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Long-term Outcome following Percutaneous Intervention of Intra-stent Coronary Occlusion and Evaluating the Different Treatment Modalities
- Source :
- International Journal of Cardiology. Heart & Vasculature, International Journal of Cardiology: Heart & Vasculature, Vol 34, Iss, Pp 100803-(2021)
- Publication Year :
- 2021
-
Abstract
- Highlights • Limited data on intra-stent CTO. • We explored the long-term outcomes in patients undergoing PCI to intra-stent CTO. • Acceptable rates of hard endpoints (cardiac death; 5.8%, TVMI; 4%). • High rates of TLR (45.6%). • PCI should only be undertaken if symptomatic or if there is inducible ischaemia. • If PCI is undertaken, DCB and DES should be considered over POBA.<br />Background Angioplasty for ISR remains a challenge with relatively high rates of recurrence. Although there is a plethora of data on ISR, there is relatively less data on intra-stent-CTO. In this study, we explore the long-term clinical outcomes following angioplasty to intra-stent CTO and study the differences in clinical outcomes between three treatment-arms: POBA vs. DES vs. DCB. Methods and results We evaluated all patients who underwent PCI to intra-stent CTO between 2011 and 2017. The endpoints used were: cardiac-death, TVMI, TLR, TVR, and MACE. During the study period, 403-patients with a mean age of 69.2 years had successful PCI to intra-stent CTO. 50% were diabetic, 38% had CKD and 32% had left ventricular dysfunction. 93% of cases were stable angina. 22% (n = 88) received only POBA, 28% (n = 113) received DCB and 50% (n = 202) received DES. During the median follow-up of 48-months, cardiac-death occurred in 5.8% (n = 23), TVMI in 4% (n = 16), TLR in 45.6% (n = 182), TVR in 48.7% (n = 194) and MACE of 46%. There were no differences in the hard endpoints between the 3treatment arms. However, the TLR and overall MACE were better in DCB and DES-groups as compared to POBA (TLR: 33%vs.42%vs.49%; p = 0.06); MACE (34% vs. 45% vs. 52%; p = 0.05). Conclusion This is the first study that has focussed on the outcomes following angioplasty to intra-stent CTOs with a very long-term follow-up. The hard endpoints were low, although the TLR rates were high. In regards to treatment strategy, the DCB and DES provide relatively better outcomes than POBA.
- Subjects :
- In-stent restenosis
medicine.medical_specialty
LVSD, Left ventricular dysfunction
Percutaneous
Drug coated balloon
MACE, Major adverse cardiac events
medicine.medical_treatment
TLR, Target lesion revascularisation
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
ISR, In-stent restenosis
Angioplasty
Internal medicine
medicine
Diseases of the circulatory (Cardiovascular) system
030212 general & internal medicine
Intra stent
cardiovascular diseases
Drug eluting stent
Original Paper
business.industry
CTO, Chronic total occlusion
TVMI, Target vessel myocardial infarction
DES, Drug eluting stent
Chronic total occlusion
CKD, Chronic kidney disease
DCB, Drug coated balloon
surgical procedures, operative
Coronary occlusion
Treatment modality
Drug-eluting stent
RC666-701
Conventional PCI
Cardiology
POBA, Plain old balloon angioplasty
Cardiology and Cardiovascular Medicine
business
Mace
TVR, Target vessel revascularisation
Subjects
Details
- ISSN :
- 23529067
- Volume :
- 34
- Database :
- OpenAIRE
- Journal :
- International journal of cardiology. Heartvasculature
- Accession number :
- edsair.doi.dedup.....1fa3886b279a25715e74182bb93b51e1