Impact of Lesion Length on Chronic Total Occlusion Intervention Outcomes

Transcription

1 Impact of Lesion Length on Chronic Total Occlusion Intervention Outcomes Seung-Woon Rha, Amro Elnagar, Byoung Geol Choi, Sung Il Im, Sun Won Kim, Jin Oh Na, Seong Woo Han, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea

2 Abstract Background: Chronic total occlusion (CTO) intervention is still challenging because of the limited procedural success rate and higher target failure. The aim of this study is to evaluate the impact of CTP lesion length on procedural outcomes, complications and major clinical outcomes. Methods: A total 250 consecutive patients (pts) who underwent percutanous coronary intervention (PCI) for CTOs were enrolled for this study. Study population was divided into short lesion group (less than 30 mm) and diffuse long lesion group (more than 30 mm). Results: Baseline clinical characteristics & procedure details were similar between the 2 groups, except pts with diffuse long lesion had more smokers (59.1% vs %, p: 0.044). In diffuse long lesion group needed the use of retrograde approach more frequently, used more numbers of wires & microcatheters, larger amount of contrast media and had longer total fluoroscopy time. Procedure related complications were similar between the two groups except perforation was more frequent in the diffuse long lesion group. At one year clinical follow up, although the incidence of moratlity and Q-MI were not different between the two groups, the incidence of target lesion revascularization (TLR), target vessel revascularization (TLR), TLR-major adverse cardiac events (MACEs) were higher in the diffuse long lesion group (Table). Conclusions: Diffuse long CTOs lesions were associated with more complex procedural outcomes, higher chance of complications and worse clinical outcomes up to one year.

3 Background 1. Chronic total occlusion (CTO) intervention is still challenging because of the limited procedural success rate and higher target failure. 2. The aim of this study is to evaluate the impact of lesion length on procedural and clinical outcomes.

4 Purpose In the present study, cumulative clinical outcomes up to 12 months were compared between short lesion length group and diffuse long lesion group who are undergoing CTO intervention.

5 Methods 1. Study Population The study population consisted of 201 consecutive CTO pts underwent PCI with DESs. 2. Study Group Short lesion group (less than 30mm) (n=123 pts) Diffuse long lesion group (more than 30mm) (n= 127 pts)

6 Methods 3. Antiplatelet Regimen 1) All pts received Aspirin; 100 mg orally. 2) All pts received Clopidogrel (Plavix ) preloaded mg before PCI, followed by daily administration of 75 mg and encouraged to continue at least for 1 year. 3) Usage of adjunctive Cilostazol to dual antiplatelet regimen (asprin + clopidogrel) was depending on physician s discretion. Cilostazol was administered by 200mg post-loading and then 100mg bid for at least one month

7 Methods 4. Antithrombotic therapy used for PCI 1) Enoxaparin (Clexane ); 60mg bid before PCI and after PCI during the hospital stay (within 7 days). 2) Unfractionated Heparin; a bolus of 50 U/kg prior to PCI for 1 st one hour 3) GP IIb/IIIa blocker (Reopro ); depend on physician s discretion.

8 Methods 5. PCI Procedure A variety of atheroablative devices were not utilized and mostly simple predilation or was performed to get an adequate luminal diameter which was necessary to accommodate the unexpanded DES and their delivery system. 6. Study Endpoints 6-month angiographic and 12-month clinical outcomes were compared between the 2 groups.

9 Statistics 1. All statistical analyses were performed using SPSS Continuous variables were expressed as means ± standard deviation and were compared using Student s t-test. 3. Categorical data were expressed as percentages and were compared using chi-square statistics or Fisher s exact test. 4. A P-value of 0.05 was considered statistically significant.

10 Results

11 Results (1) Procedure related complications and one year clinical outcomes Variables, n (%) Procedure details: Short lesion (n=123 pts) Diffuse long lesion (n=127 pts) P Value Retrograde approach 0 (0) 4 (3.2) Numbers of wires 2.02± ±1.63 <0.001 Total fluoroscopy time 61.95± ±69.8 <0.001 Amount of dye 383.3± ±143.2 <0.001 Microcatheter 46 (37.4) 70 (55.6) Double wires 10 (8.1) 19 (15.1) Procedure related complications: Dissection 12 (9.8) 20 (15.9) No reflow 5 (4.1) 2 (1.6) Perforation 0 (0) 5 (4.0) Acute thrombosis 1 (0.8) 0 (0) Myocardial infarction 2 (1.6) 1 (0.8) Mortality 2 (1.6) 1 (0.8) 0.547

12 Results (2) One-year clinical outcomes Variables, n (%) Short lesion (n=123 pts) Diffuse long lesion (n=127 pts) P Value Clinical outcomes 6 (5.8) 2 (1.9) Total death 2 (1.9) 1 (0.9) Q-MI 6 (5.8) 17 (15.9) TLR 8 (7.8) 21 (19.6) TVR 15 (14.6) 26 () All MACE 0 (0) 4 (3.2) TLR MACE 2.02± ±1.63 <0.001 TVR MACE 61.95± ±69.8 <0.001

13 Results (3) 1. Baseline clinical characteristics & procedure details were similar between the two groups, except pts with diffuse long lesion were more smokers (59.1% vs %, p: 0.044). 2. In long lesion group; use of retrograde approach, numbers of wires, microcatheter, amount of dye and total fluoroscopy time, were higher. Except for perforation, procedure related complications were similar between the two groups. 3. At one year, diffuse long lesion group showed worse clinical outcomes including higher incidence of target lesions revascularization (TLR), target vessel revascularization (TVR) and TLR-major adverse cardiac events (MACE, Table).

14 Conclusion 1. Diffuse long CTO lesions needed more complex procedure techniques and devices. 2. Further, those were associated with worse clinical outcomes at one year follow up as compared with shorter CTO lesions.