Abstract 20130: Incidence of Major Adverse Cardiovascular Events After Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Multicenter Registry
Introduction: High procedural success rates are currently achieved in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but data on long-term outcomes is limited.
Methods: We examined the incidence of major adverse cardiac events (MACE) among 307 patients from 2 US CTO PCI centers participating in a contemporary US registry. MACE was defined as the composite of death, stroke, acute coronary syndrome, definite/probable stent thrombosis and repeat coronary revascularization. Target lesion revascularization (TLR) was defined as unplanned target lesion PCI or coronary artery bypass graft surgery (CABG).
Results: Mean age was 65 ± 9 years, 95% were men, 53% had diabetes mellitus and 31% had prior CABG. Mean lesion length was 38±28 mm; mean stented length was 76±40 mm; mean J-CTO score was 2.5±1.1. Technical success was 87.3%, procedural success was 86.0%, and in-hospital MACE (death, myocardial infarction, re-PCI, emergency CABG, stroke, or tamponade requiring pericardiocentesis) occurred in 2.9% of cases. Follow-up was obtained for the successful CTO PCI cases (median follow-up 238 days). One-year incidence of MACE was 42.1% and the incidence of TLR was 23.2%. On multivariable analysis the following characteristics were associated with TLR: moderate/severe calcification (hazard ratio [HR] 2.90, 95% confidence interval [95% CI] 1.30-6.72, p = 0.001) and lesion length ≥40 mm (HR 2.64, 95% CI 1.24-5.38, p=0.012). The following variables were associated with MACE: age (HR 0.96, 95% CI 0.93-0.99, p=0.008), diabetes mellitus (HR 2.10, 95% CI 1.22-3.72, p=0.007), moderate/severe calcification (HR 2.78, 95% CI 1.55-4.99, p<0.001), lesion length ≥40 mm (HR 2.30, 95% CI 1.37-3.87, p=0.002), and vessel diameter (HR 0.27, 95% CI 0.13-0.54, p<0.001) (Figure).
Conclusion: The incidence of MACE and TLR after CTO PCI was acceptable. Several baseline angiographic and clinical characteristics were associated with intermediate-term outcomes.
Author Disclosures: B.A. Danek: None. A. Karatasakis: None. A. Doing: None. P. Dattilo: None. P.J. Nguyen-Trong: None. J. Karacsonyi: None. A. Alame: None. E. Resendes: None. P. Kalsaria: None. B. Rangan: Research Grant; Modest; InfraReDx, Inc, Spectranetics. M. Roesle: None. C. Thompson: Employment; Significant; Boston Scientific. S. Banerjee: Research Grant; Modest; Gilead and the Medicines Company. Ownership Interest; Modest; ownership in MDCARE Global (spouse). Other; Modest; consultant/speaker honoraria from Covidien, Merck, and Medtronic;intellectual property in HygeiaTel; and educational grant from Boston Scientific (spouse). E. Brilakis: Honoraria; Modest; Consulting/speaker honoraria from Abbott Vascular, Asahi Intecc, Boston Scientific, Elsevier, Somahlution, St. Jude Medical, and Terumo. Other; Modest; Research support from Boston Scientific and InfraRedx; and spouse is employee of Medtronic.
- © 2016 by American Heart Association, Inc.