Document Detail


Predictors of reocclusion after successful drug-eluting stent-supported percutaneous coronary intervention of chronic total occlusion.
MedLine Citation:
PMID:  23273395     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to assess the incidence of reocclusion and identification of predictors of angiographic failure after successful chronic total occlusion (CTO) drug-eluting stent-supported percutaneous coronary intervention (PCI).
BACKGROUND: Large registries have shown a survival benefit in patients with successful CTO PCI. Intuitively, sustained vessel patency may be considered as a main variable related to long-term survival. Very few data exist about the angiographic outcome after successful CTO PCI.
METHODS: The Florence CTO PCI registry started in 2003 and included consecutive patients treated with drug-eluting stents for at least 1 CTO (>3 months). The protocol treatment included routine 6- to 9-month angiographic follow-up. Clinical, angiographic, and procedural variables were included in the model of multivariable binary logistic regression analysis for the identification of the predictors of reocclusion.
RESULTS: From 2003 to 2010, 1,035 patients underwent PCI for at least 1 CTO. Of these, 802 (77%) had a successful PCI. The angiographic follow-up rate was 82%. Reocclusion rate was 7.5%, whereas binary restenosis (>50%) or reocclusion rate was 20%. Everolimus-eluting stents were associated with a significantly lower reocclusion rate than were other drug-eluting stents (3.0% vs. 10.1%; p = 0.001). A successful subintimal tracking and re-entry technique was associated with a 57% of reocclusion rate. By multivariable analysis, the subintimal tracking and re-entry technique (odds ratio [OR]: 29.5; p < 0.001) and everolimus-eluting stents (OR: 0.22; p = 0.001) were independently related to the risk of reocclusion.
CONCLUSIONS: Successful CTO-PCI supported by everolimus-eluting stents is associated with a very high patency rate. Successful subintimal tracking and re-entry technique is associated with a very low patency rate regardless of the type of stent used.
Authors:
Renato Valenti; Ruben Vergara; Angela Migliorini; Guido Parodi; Nazario Carrabba; Giampaolo Cerisano; Emilio Vincenzo Dovellini; David Antoniucci
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Publication Detail:
Type:  Journal Article     Date:  2012-12-26
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  61     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-01     Completed Date:  2013-03-25     Revised Date:  2013-08-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  545-50     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiology, Careggi Hospital, Florence, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Chronic Disease
Coronary Occlusion / diagnosis*,  epidemiology*
Drug-Eluting Stents / trends*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Percutaneous Coronary Intervention / trends*
Predictive Value of Tests
Registries
Treatment Outcome
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2013 Jun 25;61(25):2570   [PMID:  23542096 ]
J Am Coll Cardiol. 2013 Feb 5;61(5):551-2   [PMID:  23273399 ]
J Am Coll Cardiol. 2013 Jun 25;61(25):2570-1   [PMID:  23542102 ]

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