetes mellitus, calcification, tortuosity, blunt stump, right coronary artery, use of the retrograde approach, stent length ≥60 mm, and more than 3 stents were associated with TLR. The Cox proportional hazard analysis identified diabetes mellitus (adjusted hazard ratio: 1.21, 95% confidence interval: 1.01 to 1.46, p=0.04) as an independent predictor of TLR.
Conclusions: The procedural difficulty were not associated with long-term TLR after drug-eluting stent implantation for CTO. The long-term TLR rate was significantly high in the presence of diabetes mellitus.
- © 2013 by American Heart Association, Inc.