Restenosis after percutaneous coronary intervention for coronary chronic total occlusion. The central role of an optimized immediate post-procedural angiographic result. (1st December 2016)

• Record Type: Journal Article
• Authors: Isaaz, Karl; Gerbay, Antoine; Terreaux, Jérémy; Khamis, Hazem; Tammam, Khalid; Richard, Laure; Cerisier, Alexis; Lamaud, Michel; Da Costa, Antoine
• Is Part Of: International journal of cardiology. Volume 224(2016)
• Page Start: 343
• Page End: 347
• Publication Date: 2016-12-01
• Subjects: Chronic total occlusion -- Coronary occlusion -- Drug-eluting stent -- Percutaneous coronary intervention -- Restenosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.09.028
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Factors of restenosis after percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO) have not been fully explored. In particular, although the last ACC/AHA guidelines on PCI suggest that a minimum diameter stenosis of 10% with an optimal goal of as close to 0% as possible should be the new benchmark for lesions treated by stenting, angiographic success of PCI for CTO remains in the literature most often defined as a < 30% residual diameter stenosis. Whether an optimized immediate post-PCI angiographic result (OAR) defined by a minimal diameter stenosis as close to 0% is associated with a lower restenosis rate in this subset of coronary lesions remains unknown. Methods: Therefore, we assessed by quantitative coronary analysis (QCA) both the immediate post-PCI and 6-month follow-up angiographic results of 170 successfully treated true CTO. Results: Post-PCI QCA immediate residual diameter stenosis was < 30% in all 170 CTOs and OAR defined as a ≤ 10% residual stenosis was achieved in 133 (78%). Global binary restenosis rate was 21% in the 170 lesions. Restenosis rates were 46% and 14% in the non-OAR group and in the OAR group, respectively ( p < 0.0001). Multivariate analysis showed that a non-OAR, a younger age and a retrograde approach were independent factors of restenosis. Conclusion: Thus, an optimized immediate angiographic result with a minimal diameter stenosis as close to 0% as possible appears to be associated with a lower rate of restenosis after CTO PCI.