Key result
In-stent chronic total occlusion PCI had comparable technical success to non-in-stent CTO PCI (86.7% vs 83.1%, p=0.230) in a large Latin American registry.
Why the study?
In-stent chronic total occlusions represent a distinctive challenge for PCI, but literature is limited and restricted to high-resource regions of the world.
Does PCI for in-stent CTO have comparable technical success and safety compared to non-in-stent CTO in patients undergoing CTO PCI?
Observational (n=1,565)
Yes
Does PCI for in-stent CTO have comparable technical success and safety compared to non-in-stent CTO in patients undergoing CTO PCI?
Absolute Event Rate: 86.7% vs 83.1%
p-value: p=0.230
In-stent CTO PCI has comparable technical success and in-hospital safety profiles to non-in-stent CTO PCI in a contemporary Latin American registry.
IS-CTO PCI shows comparable success and safety to non-IS-CTO in Latin America; leaves open need for randomized confirmation before wider adoption.
OBJECTIVES: To inform about contemporary PCI practice of in-stent (IS) chronic total occlusions (CTO) from a large international registry in Latin America. BACKGROUND: IS-CTO represent a distinctive challenge for PCI, but literature is limited and restricted to high-resource regions of the world. METHODS: Patients undergoing CTO PCI enrolled in the LATAM CTO registry from 42 centers in eight countries were included. We analyzed demographics, angiographic, procedure technique, success and postprocedural outcomes between IS-CTO and non-IS-CTO PCI. RESULTS: From 1,565 patients IS-CTO was present in 181 patients (11.5%). IS-CTO patients had higher prevalence of diabetes and hypertension than patients without IS-CTO. IS-CTOs had less calcification (32.5 vs. 46.7%, p < .001), lower prevalence of a proximal branch (36.3 vs. 50.1%, p < .001), more likely to be ostial (24.4 vs. 18.1%, p = .042), were longer (28.5 vs. 25.2 mm, p = .062), and had less interventional collaterals (49.1 vs. 57.3%, p = .038) compared with non-IS-CTO. CTO complexity scores were similar between both groups. There was no statistically significant difference in the initial or successful strategy between IS-CTO and non-IS-CTO PCI. Technical success rates remained high in IS-CTO (86.7%) and non-IS-CTO (83.1%, p = .230). There was no independent association between IS-CTO and technical success in multivariable analysis. There were no differences between IS-CTO and non-IS-CTO groups for in-hospital clinical outcomes. CONCLUSION: In a contemporary, multicenter, and international registry from Latin America, IS-CTO PCI is frequent and has comparable technical success and safety profile compared to non-IS-CTO PCI.
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Lamelas et al. (2020) conducted an observational in Chronic total occlusion (CTO) (n=1,565). In-stent chronic total occlusion (IS-CTO) vs. Non-in-stent chronic total occlusion (non-IS-CTO) was evaluated on Technical success (p=0.230). In-stent chronic total occlusion PCI had comparable technical success to non-in-stent CTO PCI (86.7% vs 83.1%, p=0.230) in a large Latin American registry.
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