Key result
Treatment with zotarolimus-eluting stents for chronic total occlusion PCI yielded a 1-year MACE rate of 18.2%, significantly lower than the 25.2% performance goal (upper CI 23.6%; P=0.017).
Why the study?
Limited research had detailed the outcomes of chronic total occlusion PCI with independent core laboratory and event adjudication.
Does CTO PCI with zotarolimus-eluting stents improve 1-year MACE and health status compared to historical performance goals in patients with chronic total occlusions?
Cohort (n=500)
Does CTO PCI with zotarolimus-eluting stents improve 1-year MACE and health status compared to historical performance goals in patients with chronic total occlusions?
Absolute Event Rate: 18.2% vs 25.2%
p-value: p=0.017
CTO PCI using zotarolimus-eluting stents achieves high procedural success, significant angina relief, and lower 1-year MACE compared to historical performance goals.
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.
No takes yet. Share an insight, caveat, or question.
Kandzari et al. (2019) conducted a cohort in Chronic total coronary occlusion (n=500). Zotarolimus-eluting stents (ZES) vs. Performance goal derived from prior CTO DES trials was evaluated on 1-year hierarchal major adverse cardiac events (MACE) (95% CI upper CI 23.6, p=0.017). Treatment with zotarolimus-eluting stents for chronic total occlusion PCI yielded a 1-year MACE rate of 18.2%, significantly lower than the 25.2% performance goal (upper CI 23.6%; P=0.017).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: