Background:The appropriateness of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions has rarely been investigated. Methods and Results:The Japanese CTO-PCI Expert Registry enrolled consecutive patients undergoing CTO-PCI carried out by highly experienced Japanese CTO specialists who performed more than 50 CTO-PCIs per year and 300 CTO-PCIs in total. This study included patients undergoing CTO-PCI between January 2014 and December 2019. The appropriateness, trends, and differences among the procedures performed by the operators using the 2017 appropriate use criteria were analyzed. Furthermore, we performed a logistic regression analysis to assess whether the appropriateness was associated with in-hospital major adverse cardiovascular and cerebrovascular events (MACCE). Of the 5,062 patients who underwent CTO-PCI, 4,309 (85.1%) patients who did not undergo the non-invasive stress test were classified as having no myocardial ischemia. Of the total cases, 3,150 (62.2%) were rated as "may be appropriate," and 642 (12.7%) as "rarely appropriate" CTO-PCI cases. The sensitivity analyses showed that the number (%) of "may be appropriate" ranged from 4,125 (57.8%) to 4,744 (66.4%) and the number of "rarely appropriate" ranged from 843 (11.8%) to 970 (13.6%) among best and worst scenarios. Conclusions:In a large Japanese CTO-PCI registry, approximately 13% of CTO-PCI procedures were classified as "rarely appropriate". Substantial efforts would be required to decrease the number of "rarely appropriate" CTO-PCI procedures.

No abstract

Background: Little is known about the clinical follow-up after sirolimus-eluting stent (SES) implantation and about the effect of SES implantation in in-stent restenosis (ISR) lesion more than five years. We aimed to compare clinical outcomes up to 10 years after SES implantation in de novo lesion and ISR lesion. Methods: A series of 392 patients underwent the first SES implantation between November 2002 and December 2004, whose clinical outcomes were investigated. There were 253 patients for de novo lesion and 139 patients for ISR lesion. We evaluated the outcomes from the SES implantation to five years and beyond five years. Clinical information was obtained either from a review of the hospital records or by telephone interviews with the patients, family members, or primary care physicians. Results: Mean follow up period was 10.0 years. Cumulative incidence of major cardiac events (MACE) and target-lesion revascularization in ISR group were significantly higher than that in de novo group through 10 years (56.1% vs. 38.7%; p = 0.01, and 41.3% vs. 20.6%; p = 0.004, respectively) and the difference of the MACE and TLR rate in two groups increased in this period. Cumulative incidence of myocardial infarction (MI) and stent thrombosis (ST) between 2 groups were not significantly different (13.0% vs. 7.9%; p = 0.1, and 5.0% vs. 2.4%; p = 0.15, respectively). Conclusion: The incidence of MACE and TLR after the SES implantation in ISR lesion was significantly higher than that in de novo lesion and the difference of the TLR rate between in two lesions became more clear through 10 years, although the incidence of MI and ST had no significant difference in 2 groups.

No abstract