Abstract 9690: Impact of Lesion Morphology on Angiographic and Clinical Outcomes in Patients With Chronic Total Occlusion After Successful Recanalization With Drug-eluting stents. A Multislice Computed Tomography Study
Background: Which subgroup of patients with chronic total occlusion (CTO) would be likely to derive a benefit from percutaneous coronary intervention (PCI) in the drug-eluting stent (DES) era has not yet been fully clarified. The aim of this study was to investigate the morphological characteristics of CTO associated with angiographic and clinical adverse outcomes after PCI with DES using multislice computed tomography (MSCT).
Methods: In this study, 263 patients who underwent MSCT before CTO-PCI were followed clinically (the median follow-up was 4.0 years). Of these, 1 year follow-up angiography was performed in 203 patients. Lesion morphology was assessed with MSCT. Angiographic restenosis, reocclusion, and MACE (a composite of cardiac death, stent thrombosis and target lesion revascularization) were analyzed.
Results: MACE was observed in 36 patients (13.6%). Occlusion length was longer (39.5±19.9 mm vs. 22.3±13.7 mm, p<0.01), minimal vessel area was smaller (11.2±5.7mm2 vs. 14.5±5.6mm2, p<0.01) and severe calcification (involving >50% of the coronary wall on cross sectional image) was more common (36% vs. 12%, p<0.01) in the MACE group. In multivariate analysis, occlusion length (Odds ratio (OR); 1.06, p<0.01), minimal vessel area (OR; 0.48, p<0.01) and severe calcification (OR; 3.57, p<0.01) were independent predictors of the MACE. Receiver operating characteristic analysis provided the cut-off value of occluded length (25.4 mm; area under the curve (AUC) 0.79; sensitivity 0.86, specificity 0.62) and minimal vessel area (11.9 mm2; AUC 0.69; sensitivity 0.62, specificity 0.72) to predict the MACE. We defined occluded length >25.4mm, minimal vessel area <11.9mm2 and severe calcification as CT-derived risk factors. Angiographic restenosis (60% vs. 12% vs. 7%, p<0.01), reocclusion (29% vs. 2% vs. 2%, p<0.01), and MACE (43% vs. 6% vs. 3%, p<0.01) rates were significantly higher in patients with more than 2 risk factors than in those with 1 and 0.
Conclusions: MSCT characteristics associated with angiographic and clinical adverse outcomes after CTO-PCI were occluded length, vessel area, and the degree of calcification.
- © 2013 by American Heart Association, Inc.