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.
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