Background: In-stent restenosis (ISR) chronic total occlusion (CTO) represents a challenging subgroup for revascularization of CTO by percutaneous coronary intervention (PCI). There are limited data on the treatment and outcomes of PCI for ISR CTO.
Objective: We aimed to evaluate the procedural results and 2-year outcomes of PCI for ISR CTO compared with de novo CTO.
Methods: Patients undergoing attempted CTO PCI between January 2017 and December 2019 were prospectively enrolled. We analyzed the procedural results and 2-year major adverse cardiac events (MACE) in patients undergoing ISR CTO and those undergoing de novo CTO PCI.
Results: A total of 426 patients undergoing 484 consecutive CTO PCI (ISR CTO PCI, n=84; de novo CTO, n=400) were enrolled during the study period. Patients undergoing de novo CTO PCI had a significantly greater syntax score than those undergoing ISR CTO PCI [23.0 (17.5, 30.5) vs 21.5 (14.5, 27.0), p=0.039]. Technical (73.8% vs 79.0%, p=0.296) and procedural (73.8% vs 78.0, p=0.405) success rates, as well as the incidence of major procedural complications (1.2% vs 2.3%, p=0.842), were comparable between the two groups. After a median follow-up of 20 months, patients who underwent ISR CTO PCI had a significantly higher incidence of MACE (33.3% vs 10.3%, p< 0.001), mainly attributed to the higher TVR rates (24.7% vs 7.6%, p< 0.001). ISR CTO was the only independent predictor of MACE (hazard ratio, 4.124; 95% confidence interval, 1.951– 8.717; p< 0.001) during follow-up in patients who underwent CTO PCI.
Conclusion: ISR CTO PCI shows comparable technical and procedural success, as well as major procedural complications compared with de novo CTO PCI. However, patients who underwent ISR CTO PCI had a significantly worse prognosis than those who underwent de novo CTO PCI, in terms of MACE, driven by TVR. ISR CTO was the only independent predictor of MACE during the follow-up.



中文翻译：

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经皮冠状动脉介入治疗支架内再狭窄慢性完全闭塞的手术结果和长期结果与新发慢性完全闭塞的比较

背景：支架内再狭窄 (ISR) 慢性完全闭塞 (CTO) 代表了通过经皮冠状动脉介入治疗 (PCI) 进行 CTO 血运重建的一个具有挑战性的亚组。关于 ISR CTO 的 PCI 治疗和结果的数据有限。
目的：我们旨在评估 ISR CTO 与 de novo CTO 相比 PCI 的程序结果和 2 年结果。
方法：前瞻性纳入 2017 年 1 月至 2019 年 12 月期间尝试进行 CTO PCI 的患者。我们分析了接受 ISR CTO 和接受 de novo CTO PCI 的患者的手术结果和 2 年主要不良心脏事件 (MACE)。
结果：在研究期间，共有 426 名患者接受了 484 次连续 CTO PCI（ISR CTO PCI，n=84；de novo CTO，n=400）。接受 de novo CTO PCI 的患者的语法评分明显高于接受 ISR CTO PCI 的患者 [23.0 (17.5, 30.5) vs 21.5 (14.5, 27.0)，p = 0.039]。技术（73.8% vs 79.0%，p = 0.296）和手术（73.8% vs 78.0，p = 0.405）成功率以及主要手术并发症的发生率（1.2% vs 2.3%，p = 0.842）具有可比性两组之间。中位随访 20 个月后，接受 ISR CTO PCI 的患者 MACE 发生率显着升高（33.3% vs 10.3%，p< 0.001），主要归因于较高的 TVR 率（24.7% vs 7.6%，p < 0.001）。在接受 CTO PCI 的患者随访期间，ISR CTO 是 MACE 的唯一独立预测因子（风险比，4.124；95% 置信区间，1.951–8.717；p < 0.001）。
结论：与从头 CTO PCI 相比，ISR CTO PCI 显示出相当的技术和手术成功，以及主要的手术并发症。然而，在由 TVR 驱动的 MACE 方面，接受 ISR CTO PCI 的患者的预后明显低于接受 de novo CTO PCI 的患者。ISR CTO 是随访期间 MACE 的唯一独立预测因子。