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17 Impact of incomplete revascularisation on long-term outcomes following chronic total occlusion percutaneous coronary intervention
  1. Luciano Candilio1,2,
  2. Soledad Ojeda3,
  3. Joseph Dens4,
  4. Alessio La Manna5,
  5. Susanna Benincasa1,
  6. Barbara Bellini1,
  7. Francisco Hidalgo3,
  8. Joren Maeremans4,6,
  9. Giacomo Gravina5,
  10. Eligio Miccichè5,
  11. Guido D’Agosta5,
  12. Giuseppe Venuti5,
  13. Corrado Tamburino5,
  14. Manuel Pan3,
  15. Mauro Carlino1,
  16. Antonio Colombo1,
  17. Lorenzo Azzalini1
  1. 1Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
  2. 2Cardiology Department, The Hammermith Hospital, Imperial College, London
  3. 3Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
  4. 4Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
  5. 5Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
  6. 6Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium

Abstract

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.

https://doi.org/10.1136/heartjnl-2018-BCIS.17

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