Prognostic significance of occlusion length in recanalized chronic total occlusion lesion: a retrospective cohort study with 5-year follow-up

Abstract

ObjectivesThis study sought to investigate the relationship between occlusion length and long-term outcomes of patients with recanalised chronic total occlusion (CTO) lesion.DesignA retrospective cohort study.SettingFuwai Hospital, National Center for Cardiovascular Disease, Beijing, ChinaParticipantsConsecutive patients with successfully recanalised CTO were included from January 2010 to December 2013.Primary and secondary outcome measuresThe primary endpoint of the present study was a composite event of all-cause death and myocardial infarction (MI). The secondary endpoints included target lesion revascularisation (TLR) and target vessel revascularisation (TVR).ResultsA total of 1987 patients were included and 1801 (90.6%) subjects completed 5-year follow-up in this study. Based on occlusion length, the patients were divided equally into two groups: short (length <15 mm, n=957) and long (length ≥15 mm, n=1030) CTO group. Kaplan-Meier survival curve showed no significant difference in the risk of the composite primary endpoint between short and long CTO groups (p=0.242). Receiver operating characteristic curve analysis also established occlusion length ≥15 mm as a cut-off value for predicting TLR and TVR, with an area under the curve of 0.604 (95% CI: 0.569 to 0.638, p<0.001) and 0.605 (95% CI: 0.572 to 0.638; p<0.001). Kaplan-Meier analysis revealed that the risks for TLR (p=0.002) and TVR (p=0.002) were higher in a patient with long CTO lesion. Multivariate Cox analysis also identified long CTO lesion as an independent predictor of TLR (HR: 1.539, 95% CI: 1.033 to 2.293; p=0.034) and TVR (HR: 1.476, 95% CI: 1.012 to 2.151; p=0.043).ConclusionPatients with long CTO lesion did not show a higher risk of death and MI after recanalisation, but had higher risks of TLR and TVR. Lesion with occlusion length ≥15 mm should be under close surveillance for restenosis after recanalisation.

Impact of lesion length on the outcomes of chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS‐CTO registry

“…The first study did not find significant differences in long‐term mortality and MACE, between patients with long and short CTOs, but target vessel revascularization (TVR) was more often performed in patients with lesions ≥30 mm (OR: 4.24; 95% CI: 1.52, 11.84) 21 . The second study demonstrated no difference in long‐term mortality and MACE risk in patients with lesions ≥15 mm, but higher risk of both TVR (hazard ratio (HR): 1.48; 95% CI: 1.01, 2.15) and target lesion revascularization (TLR) (HR: 1.54; 95% CI: 1.03, 2.29) in multivariable analysis 22 …”

Factors Influencing Stent Failure in Chronic Total Occlusion Coronary Intervention

“…In a retrospective analysis by Tian et al, 5-year outcomes demonstrated CTO length >15 mm to be a predictor of TLR, whereas Ahn et al found CTO length >30 mm was associated with higher repeat PCI driven by TVR at 2 years. 38,39 In the diabetic cohort of the OPEN-CTO study, approximately 60% had occlusion length >20 mm, whereas in the dissection and re-entry technique (DART) cohort of the CONSISTENT-CTO study, a mean (± SD) lesion length of 32 ± 22 mm was associated with an overall 2-year TVR of 14.9%, reiterating the potential for ISR and, further, development of downstream in-stent CTO. 13,40 CTO location at the aorto-ostium or bifurcation increases procedural difficulty and carries a higher risk of SF.…”

Clinical outcomes of percutaneous coronary intervention for chronic total occlusion by treated segment length

“…While collaterals regress following restoration of antegrade flow, in the event of reocclusion of the recanalized vessel, there is evidence these collaterals can recover to mitigate myocardial ischaemia and reduce allcause death. 10,29,30 Such physiological processes would not be expected to be influenced by treated segment length but whether this accounts for similar short and longer-term survival among our treatment groups remains to be determined.…”

“…In a study of 1987 patients who underwent CTO PCI in China from 2010 to 2013, the risk of all-cause death (5.7% vs. 5.1%, p = 0.56) and MI (7.6% vs. 5.9%, p = 0.13) were similar at follow up of 5 years between CTO PCI for long (> 15 mm, n = 1030) and short lesions (length < 15 mm, n = 957). 10 In a single center study of 235 consecutive patients who underwent successful CTO PCI, the incidence of in-hospital complications was found to be similar between short (< 30 mm) and long (≥ 30 mm) CTO lesion lengths. 11 Finally, in a single center study of 102 patients, longer total stent length was found to be independently associated with restenosis (hazard ratio 1.02, CI: 1.00-1.03, p = 0.05).…”

“…In contrast to non‐CTO PCI, the short‐ and long‐term clinical outcomes of successful CTO PCI recanalization by treated segment length is relatively unexplored. In a study of 1987 patients who underwent CTO PCI in China from 2010 to 2013, the risk of all‐cause death (5.7% vs. 5.1%, p = 0.56) and MI (7.6% vs. 5.9%, p = 0.13) were similar at follow up of 5 years between CTO PCI for long (> 15 mm, n = 1030) and short lesions (length < 15 mm, n = 957) 10 . In a single center study of 235 consecutive patients who underwent successful CTO PCI, the incidence of in‐hospital complications was found to be similar between short (< 30 mm) and long (≥ 30 mm) CTO lesion lengths 11 .…”