Long-term outcomes of percutaneous coronary interventions in primary and recurrent chronic occlusions of coronary arteries

• Yuriy L. Shevchenko
• Dmitriy Yu. Ermakov
• Alex A. Litvinov
• Michael M. Maslennikov
• Anastasia Yu. Vakhrameeva

Abstract

Introduction. Percutaneous coronary intervention (PCI) remains the “gold standard” for the treatment of patients with coronary artery disease. One of the most complex types of coronary artery disease (CAD) is chronic total occlusion (CTO). The main limiting factor in the effectiveness of PCI, including CTO, in the late period after the intervention is in-stent restenosis (ISR), which in the terminal stage of development is in-stent occlusion (ISR CTO).

Aim – to compare the effectiveness and safety of PCI in primary CTO and ISR CTO 2 years after the intervention.

Material and methods. The study included 145 patients with coronary artery disease and CTO who underwent PCI from 2012 to 2021. The 1^st group included 33 patients with ISR CTO, the 2^nd group – 112 patients with primary CTO. The median follow-up period was 785 (613–1012) days. The primary composite endpoint was adverse cardiovascular events (MACE). Components of the primary endpoint: ISR, MI, cardiac death. Secondary endpoints: ISR, MI, cardiac death, all-cause death, repeat revascularization.

Results. The incidence of binary ISR and re-occlusion of the coronary artery was statistically significantly higher in patients with ISR CTO: 9 (27.3%) vs 14 (12.5%), HR 2.184; 95% CI 1.156–2.982, p=0.042. The proportion of MACE was significantly higher in the ISR CTO group: 11 (33.3%) vs 19 (17.0%), HR 1.959; 95% CI 1.286–3.587, p=0.042. In multivariate analysis, the CTO IRS parameter showed a correlation with the occurrence of MACE after PCI: OR 4.387, 95% CI 1.765–9.522, p<0.001.

Conclusion. CTO ISR determines a worse long-term prognosis for MACE compared to primary CTO, including binary ISR and re-occlusion of the CA, and is an independent predictor of adverse events after PCI.

Keywords: coronary artery disease; percutaneous coronary intervention; chronic total occlusion

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