TCT CONNECT-240 CTO PCI for In-Stent Restenosis: Insights From a Pooled Analysis of Four Multicenter Registries
Vemmou E, Quadros A, Dens J, Agostoni P, Alaswad K, Belli K, Carlino M, Karmpaliotis D, Khelimskii D, Knaapen P, Krestyaninov O, Ojeda S, Padilla L, Pan M, Piccaro de Oliveira P, Rinfret S, Spratt J, Walsh S, Karacsonyi J, Nikolakopoulos I, Rangan B, Brilakis E, and Azzalini L. TCT CONNECT-240 CTO PCI for In-Stent Restenosis: Insights From a Pooled Analysis of Four Multicenter Registries. Journal of the American College of Cardiology 2020; 76(17):B106.
Journal of the American College of Cardiology
Background: The outcomes of percutaneous coronary intervention (PCI) for in-stent chronic total occlusions (CTOs) have received limited study.
Methods: We examined the clinical, angiographic characteristics and procedural outcomes of 11,966 CTO PCIs performed at 11,756 patients at 108 U.S. and international centers between 2012 and 2020, pooling patient-level data from four multicenter registries. In-hospital major adverse cardiovascular events included death, myocardial infarction, stroke, and tamponade.
Results: In-stent CTOs represented 15% of the total procedures (n = 1,753). Patients with in-stent CTOs had higher rates of diabetes mellitus (44% vs. 38%, p < 0.0001) and prior coronary artery bypass grafts (26.5% vs. 24%, p = 0.0273). In-stent CTOs had a higher Japan-CTO score (2.3 ± 1.3 vs. 2.2 ± 1.3, p = 0.009) and less proximal cap ambiguity compared with de novo lesions (27% vs. 36%, p < 0.0001). Regarding successful crossing strategies, antegrade wiring was the most used strategy in the in-stent group (70% vs. 61%) followed by antegrade dissection/re-entry (17% vs. 21%) and retrograde crossing (13% vs. 18%, p < 0.0001). Intravascular imaging was used more often (43% vs. 35%, p < 0.0001) in the in-stent CTO group. Compared with de novo CTOs, in-stent CTO PCIs required less contrast (215 [150, 300] vs. 250 [180, 341] ml, p < 0.0001).Technical (85% vs. 85%, p = 0.87) and procedural (84% vs. 84%, p = 0.82) success rates were similar between in-stent and de novo CTOs as was the incidence of in-hospital major adverse cardiovascular events (1.7% vs. 2.2%, p = 0.25).
Conclusion: In-stent CTOs represent 15% of all CTO PCIs and can be re-canalized with similar success and in-hospital complication rates as de novo CTOs.