Perspective from Ashish Pershad, MD
Source/Disclosures
Source: Nikolakopoulos I, et al. Abstract I-80. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).
Vemmou E, et al. JACC Cardiovasc Interv. 2020;doi:10.1016/j.jcin.2020.05.003.
Disclosures: Nikolakopoulos and Vemmou reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
May 22, 2020
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Success, event rates similar after PCI for in-stent, de novo CTO

Perspective from Ashish Pershad, MD
Source/Disclosures
Source: Nikolakopoulos I, et al. Abstract I-80. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).
Vemmou E, et al. JACC Cardiovasc Interv. 2020;doi:10.1016/j.jcin.2020.05.003.
Disclosures: Nikolakopoulos and Vemmou reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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PCI for in-stent chronic total occlusion had similar success rates and in-hospital complications compared with PCI for de novo CTO, according to data presented at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions.

Results from this study were also published in JACC: Cardiovascular Interventions.

Evangelia Vemmou, MD, research fellow at the Minneapolis Heart Institute Foundation, and colleagues analyzed data from the PROGRESS-CTO registry of 5,667 CTO PCIs performed on 5,547 patients between 2012 and 2020. Of the patients in the study, 894 underwent PCI of in-stent CTO (mean age, 64 years; 83% men) and 4,653 underwent de novo CTO PCIs (mean age, 65 years; 83% men).

Technical success was defined as successful CTO revascularization with restoration of TIMI grade 3 antegrade flow and less than 30% residual diameter stenosis within the treated segment. Researchers defined procedural success as the combination of technical success and no in-hospital complications.

Patients who underwent PCI for in-stent CTO were more likely to have dyslipidemia (93% vs. 88%; P < .0001), diabetes (49% vs. 42%; P = .0002), prior MI (59% vs. 44%: P < .0001) and hypertension (95% vs. 90%; P < .0001) compared with those who underwent de novo CTO. These patients also had a higher mean J-CTO score (2.6 vs. 2.4; P = .0002).

Both in-stent CTO and de novo CTO groups had similar rates of technical (85% vs. 86%, respectively; P = .2) and procedural success (83% vs. 85%, respectively; P = .21). Patients in the in-stent CTO group had lower contrast volume (210 mL vs. 240 mL; P < .0001) and the risk for perforation (3.4% vs. 4.9%; P = .397) compared with those in the de novo CTO group. No differences were observed in pericardiocentesis rates in both groups (in-stent CTO, 0.6% vs. de novo CTO, 0.9%; P = .2).

“Our findings suggest that in-stent CTO PCI is feasible with similar success rates as de novo CTO PCI, likely due to increasing expertise in CTO PCI and equipment developments over time,” Vemmou and colleagues wrote. – by Darlene Dobkowski

References:

Nikolakopoulos I, et al. Abstract I-80. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).

Vemmou E, et al. JACC Cardiovasc Interv. 2020;doi:10.1016/j.jcin.2020.05.003.

Disclosures: Nikolakopoulos and Vemmou reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.