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Procedural, clinical, and health status outcomes in chronic total coronary occlusion revascularization: Results from the PERSPECTIVE study
Author(s) -
Kandzari David E.,
Lembo Nicholas J.,
Carlson Harold D.,
Kalynych Anna,
Spertus John A.,
Gibson C. Michael,
Chi Gerald,
Morgan Jayne,
Rinehart Sarah,
Yehya Amin,
Qian Zhen,
Ajose Bola,
Karmpaliotis Dimitri
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28494
Subject(s) - medicine , mace , percutaneous coronary intervention , conventional pci , clinical endpoint , myocardial infarction , revascularization , canadian cardiovascular society , cardiology , surgery , angina , clinical trial
Background Limited research has detailed the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with independent core laboratory and event adjudication. This study examined procedural, clinical, and patient‐reported health status outcomes among patients undergoing CTO PCI with specific focus on outcomes for those treated with zotarolimus‐eluting stents (ZES). Methods Among 500 consecutive patients undergoing attempted CTO PCI, procedural and in‐hospital clinical outcomes were examined in addition to the 1‐year composite endpoint of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events, MACE). In a pre‐specified cohort of 250 patients, health status measures were ascertained at baseline and 1 year. A powered secondary endpoint was 1‐year MACE among patients treated with ZES compared with a performance goal. Results Demographic, lesion, and procedural characteristics for the overall population included prior bypass surgery, 29.8%; diabetes, 35.2%; occlusion length >20 mm, 71.3%; J‐CTO score, 2.5 ± 1.1; and primary retrograde strategy, 30.8%. Overall guidewire crossing was 90.9%; clinical success following guidewire crossing, 94.3%; and 1‐year MACE rate, 12.1%. One‐year health status significantly improved from baseline with successful CTO‐PCI (angina frequency, 72.7 ± 26.5 at baseline to 96.0 ± 10.8, p < .0001). Compared with a performance goal derived from prior CTO DES trials (1‐year hierarchal MACE, 25.2%), treatment with ZES was associated with significantly lower MACE (18.2%, one‐sided upper CI, 23.6%, p = .017). Conclusions Favorable procedural success, health status improvements and late‐term clinical outcomes inform the relative risks and benefits of CTO PCI when performed in a clinically indicated, complex patient population representative of those treated in clinical practice.