Key result
Extremely long CTO lesions linked to higher 5-year MACE and mortality following successful PCI.
Why the study?
Lesion length correlates with worse outcomes following PCI for CTO, but data confirming the link between extremely long lesions and clinical hard endpoints have been limited.
Does extremely long CTO lesion length (≥50 mm) worsen 5-year clinical outcomes in patients undergoing successful PCI with DESs?
Cohort (n=333)
Does extremely long CTO lesion length (≥50 mm) worsen 5-year clinical outcomes in patients undergoing successful PCI with DESs?
In patients undergoing successful PCI for CTO, extremely long lesions (≥50 mm) are associated with significantly worse 5-year clinical outcomes, including higher mortality and cardiac death.
Extremely long CTO lesions were associated with higher long-term MACE, cardiac death, and mortality after successful PCI; leaves open whether lesion length should guide strategy or trial enrollment.
BACKGROUND: Lesion length is related to worse clinical outcomes following percutaneous coronary intervention (PCI) for the treatment of chronic total occlusion (CTO). However, the data to confirm the association between extremely long lesions and clinical hard endpoints have been limited. Therefore, we investigated the impact of extremely long CTO lesions (≥50 mm, treated lesion length) on the long-term clinical outcomes following successful PCI. METHODS: A total of 333 consecutive patients with CTO who underwent successful PCI with drug-eluting stents (DESs) were allocated to either the extremely long or the short CTO group according to their CTO lesion length. The 5-year clinical outcomes were compared between the two groups. The incidence of myocardial infarction, cardiac death (CD), revascularization, and major adverse cardiovascular events (MACE) was higher in the extremely long CTO group. The 5-year clinical outcomes were analyzed using the Cox hazard ratio (HR) model. RESULTS: In the entire study population, the extremely long CTO lesion was an independent predictor for higher rate of revascularization, MACE, CD, or mortality. CONCLUSIONS: In our study, CTO patients with extremely long lesions (≥50 mm) who underwent successful PCI were associated with a higher risk of worse long-term clinical outcomes, including hard clinical endpoints such as CD and mortality even in the DESs era.
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Ahn et al. (2023) conducted a cohort in Chronic total occlusion (CTO) (n=333). Extremely long CTO lesions (≥50 mm) vs. Short CTO lesions was evaluated on 5-year clinical outcomes including myocardial infarction, cardiac death, revascularization, and MACE. Extremely long CTO lesions (≥50 mm) were associated with a higher risk of revascularization, MACE, cardiac death, and mortality over 5 years following successful PCI.
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