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Open Access 01-05-2020 | Myocardial Infarction | Original Paper

A comparison of procedural success rate and long-term clinical outcomes between in-stent restenosis chronic total occlusion and de novo chronic total occlusion using multicenter registry data

Authors: Seung Hun Lee, Jae Young Cho, Je Sang Kim, Hyun Jong Lee, Jeong Hoon Yang, Jae Hyoung Park, Soon Jun Hong, Rak Kyeong Choi, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Do-Sun Lim, Cheol Woong Yu

Published in: Clinical Research in Cardiology | Issue 5/2020

Abstract

Background

There have been little data about outcomes of percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) chronic total occlusion (CTO) in the drug eluting stent (DES) era. This study aimed to compare the procedural success rate and long-term clinical outcomes of ISR CTO and de novo CTO.

Methods and results

Patients who underwent PCI for ISR CTO (n = 164) versus de novo CTO (n = 1208) were enrolled from three centers in Korea between January 2008 and December 2014. Among a total of ISR CTO, a proportion of DES ISR CTO was 79.3% (n = 130). The primary outcome was major adverse cardiac events (MACEs); a composite of all-cause death, non-fatal myocardial infarction (MI), or target lesion revascularization (TLR). Following propensity score-matching (1:3), the ISR CTO group (n = 156) had a higher success rate (84.6% vs. 76.0%, p = 0.035), mainly driven by high success rate of PCI for DES ISR CTO (88.6%), but showed a higher incidence of MACEs [hazard ratio (HR): 2.06; 95% confidence interval (CI) 1.37–3.09; p < 0.001], mainly driven by higher prevalence of MI [HR: 9.71; 95% CI 2.06–45.81; p = 0.004] and TLR [HR: 3.04; 95% CI 1.59–5.81; p = 0.001], during 5 years of follow-up after successful revascularization, as compared to the de novo CTO group (n = 408).

Conclusion

The procedural success rate was higher in the ISR CTO than the de novo CTO, especially in DES ISR CTO. However, irrespective of successful revascularization, the long-term clinical outcomes for the ISR CTO were significantly worse than those for the de novo CTO, in terms of MI and TLR.

Graphic abstract

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Title: A comparison of procedural success rate and long-term clinical outcomes between in-stent restenosis chronic total occlusion and de novo chronic total occlusion using multicenter registry data
Authors: Seung Hun Lee
Jae Young Cho
Je Sang Kim
Hyun Jong Lee
Jeong Hoon Yang
Jae Hyoung Park
Soon Jun Hong
Rak Kyeong Choi
Seung-Hyuk Choi
Hyeon-Cheol Gwon
Do-Sun Lim
Cheol Woong Yu
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keyword: Myocardial Infarction
Published in: Clinical Research in Cardiology / Issue 5/2020
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-019-01550-7

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A comparison of procedural success rate and long-term clinical outcomes between in-stent restenosis chronic total occlusion and de novo chronic total occlusion using multicenter registry data

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Conclusion

Graphic abstract

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