Author + information
- Jake Cleaman1,
- Matthew Finn2,
- Lei Song3,
- Akiko Maehara4,
- Sanjog Kalra5,
- Justin Fried2,
- Jeffrey Moses6,
- Manish Parikh6,
- Ajay Jayant Kirtane7,
- Michael Collins6,
- Tamim Nazif6,
- Khady Fall8,
- Philip Green2,
- Candido Batres9,
- Ziad Ali6,
- Martin Leon10 and
- Gary Mintz4
- 1Columbia University Medical Center, New york, New York, United States
- 2Columbia University Medical Center, New York, New York, United States
- 3Fuwai Hospital, Beijing, Beijing, China
- 4Cardiovascular Research Foundation, New York, New York, United States
- 5Einstein Healthcare Network, Philadelphia, Pennsylvania, United States
- 6NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 7Columbia University / New York-Presbyterian Hospital, New York, New Jersey, United States
- 8Columbia Presbyterian Hospital, New York, New York, United States
- 9Columbia University, New York, New York, United States
- 10Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) utilizes both intraluminal and subintimal wire tracking to achieve successful technical success. IVUS visualization can precisely determine wire tracking in CTO PCI. A recent report from our center demonstrated that subintimal stenting was associated with a higher rate of in-hospital adverse events compared to intraplaque stenting. Here, we report the 1 year follow-up results.
From March 2014 to March 2016, data were collected into a single-center database from patients undergoing CTO PCI with concomitant IVUS imaging. 1 year clinical outcomes were obtained with a composite cardiovascular endpoint of all-cause death, myocardial infarction, and unplanned revascularization.
Of the 219 patients initially evaluated, 91 patients had completed 1 year follow up data. Subintimal tracking was detected in 50.5% of overall cases. Patients with subintimal tracking were older (63 ± 9 vs 68±9) and had a greater rate of prior PCI compared (52.3 vs 73.9%) to intraplaque tracking. At 1 year, the observed rate of the composite endpoint in the subintimal tracking group was numerically higher than the intraplaque group (21.7% vs.11.1%, OR 2.2; 95% CI 0.69-7.12, P= 0.17), driven by a non-significant, higher rate of unplanned revascularization (13.0 vs. 2.2% OR 6.6 95% CI 0.76-57.2 P = 0.11).
Subintimal tracking was observed in one-half of all successful CTO PCI cases and is associated with a non-significant, increase in revascularization. Larger, prospective studies should be undertaken to further characterize these findings.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)