Chronic Total Occlusion and Everolimus-Eluting Stents | Journal Scan
What are the procedural and clinical outcomes of patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using contemporary methods and everolimus-eluting stents (EES)?
The EXPERT CTO trial investigators performed an observational study of 250 consecutive patients enrolled at 20 centers who underwent attempted CTO PCI. The primary endpoint was death, myocardial infarction, and target lesion revascularization (major adverse cardiac events [MACE]) at 1 year.
Approximately 10% of the patients were diabetics and the lesion length was 36 ± 18 mm. The total stent length used was 52 ± 27 mm. Procedural success, defined as guidewire recanalization with no in-hospital MACE, was 96.4%. Success with antegrade-only methods was 97.9% and 86.2% with the retrograde/combined approach. The 1-year MACE rate was 18.5% in the intent-to-treat population and 8.2% in the per-protocol population. The target lesion revascularization rate at 1 year was 6.3% and mortality was 1.9%. Dual antiplatelet therapy adherence was 54% at 1 year, yet subacute definite stent thrombosis occurred in only two patients (0.9%), and late probable stent thrombosis occurred in one patient (0.5%).
Contemporary techniques and EES are associated with favorable procedural success and 1-year outcome in patients undergoing CTO PCI.
These data suggest remarkable long-term efficacy of the EES stent in CTOs, and it is likely that other second-generation DES would perform similarly. The safety and procedural success rate of CTO PCI has improved over the last few years, and the currently observed outcomes are similar to those seen in less complex lesions. The biggest unanswered question in CTO PCI is whether revascularization has any benefit over medical therapy in patients who do not have angina, and randomized data are sorely needed to guide therapy in this large population.
Keywords: Angina Pectoris, Drug-Eluting Stents, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Sirolimus, Stents, Thrombosis
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