RT Journal Article
SR Electronic
T1 17 Impact of incomplete revascularisation on long-term outcomes following chronic total occlusion percutaneous coronary intervention
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP A9
OP A9
DO 10.1136/heartjnl-2018-BCIS.17
VO 104
IS Suppl 1
A1 Luciano Candilio
A1 Soledad Ojeda
A1 Joseph Dens
A1 Alessio La Manna
A1 Susanna Benincasa
A1 Barbara Bellini
A1 Francisco Hidalgo
A1 Joren Maeremans
A1 Giacomo Gravina
A1 Eligio Miccichè
A1 Guido D’Agosta
A1 Giuseppe Venuti
A1 Corrado Tamburino
A1 Manuel Pan
A1 Mauro Carlino
A1 Antonio Colombo
A1 Lorenzo Azzalini
YR 2018
UL http://heart.bmj.com/content/104/Suppl_1/A9.abstract
AB 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.