Restenosis after percutaneous coronary intervention for coronary chronic total occlusion. The central role of an optimized immediate post-procedural angiographic result.
BACKGROUND
Factors of restenosis after percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO) have not been fully explored. In particular, although the last ACC/AHA guidelines on PCI suggest that a minimum diameter stenosis of 10% with an optimal goal of as close to 0% as possible should be the new benchmark for lesions treated by stenting, angiographic success of PCI for CTO remains in the literature most often defined as a <30% residual diameter stenosis. Whether an optimized immediate post-PCI angiographic result (OAR) defined by a minimal diameter stenosis as close to 0% is associated with a lower restenosis rate in this subset of coronary lesions remains unknown.


METHODS
Therefore, we assessed by quantitative coronary analysis (QCA) both the immediate post-PCI and 6-month follow-up angiographic results of 170 successfully treated true CTO.


RESULTS
Post-PCI QCA immediate residual diameter stenosis was <30% in all 170 CTOs and OAR defined as a ≤10% residual stenosis was achieved in 133 (78%). Global binary restenosis rate was 21% in the 170 lesions. Restenosis rates were 46% and 14% in the non-OAR group and in the OAR group, respectively (p<0.0001). Multivariate analysis showed that a non-OAR, a younger age and a retrograde approach were independent factors of restenosis.


CONCLUSIONS
Thus, an optimized immediate angiographic result with a minimal diameter stenosis as close to 0% as possible appears to be associated with a lower rate of restenosis after CTO PCI.
Division of Cardiology, University of Saint Etienne, Saint Etienne, France. Electronic address: isaaz@univ-st-etienne.fr.
Karl
K
Isaaz
Division of Cardiology, University of Saint Etienne, Saint Etienne, France.
Antoine
A
Gerbay
Division of Cardiology, University of Saint Etienne, Saint Etienne, France.
Jérémy
J
Terreaux
Division of Cardiology, University of Saint Etienne, Saint Etienne, France.
Hazem
H
Khamis
Division of Cardiology, University of Saint Etienne, Saint Etienne, France.
Khalid
K
Tammam
Division of Cardiology, University of Saint Etienne, Saint Etienne, France.
Laure
L
Richard
Division of Cardiology, University of Saint Etienne, Saint Etienne, France.
Alexis
A
Cerisier
Division of Cardiology, University of Saint Etienne, Saint Etienne, France.
Michel
M
Lamaud
Division of Cardiology, University of Saint Etienne, Saint Etienne, France.
Antoine
A
Da Costa
D017023:Coronary Angiography / Q000379:methods*; D054059:Coronary Occlusion / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D023903:Coronary Restenosis / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D011182:Postoperative Care / Q000379:methods*; D058996:Quality Improvement; D013997:Time Factors
Chronic total occlusion; Coronary occlusion; Drug-eluting stent; Percutaneous coronary intervention; Restenosis