title: Predictors of reocclusion after successful drug-eluting stent-supported percutaneous coronary intervention of chronic total occlusion.
abstract: OBJECTIVE
  This study sought to assess the incidence of reocclusion and identification of predictors of angiographic failure after successful chronic total occlusion (CTO) drug-eluting stent-supported percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Large registries have shown a survival benefit in patients with successful CTO PCI. Intuitively, sustained vessel patency may be considered as a main variable related to long-term survival. Very few data exist about the angiographic outcome after successful CTO PCI.
  
  
  METHODS
  The Florence CTO PCI registry started in 2003 and included consecutive patients treated with drug-eluting stents for at least 1 CTO (>3 months). The protocol treatment included routine 6- to 9-month angiographic follow-up. Clinical, angiographic, and procedural variables were included in the model of multivariable binary logistic regression analysis for the identification of the predictors of reocclusion.
  
  
  RESULTS
  From 2003 to 2010, 1,035 patients underwent PCI for at least 1 CTO. Of these, 802 (77%) had a successful PCI. The angiographic follow-up rate was 82%. Reocclusion rate was 7.5%, whereas binary restenosis (>50%) or reocclusion rate was 20%. Everolimus-eluting stents were associated with a significantly lower reocclusion rate than were other drug-eluting stents (3.0% vs. 10.1%; p = 0.001). A successful subintimal tracking and re-entry technique was associated with a 57% of reocclusion rate. By multivariable analysis, the subintimal tracking and re-entry technique (odds ratio [OR]: 29.5; p < 0.001) and everolimus-eluting stents (OR: 0.22; p = 0.001) were independently related to the risk of reocclusion.
  
  
  CONCLUSIONS
  Successful CTO-PCI supported by everolimus-eluting stents is associated with a very high patency rate. Successful subintimal tracking and re-entry technique is associated with a very low patency rate regardless of the type of stent used.
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Valenti
authors.forename: Ruben
authors.initials: R
authors.lastname: Vergara
authors.forename: Angela
authors.initials: A
authors.lastname: Migliorini
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.forename: Nazario
authors.initials: N
authors.lastname: Carrabba
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Cerisano
authors.forename: Emilio Vincenzo
authors.initials: EV
authors.lastname: Dovellini
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
mesh_terms: D000368:Aged; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000453:epidemiology*; D054855:Drug-Eluting Stents / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000639:trends*; D011237:Predictive Value of Tests; D012042:Registries; D016896:Treatment Outcome