Major Adverse Cardiovascular Events After Drug-Eluting Stent Implantation in Patients With Single Chronic Total Occlusion: A Single-Center Registry

作者：Gilis Siek Natasza; Fijalkowski Marcin; Jaguszewski Milosz^*; Targonski Radoslaw; Strozyk Aneta; Cackowska Monika; MasiewiczMd Emilia; Skarzynski Pawel; Burakowski Slawomir; Chmielecki Michal; Lewicki Lukasz; Dubaniewicz Witold; Gruchala Marcin; Ciecwierz Dariusz; Rynkiewicz Andrzej

来源：Journal of Invasive Cardiology, 2013, 25(11): 567-572.

• chronic total occlusion
• drug-eluting stent
• bare-metal stent
• major adverse cardiovascular events

Background. There are limited data on the long-term safety and efficacy of drug-eluting stents (DES) implantation in patients with stable angina referred for elective percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). We therefore aim to investigate whether DES compared with bare-metal stent (BMS) implantation improves long-term outcomes after successful recanalization of single CTO. Methods. A total of 345 consecutive patients who underwent successful recanalization of single CTO and received DES or BMS in the Cardioangiology Laboratories of the Medical University of Gdansk between January 1, 2006 and December 31, 2010 were included in the CTO Registry database. We compared the 1-year and long-term clinical outcomes of 137 consecutive patients who underwent PCI for CTO and DES implantation with outcomes of 208 patients after successful CTO treatment with BMS implantation. The median follow-up was 22.6 +/- 3 months (21.0 +/- 3.9 months for DES vs 23.6 +/- 1.5 months for BMS; P<.001). The primary endpoints included a composite of all-cause death and non-fatal myocardial infarction (MI) and composite safety endpoint of major adverse cardiovascular events (MACEs), including death, MI and symptom-driven target lesion revascularization (TLR). A secondary endpoint was a symptom-driven TLR. Results. After stent implantation we noted lower rates of the composite endpoint at 1-year (9.5% DES vs 18.3% BMS; P=.01) and long-term follow-up (11.7% DES vs 21.1% BMS; P=.02) due to fewer episodes of TLR in the DES group (5.1% DES vs 14.4% BMS; P=.006 at 1-year follow-up; 7.3% DES vs 14.4% BMS; P=.04 at long-term follow-up). No significant differences were documented in the rate of death, MI, or in-stent thrombosis between investigated subsets. After adjusting for patient and procedural characteristics as well as propensity, BMS implantation remained independently associated with an increased hazard of 1-year MACE (adjusted hazard ratio [AHR], 2.09; 95% confidence interval [CI], 1.2-3.64; P=.005) and long-term MACEs (AHR, 1.99; 95% CI, 1.18-3.38; P<.01). Conclusions. DES implantation during PCI for single CTO reduces MACE rate at 1-year and long-term follow-up due to the significant reduction of TLR in the DES group. Therefore, DES implantation should be preferred as an optimal treatment strategy of single CTO in stable angina patients.

• 出版日期2013-11