title: Impact of lesion morphology on angiographic and clinical outcomes in patients with chronic total occlusion after recanalization with drug-eluting stents: a multislice computed tomography study.
abstract: OBJECTIVE
  The aim of this study was to investigate the multislice computed tomography (MSCT) parameters associated with adverse outcomes after chronic total occlusion percutaneous coronary intervention (CTO-PCI) with drug-eluting stents.
  
  
  METHODS
  A total of 285 patients who underwent MSCT before CTO-PCI were analyzed. Lesion morphology was assessed with MSCT. Angiographic restenosis, reocclusion, and MACE (a composite of cardiac death, myocardial infarction, stent thrombosis, and target lesion revascularization) were analyzed.
  
  
  RESULTS
  MACE was observed in 36 patients (13.6%). Occlusion length was greater (39.5 ± 19.9 mm vs. 22.3 ± 13.7 mm, p < 0.01), minimal vessel area smaller (11.2 ± 5.7 mm(2) vs. 14.5 ± 5.6 mm(2), p < 0.01), and severe calcification more common (36% vs. 12 %, p < 0.01) in the MACE group compared to the non-MACE group. We defined occluded length >25.4 mm, minimal vessel area <11.9 mm(2), which were identified by receiver operating characteristic analysis, and severe calcification as CT-derived risk factors. Angiographic restenosis (60% vs. 12% vs. 7%, p < 0.01), reocclusion (29% vs. 2% vs. 2%, p < 0.01), and MACE (43% vs. 6% vs. 3%, p < 0.01) were more common in patients with 2 or more risk factors than in those with 1 or 0.
  
  
  CONCLUSIONS
  MSCT characteristics associated with adverse outcomes after CTO-PCI were occlusion length, minimal vessel area, and severe calcification.
  
  
  CONCLUSIONS
  • Percutaneous coronary intervention of chronic total occlusion remains a challenge. • The parameters related to adverse outcomes after CTO-PCI have not been clarified. • MSCT can provide useful information associated with adverse outcomes after CTO-PCI.
authors.affiliation: Toyohashi Heart Center, Toyohashi, Japan, tuyosiito@gmail.com.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ito
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Yoriyasu
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Mariko
authors.initials: M
authors.lastname: Ehara
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Maoto
authors.initials: M
authors.lastname: Habara
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ohte
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000473:pathology* / Q000601:surgery; D023903:Coronary Restenosis / Q000209:etiology / Q000473:pathology; D003328:Coronary Thrombosis / Q000209:etiology / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology; D009204:Myocardial Revascularization / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome