title: Dissection and re-entry techniques and longer-term outcomes following successful percutaneous coronary intervention of chronic total occlusion.
abstract: New techniques involving dissection of the subintimal space and re-entry into the true lumen increase success rates in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, their long-term safety and efficacy were unknown. This study included a series of consecutive patients who underwent CTO PCI. All patients who did not present events were contacted 12 to 18 months after their PCI. The combined incidence of cardiac death, myocardial infarction, ischemia-driven target-vessel revascularization (TVR), or reocclusion was assessed as our primary outcome. From January 2010 to January 2013, of 212 CTOs treated in our CTO program, 192 (91%) were successfully opened (in 179 patients). Follow-up data were available for 187 CTOs (97.4%), with 82 (44%) that were opened with dissection re-entry and 105 (56%) with conventional wire escalation techniques. At a median follow-up of 398 days, the primary outcome occurred in 18 of 179 CTOs treated (10.7%), driven by TVR. No patient died from cardiac causes. Eleven CTOs (15.2%) treated with dissection re-entry versus 7 CTOs (7.3%) treated with wire escalation presented with the primary outcome (p = 0.17). With multivariate adjustment, dissection re-entry techniques had no significant impact on outcomes. However, treatment of an in-stent occlusion was independently associated with TVR (hazards ratio >6.0, p <0.001). In conclusion, dissection re-entry techniques have minimal impact on long-term outcomes after CTO PCI, which are favorable in most patients. However, treatment of an in-stent occlusion and use of sirolimus-eluting stent were predictors of subsequent adverse outcomes.
authors.affiliation: Multidisciplinary Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Laval University, Quebec City, Quebec, Canada. Electronic address: stephane.rinfret@criucpq.ulaval.ca.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Rinfret
authors.affiliation: Multidisciplinary Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Laval University, Quebec City, Quebec, Canada.
authors.forename: Henrique Barbosa
authors.initials: HB
authors.lastname: Ribeiro
authors.affiliation: Multidisciplinary Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Laval University, Quebec City, Quebec, Canada.
authors.forename: Can Manh
authors.initials: CM
authors.lastname: Nguyen
authors.affiliation: Multidisciplinary Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Laval University, Quebec City, Quebec, Canada.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Multidisciplinary Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Laval University, Quebec City, Quebec, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Ureña
authors.affiliation: Multidisciplinary Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec (Quebec Heart & Lung Institute), Laval University, Quebec City, Quebec, Canada.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors