Safety and Effectiveness of Everolimus-Eluting Stents in Chronic Total Coronary Occlusion Revascularization

被引：46

作者：

Kandzari, David E. ^{[1
]}

Kini, Annapoorna S. ^{[2
]}

Karmpaliotis, Dimitri ^{[3
,4
]}

Moses, Jeffrey W. ^{[3
,4
]}

Tummala, Pradyumna E. ^{[5
]}

Grantham, J. Aaron ^{[6
]}

Orr, Charles ^{[7
]}

Lombardi, William ^{[8
]}

Nicholson, William J. ^{[9
]}

Lembo, Nicholas J. ^{[1
]}

Popma, Jeffrey J. ^{[10
]}

Wang, Jin ^{[11
]}

Larracas, Cristina ^{[11
]}

Rutledge, David R. ^{[11
]}

机构：

[1] Piedmont Heart Inst, Atlanta, GA 30309 USA

[2] Mt Sinai Med Ctr, New York, NY 10029 USA

[3] Columbia Univ, Med Ctr, New York, NY USA

[4] Cardiovasc Res Fdn, New York, NY USA

[5] Northeast Georgia Heart Ctr, Gainesville, GA USA

[6] St Lukes Mid Amer Heart Inst, Kansas City, MO USA

[7] St Vincents Heart Ctr, Indianapolis, IN USA

[8] PeaceHlth St Joseph Med Ctr, Ctr Cardiovasc, North Cascade Cardiol, Bellingham, WA USA

[9] York Hosp, York, PA USA

[10] Beth Israel Deaconess Med Ctr, Boston, MA USA

[11] Abbott Vasc Inc, Santa Clara, CA USA

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2015年 / 8卷 / 06期

关键词：

chronic total occlusion; drug-eluting stent; everolimus; percutaneous coronary intervention; IN-HOSPITAL OUTCOMES; CONSENSUS DOCUMENT; INTERVENTION; ARTERIES; RECANALIZATION; MULTICENTER; IMPACT; IMPLANTATION; METAANALYSIS; IMMEDIATE;

D O I：

10.1016/j.jcin.2014.12.238

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES This study sought to evaluate procedural and clinical outcomes among patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using contemporary methods and everolimus-eluting stents (EES). BACKGROUND Limited studies have detailed the procedural and late-term safety and efficacy of CTO revascularization among multiple centers applying modern techniques and with newer-generation drug-eluting stents. METHODS Among 20 centers, 250 consecutive patients were enrolled for attempted CTO PCI. Procedural and in-hospital clinical outcomes were examined in addition to the 1-year primary endpoint of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events [MACE]). RESULTS Demographic, lesion, and procedural characteristics included prior bypass surgery: 9.9%; diabetes: 40.1%; lesion length: 36.1 +/- 18.5 mm; and stent length: 51.7 +/- 27.2 mm. Procedural success, defined as guidewire recanalization with no in-hospital MACE, was 96.4%. Success with antegrade-only methods was 97.9% and 86.2% by retrograde/combined methods, respectively. Compared with a pre-specified performance goal derived from 6 prior CTO drug-eluting stent trials (1-year MACE: 24.4%), treatment with EES was associated with significantly lower composite adverse events for both intent-to-treat (18.5%, 1-sided upper confidence interval: 23.4%, p = 0.025) and per-protocol populations (8.2%, 1-sided upper confidence interval: 12.3%, p < 0.0001). Target lesion revascularization at 1 year was 6.3%. Dual antiplatelet therapy adherence was 53.9% at 1 year, yet subacute definite stent thrombosis occurred in only 2 patients (0.9%), and late probable stent thrombosis occurred in 1 patient (0.5%). CONCLUSIONS In a multicenter registration trial representing contemporary technique and EES, favorable procedural success and late-term clinical outcomes support CTO PCI in a patient population with high lesion complexity. (EXPERT CTO: Evaluation of the XIENCE PRIME LL and XIENCE Nano Everolimus Eluting Coronary Stent Coronary Stents, Performance, and Technique in Chronic Total Occlusions; NCT01435031) (C) 2015 by the American College of Cardiology Foundation.

引用

页码：761 / 769

页数：9