Author + information
- David Kandzari1,
- Nicholas Lembo2,
- Harold Carlson1,
- Mike Gibson3,
- Jayne Morgan1,
- Sarah Rinehart1,
- Amin Yehya1 and
- Dimitri Karmpaliotis4
Limited study has detailed the procedural, clinical and health status outcomes among patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using contemporary methods.
The PERSPECTIVE trial included consecutive patients undergoing attempted CTO revascularization at a single center. Procedural and in-hospital outcomes, in addition to clinical events were assessed at baseline, 6 months and 1 year. The primary endpoint is 1-year occurrence of death, myocardial infarction and target lesion revascularization. Among a pre-specified cohort of 250 prospectively followed consecutive patients, health status (CCS angina, Seattle Angina Questionnaire, EQ5D) outcomes were ascertained at baseline, 6 months and 1 year. Additional secondary endpoints include procedural success, completeness of revascularization and 1-year MACE among patients treated with zotarolimus-eluting stents. An independent clinical events committee adjudicated all clinical endpoints. Coronary angiograms performed at baseline and follow-up, if clinically indicated, were reviewed by an independent angiographic core laboratory.
Between June 2013 and March 2016, 491 consecutive CTO patients providing informed consent were enrolled. Angina class III/IV was 70.1%; diabetes, 35.4%; previous bypass surgery, 29.7%; prior attempted revascularization, 21.4%; and J CTO score, 2.5 ± 1.1. Technical success with guidewire crossing was 90.3%. A primary antegrade strategy was attempted in 67.8% of procedures, and the mean number of guidewires/case was 7.5 ± 4.6. Clinically significant perforation was 5.3%, and rates of in-hospital MI and death were 1.6% and 0.8%, respectively. The mean reduction in SYNTAX score with CTO PCI was 11.6 ± 6.7. Final 1-year clinical and health status outcomes will be reported.
In a large series of patients undergoing attempted CTO PCI representing contemporary technique and strategy, the PERSPECTIVE trial informs the association between procedural results and the impact of CTO PCI on completeness of revascularization with clinical and health status outcomes.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)