Simon J Walsh1, Colm G Hanratty2, Margaret McEntegart3, Julian W Strange4, Johannes Rigger2, Peter A Henriksen5, Elliot J Smith6, Simon J Wilson2, Jonathan M Hill7, Zlatko Mehmedbegovic8, Bernard Chevalier9, Marie-Claude Morice9, James C Spratt10. 1. Belfast Health & Social Care Trust, Belfast, United Kingdom. Electronic address: simon.walsh@belfasttrust.hscni.net. 2. Belfast Health & Social Care Trust, Belfast, United Kingdom. 3. Golden Jubilee Hospital, Glasgow, United Kingdom. 4. Bristol Heart Institute, Bristol, United Kingdom. 5. Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. 6. St. Bartholemew's Hospital, London, United Kingdom. 7. King's College Hospital, London, United Kingdom. 8. Clinical Center of Serbia, Cardiology Clinic, Belgrade, Serbia. 9. Cardiovascular European Research Centre, Massy, France. 10. St. George's University Hospital, London, United Kingdom.
Abstract
OBJECTIVES: The aim of this study was to assess angiographic, imaging, and clinical outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with dissection and re-entry techniques (DART) and subintimal (SI) stenting compared with intimal techniques. BACKGROUND: Reliable procedural success and safety in CTO PCI require the use of DART to treat the most complex patients. Potential concerns regarding the durability of DART with SI stenting still need to be addressed. METHODS: This was a prospective, multicenter, single-arm trial of patients with appropriate indications for CTO PCI. RESULTS: Successful CTO PCI was performed in 210 of 231 patients (91% success). At 1 year, the primary endpoint of target vessel failure (cardiac death, myocardial infarction related to the target vessel, or any ischemia-driven revascularization) occurred in 5.7% of patients, meeting the pre-set performance goal. Major adverse cardiovascular events (all-cause mortality, myocardial infarction, or target vessel revascularization) occurred in 10% at 1 year and 17% by 2 years and was not influenced by DART. Quality-of-life measures significantly improved from baseline to 12 months. There was no difference in intravascular healing assessed using optical coherence tomography at 12 months for patients treated with DART and SI stenting compared with intimal strategies. CONCLUSIONS: Contemporary CTO PCI is associated with medium-term clinical outcomes comparable with those achieved in other complex PCI cohorts and significant improvements in quality of life. The use of DART with SI stenting does not adversely affect intravascular healing at 12 months or medium-term major adverse cardiovascular events. (Consistent CTO Trial; NCT02227771).
OBJECTIVES: The aim of this study was to assess angiographic, imaging, and clinical outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with dissection and re-entry techniques (DART) and subintimal (SI) stenting compared with intimal techniques. BACKGROUND: Reliable procedural success and safety in CTO PCI require the use of DART to treat the most complex patients. Potential concerns regarding the durability of DART with SI stenting still need to be addressed. METHODS: This was a prospective, multicenter, single-arm trial of patients with appropriate indications for CTO PCI. RESULTS: Successful CTO PCI was performed in 210 of 231 patients (91% success). At 1 year, the primary endpoint of target vessel failure (cardiac death, myocardial infarction related to the target vessel, or any ischemia-driven revascularization) occurred in 5.7% of patients, meeting the pre-set performance goal. Major adverse cardiovascular events (all-cause mortality, myocardial infarction, or target vessel revascularization) occurred in 10% at 1 year and 17% by 2 years and was not influenced by DART. Quality-of-life measures significantly improved from baseline to 12 months. There was no difference in intravascular healing assessed using optical coherence tomography at 12 months for patients treated with DART and SI stenting compared with intimal strategies. CONCLUSIONS: Contemporary CTO PCI is associated with medium-term clinical outcomes comparable with those achieved in other complex PCI cohorts and significant improvements in quality of life. The use of DART with SI stenting does not adversely affect intravascular healing at 12 months or medium-term major adverse cardiovascular events. (Consistent CTO Trial; NCT02227771).
Authors: Leszek Bryniarski; Maksymilian P Opolski; Jarosław Wójcik; Maciej Lesiak; Tomasz Pawłowski; Jakub Drozd; Wojciech Wojakowski; Sławomir Surowiec; Maciej Dąbrowski; Adam Witkowski; Dariusz Dudek; Marek Grygier; Stanisław Bartuś Journal: Postepy Kardiol Interwencyjnej Date: 2021-03-27 Impact factor: 1.426