Long-term Outcome following Percutaneous Intervention of Intra-stent Coronary Occlusion and Evaluating the Different Treatment Modalities.
Basavarajaiah, Sandeep Mitomo, Satoru Nakamura, Sunao Sharma, Vinoda Mohammed, Ishaq Watanabe, Yusuke Ouchi, Toru Bhatia, Gurbir Ment, Jerome Athukorala, Sampath
Basavarajaiah, Sandeep
Mitomo, Satoru
Nakamura, Sunao
Sharma, Vinoda
Mohammed, Ishaq
Watanabe, Yusuke
Ouchi, Toru
Bhatia, Gurbir
Ment, Jerome
Athukorala, Sampath
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Affiliation
University Hospitals Birmingham; New Tokyo Hospital; Sandwell and West Birmingham NHS Trust
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Publication date
2021-05-31
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Abstract
Background: Angioplasty for ISR remains a challenge with relatively high rates of recurrence. Although there is a plethora of data on ISR, there is relatively less data on intra-stent-CTO. In this study, we explore the long-term clinical outcomes following angioplasty to intra-stent CTO and study the differences in clinical outcomes between three treatment-arms: POBA vs. DES vs. DCB.
Methods and results: We evaluated all patients who underwent PCI to intra-stent CTO between 2011 and 2017. The endpoints used were: cardiac-death, TVMI, TLR, TVR, and MACE.During the study period, 403-patients with a mean age of 69.2 years had successful PCI to intra-stent CTO. 50% were diabetic, 38% had CKD and 32% had left ventricular dysfunction. 93% of cases were stable angina. 22% (n = 88) received only POBA, 28% (n = 113) received DCB and 50% (n = 202) received DES. During the median follow-up of 48-months, cardiac-death occurred in 5.8% (n = 23), TVMI in 4% (n = 16), TLR in 45.6% (n = 182), TVR in 48.7% (n = 194) and MACE of 46%. There were no differences in the hard endpoints between the 3treatment arms. However, the TLR and overall MACE were better in DCB and DES-groups as compared to POBA (TLR: 33%vs.42%vs.49%; p = 0.06); MACE (34% vs. 45% vs. 52%; p = 0.05).
Conclusion: This is the first study that has focussed on the outcomes following angioplasty to intra-stent CTOs with a very long-term follow-up. The hard endpoints were low, although the TLR rates were high. In regards to treatment strategy, the DCB and DES provide relatively better outcomes than POBA.
Citation
Basavarajaiah S, Mitomo S, Nakamura S, Sharma V, Mohammed I, Watanabe Y, Ouchi T, Bhatia G, Ment J, Athukorala S, Pitt M, Pulikal G, Freestone B, Rides H, Kumar N, Watkin R, Lee K. Long-term Outcome following Percutaneous Intervention of Intra-stent Coronary Occlusion and Evaluating the Different Treatment Modalities. Int J Cardiol Heart Vasc. 2021 May 31;34:100803.
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Article