2. Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Korea, Republic Of
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Methods and results: We evaluated 1,516 consecutive patients who underwent PCI for 147 in-stent CTOs (9.3%) and 1,439 de novo CTOs between 2007 and 2018. The primary endpoint was target vessel failure (TVF) consisting of a composite of cardiac death, target vessel–related myocardial infarction, or target vessel revascularization. The final post-stenting intravascular ultrasound (IVUS) images were analysed. Target lesion complexity reflected by the Japanese-CTO score was similar, albeit calcification was more prevalent in de novo CTOs, whereas occlusion length >20 mm was more frequent in in-stent CTOs. The technical success (88.4% vs. 87.5%, P=0.84) and in-hospital adverse event (1.4% vs. 3.6%, P=0.26) rates were similar between CTO types. Among those who received drug-eluting stents, the 5-year TVF (11.0% vs. 10.7%, P=0.99) and target vessel revascularization (4.2% vs. 3.7%, P=0.81) rates were similar between groups. Total stent length, minimum stent area (5.4±1.8 vs. 5.5±1.8 mm2, P=0.77), and maximal plaque burden of the reference segments were largely comparable between groups.
Conclusions: In-stent CTO-PCI with drug-eluting stent optimized by IVUS guidance offers acceptable long-term clinical results as that achieved in de novo CTOs.
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