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Title: Impact of Incomplete Revascularization on Long-Term Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention
Authors: Azzalini, Lorenzo
Candilio, Luciano
Ojeda, Soledad
La Manna, Alessio
Benincasa, Susanna
Bellini, Barbara
Hidalgo, Francisco
Chavarria, Jorge
Gravina, Giacomo
Micciche, Eligio
D'Agosta, Guido
Venuti, Giuseppe
Tamburino, Corrado
Pan, Manuel
Carlino, Mauro
Colombo, Antonio
Issue Date: 2018
Source: AMERICAN JOURNAL OF CARDIOLOGY, 121(10), p. 1138-1148
Abstract: We aimed to evaluate the impact of incomplete revascularization (ICR) on long-term outcomes of patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Consecutive patients undergoing CTO PCI at 4 centers were included. Baseline SYNTAX score (bSS: low [<= 22], intermediate [>22 and <33], high [>33]), residual SYNTAX score (rSS: 0, >0 and <= 8, >8), and SYNTAX revascularization index (SRI: 100 X (bSS-rSS)/bSS: 100%, 50% to 99%, <50%) were calculated. The primary end point was major adverse cardiac events (MACEs; cardiac death, any myocardial infarction, any revascularization) on follow-up. Multivariable Cox regression analysis was conducted to identify predictors of MACEs. Overall, 686 patients were included (low bSS: n = 437; intermediate bSS: n = 187; high bSS: n = 62). Occlusion complexity, crossing strategies, and procedural success rates were similar across groups. The degree of ICR increased with higher bSS categories (rSS was 2.5 +/- 4.7 in low vs 6.2 +/- 9.3 in intermediate vs 9.1 +/- 12.2 in high bSS, p <0.001). The SRI followed a similar pattern. Median follow-up was 781 (369 to 1,217) days. Three-year MACE rates increased with higher bSS and rSS, and decreasing SRI categories (bSS: low 19.4% vs intermediate 25.9% vs high 33.3%, p = 0.02), which was driven by a higher incidence of repeat revascularization. Compared with an rSS = 0, both an rSS >0 and <8 (hazard ratio 2.06, p = 0.004) and an rSS >8 (hazard ratio 3.19, p <0.001) were independent predictors of MACEs. Similar findings were observed when the SRI was entered in a separate model. In conclusion, even a mild degree of ICR is associated with a higher incidence of MACEs on long-term follow-up after CTO PCI. (C) 2018 Elsevier Inc. All rights reserved.
Notes: Azzalini, L (reprint author), Ist Sci San Raffaele, Intervent Cardiol Unit, Cardiothorac Vasc Depart, Milan, Italy.
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ISSN: 0002-9149
e-ISSN: 1879-1913
DOI: 10.1016/j.amjcard.2018.01.033
ISI #: 000433402600003
Rights: © 2018 Elsevier Inc. All rights reserved.
Category: A1
Type: Journal Contribution
Validations: ecoom 2019
Appears in Collections:Research publications

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