Impact of lesion morphology on angiographic and clinical outcomes in patients with chronic total occlusion after recanalization with drug-eluting stents: a multislice computed tomography study.

ABSTRACT

OBJECTIVES: The aim of this study was to investigate the multislice computed tomography (MSCT) parameters associated with adverse outcomes after chronic total occlusion percutaneous coronary intervention (CTO-PCI) with drug-eluting stents. METHODS: A total of 285 patients who underwent MSCT before CTO-PCI were analyzed. Lesion morphology was assessed with MSCT. Angiographic restenosis, reocclusion, and MACE (a composite of cardiac death, myocardial infarction, stent thrombosis, and target lesion revascularization) were analyzed. RESULTS: MACE was observed in 36 patients (13.6%). Occlusion length was greater (39.5 ± 19.9 mm vs. 22.3 ± 13.7 mm, p < 0.01), minimal vessel area smaller (11.2 ± 5.7 mm(2) vs. 14.5 ± 5.6 mm(2), p < 0.01), and severe calcification more common (36% vs. 12 %, p < 0.01) in the MACE group compared to the non-MACE group. We defined occluded length >25.4 mm, minimal vessel area <11.9 mm(2), which were identified by receiver operating characteristic analysis, and severe calcification as CT-derived risk factors. Angiographic restenosis (60% vs. 12% vs. 7%, p < 0.01), reocclusion (29% vs. 2% vs. 2%, p < 0.01), and MACE (43% vs. 6% vs. 3%, p < 0.01) were more common in patients with 2 or more risk factors than in those with 1 or 0. CONCLUSIONS: MSCT characteristics associated with adverse outcomes after CTO-PCI were occlusion length, minimal vessel area, and severe calcification. KEY POINTS • Percutaneous coronary intervention of chronic total occlusion remains a challenge. • The parameters related to adverse outcomes after CTO-PCI have not been clarified. • MSCT can provide useful information associated with adverse outcomes after CTO-PCI.