17 Impact of incomplete revascularisation on long-term outcomes following chronic total occlusion percutaneous coronary intervention. (25th January 2018)

• Record Type: Journal Article
• Authors: Candilio, Luciano; Ojeda, Soledad; Dens, Joseph; Manna, Alessio La; Benincasa, Susanna; Bellini, Barbara; Hidalgo, Francisco; Maeremans, Joren; Gravina, Giacomo; Miccichè, Eligio; D'Agosta, Guido; Venuti, Giuseppe; Tamburino, Corrado; Pan, Manuel; Carlino, Mauro; Colombo, Antonio; Azzalini, Lorenzo
• Is Part Of: Heart. Volume 104(2018)Supplement 1
• Page Start: A9
• Page End: A9
• Publication Date: 2018-01-25
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2018-BCIS.17
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objectives: To evaluate the impact of incomplete revascularisation (ICR) on long-term outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: ICR is associated with worse post-PCI outcomes. Methods: We included consecutive patients undergoing CTO PCI at 4 centres (07/2011 to 01/2017). Baseline SYNTAX score (bSS: low [≤22], intermediate [23–32], high [≥33]), residual SYNTAX score (rSS: 0–4, 4.5–8, >8), and SYNTAX Revascularisation Index (SRI: 100×(bSS-rSS)/bSS: 100%, 50%–99%, <50%) were calculated. Primary endpoint was major adverse cardiac events (MACE: cardiac death, any myocardial infarction, any revascularisation). Multivariable Cox regression analysis was conducted to identify MACE predictors. Results: We included 686 patients (low bSS: n=437; intermediate bSS: n=187; high bSS: n=62). Mean bSS was 14.0±4.7 vs 26.0±2.6 vs 39.7±6.0 (p<0.001). Occlusion complexity, crossing strategies, and procedural success rates were similar across groups. ICR degree increased with higher bSS categories (rSS: 2.5±4.7 in low vs 6.2±9.3 in intermediate vs 9.1±12.2 in high bSS, p<0.001). SRI followed a similar pattern. Median follow-up was 781 (369–1217) days. Thirty-six-month MACE rate increased with higher bSS, rSS, and SRI (bSS: low 19.4% vs intermediate 25.9% vs high 33.3%, p=0.02). Compared with rSS of 0–4, rSS of 4.5–8 (HR 2.13, 95% CI: 1.10 to 4.13, p=0.03) and rSS >8 (HR 3.00, 95% CI: 1.85 to 4.86, p<0.001) were independent predictors of MACE. Conclusions: Even a mild degree of ICR is associated with worse long-term outcomes following CTO PCI.