1. Restenosis after percutaneous coronary intervention for coronary chronic total occlusion. The central role of an optimized immediate post-procedural angiographic result
- Author
-
Jérémy Terreaux, Laure Richard, Hazem Khamis, Khalid Tammam, Karl Isaaz, Michel Lamaud, Alexis Cerisier, Antoine Da Costa, and Antoine Gerbay
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Long Term Adverse Effects ,030204 cardiovascular system & hematology ,Background factors ,Coronary Angiography ,Total occlusion ,Coronary Restenosis ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Restenosis ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Postoperative Care ,business.industry ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,Coronary Vessels ,Quality Improvement ,surgical procedures, operative ,Coronary Occlusion ,Drug-eluting stent ,Coronary occlusion ,Conventional PCI ,Diameter stenosis ,Cardiology ,Female ,Radiology ,France ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Factors of restenosis after percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO) have not been fully explored. In particular, although the last ACC/AHA guidelines on PCI suggest that a minimum diameter stenosis of 10% with an optimal goal of as close to 0% as possible should be the new benchmark for lesions treated by stenting, angiographic success of PCI for CTO remains in the literature most often defined as a30% residual diameter stenosis. Whether an optimized immediate post-PCI angiographic result (OAR) defined by a minimal diameter stenosis as close to 0% is associated with a lower restenosis rate in this subset of coronary lesions remains unknown.Therefore, we assessed by quantitative coronary analysis (QCA) both the immediate post-PCI and 6-month follow-up angiographic results of 170 successfully treated true CTO.Post-PCI QCA immediate residual diameter stenosis was30% in all 170 CTOs and OAR defined as a ≤10% residual stenosis was achieved in 133 (78%). Global binary restenosis rate was 21% in the 170 lesions. Restenosis rates were 46% and 14% in the non-OAR group and in the OAR group, respectively (p0.0001). Multivariate analysis showed that a non-OAR, a younger age and a retrograde approach were independent factors of restenosis.Thus, an optimized immediate angiographic result with a minimal diameter stenosis as close to 0% as possible appears to be associated with a lower rate of restenosis after CTO PCI.
- Published
- 2016