Key result
Long CTO lesions link to ~4.3-fold higher odds of repeat PCI despite similar 2-year MACE.
Why the study?
Does long CTO lesion length increase major adverse cardiovascular events and repeat revascularization in patients undergoing successful CTO PCI?
Cohort (n=235)
No
Does long CTO lesion length increase major adverse cardiovascular events and repeat revascularization in patients undergoing successful CTO PCI?
Absolute Event Rate: 21.3% vs 13.1%
p-value: p=0.130
In patients undergoing successful CTO PCI, long lesions (≥30mm) are associated with a higher risk of repeat revascularization compared to short lesions, highlighting the need for careful angiographic follow-up.
Long CTO lesions were associated with higher repeat PCI risk; leaves open whether length modifies outcomes in prospective CTO trials.
Background Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is known to be associated with improved clinical outcomes compared with failed CTO PCI. However, it is not clear whether the angiographic and clinical outcomes of long CTO lesionis different with those of short CTO lesion in the drug eluting stent (DES) era. Method sand Results A total of 235 consecutive patients underwent successful CTO intervention were divided into two groups according the CTO lesion length. Six-month angiographic and two-year clinical outcomes were compared between the two groups. The baseline clinical characteristics were similar between the two groups except prior PCI was more frequent in long CTO group whereas bifurcation lesion was more frequent in the short CTO group. In-hospital complications were similar between the two groups except intimal dissection was more frequent in long CTO group. Both groups had similar angiographic outcomes at 6 months and clinical outcomes up to 2 years except the incidence of repeat PCI, predominantly target vessel revascularization (TVR) was higher in long CTO group. In multivariate analysis, long CTO was an important predictor for repeat PCI (OR;4.26, CI 1.53-11.9, p=0.006). Conclusion The safety profile, angiographic and 2-year clinical outcomes were similar between the two groups except higher incidence of repeat PCI in long CTO group despite of successful PCI with DESs.
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Ahn et al. (2018) conducted a cohort in Chronic total occlusion (CTO) (n=235). Long CTO lesion (≥30mm) vs. Short CTO lesion (<30mm) was evaluated on Major adverse cardiovascular events (MACE) at 2 years (p=0.130). While 2-year MACE was similar (21.3% vs 13.1%, p=0.13), long CTO lesions (≥30mm) independently predicted the need for repeat PCI (OR 4.26, 95% CI 1.53-11.9, p=0.006) compared to short lesions.
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