Procedural, clinical, and health status outcomes in chronic total coronary occlusion revascularization: Results from the PERSPECTIVE study. Issue 3 (12th September 2019)

• Record Type: Journal Article
• Authors: Kandzari, David E.; Lembo, Nicholas J.; Carlson, Harold D.; Kalynych, Anna; Spertus, John A.; Gibson, C. Michael; Chi, Gerald; Morgan, Jayne; Rinehart, Sarah; Yehya, Amin; Qian, Zhen; Ajose, Bola; Karmpaliotis, Dimitri
• Is Part Of: Catheterization and cardiovascular interventions. Volume 96:Issue 3(2020)
• Page Start: 567
• Page End: 576
• Publication Date: 2019-09-12
• Subjects: chronic total occlusion -- drug‐eluting stent -- percutaneous coronary intervention -- zotarolimus; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.28494
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract : Background: Limited research has detailed the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with independent core laboratory and event adjudication. This study examined procedural, clinical, and patient‐reported health status outcomes among patients undergoing CTO PCI with specific focus on outcomes for those treated with zotarolimus‐eluting stents (ZES). Methods: Among 500 consecutive patients undergoing attempted CTO PCI, procedural and in‐hospital clinical outcomes were examined in addition to the 1‐year composite endpoint of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events, MACE). In a pre‐specified cohort of 250 patients, health status measures were ascertained at baseline and 1 year. A powered secondary endpoint was 1‐year MACE among patients treated with ZES compared with a performance goal. Results: Demographic, lesion, and procedural characteristics for the overall population included prior bypass surgery, 29.8%; diabetes, 35.2%; occlusion length >20 mm, 71.3%; J‐CTO score, 2.5 ± 1.1; and primary retrograde strategy, 30.8%. Overall guidewire crossing was 90.9%; clinical success following guidewire crossing, 94.3%; and 1‐year MACE rate, 12.1%. One‐year health status significantly improved from baseline with successful CTO‐PCI (angina frequency, 72.7 ± 26.5 at baseline to 96.0 ± 10.8, p < .0001). Compared with a performance goal derived from prior CTO DES trials (1‐year hierarchal MACE, 25.2%), treatment with ZES was associated with significantly lower MACE (18.2%, one‐sided upper CI, 23.6%, p = .017). Conclusions: Favorable procedural success, health status improvements and late‐term clinical outcomes inform the relative risks and benefits of CTO PCI when performed in a clinically indicated, complex patient population representative of those treated in clinical practice.