The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Importance of Stent Optimization for Favourable Outcomes after Percutaneous Coronary Intervention for Chronic In-Stent Occlusions

DOI: 10.4244/EIJ-D-19-00650

1. Division of Cardiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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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Aims: To compare percutaneous coronary intervention (PCI) outcomes in relation to stent optimization profiles between in-stent chronic total occlusions (CTOs) and de novo CTOs.

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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