Long-term outcome of DES in CTOs

Imre UNGI

University of Szeged

Szeged, Hungary

BMS or DES?

4394 pts;

14 studies;

Endpoints:

mortality, MI,

TVR, MACE,

ST, ISR, ISO

Ten years outcome of overlapping BMSs in RCA PCI

First- or second-generation DES?

1st or 2nd generation?

Patient population:742/7765 CTO PCI (2006-2011)

Single center retrospective analysis

MACEfreesurvival

MACEfreesurvivalafter PA

TLRfreesurvival

TLRfreesurvivalafter PA

1st gen=557; 2nd gen=449

Mortality andmyocardial infarction

TVR and TLR

MACE and ST Binary restenosis and reocclusion

Non-CTO lesions and CTO are the same forlong-term results of DES?

TWENTE: CTO PCI with 2nd Gen DES

van Houwelingen et al, CCI 2015

Analysis of 59 CTO pts treated with ZES (Resolute) or EES 56% with J-CTO scores ≥2; mean lesion length 31.3 mm Similar rates of ST (1.7% CTO vs. 1.5% for non-CTO)

Resolute ZES in Coronary Occlusions2 year outcomes: 256 CTO lesions, 292 non-chronic TO lesions

Kelbaek et al, Eurointervention 2015

EuroIntervention 2014;10

We found a significantly higher rate of uncovered and malapposed stent struts in DES implanted afterinterventional revascularisation of CTO lesions, suggesting these patients to be at higher risk for STcompared to the control group. Furthermore, the OCT analyses found uncovered and malapposedstent struts even beyond 12-month follow-up. While antegrade wiring as well as dissection and re-entrytechniques are leading to similar coverage and apposition, the healing of DES implanted into CTO lesionsseems to be independent of the applied revascularisation approach.We suggest regular use of OCT-based follow-up examinations in patients after successful PCI of CTOlesions to assess the duration of DAPT and improve the patient’s outcome.

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2

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Conclusions

BMS or DES? DES

1st or 2nd generation? 2nd generation

Does it matter which drugis on the stent? No evidence

CTO is the same lesion thannon-CTO for the long-term result? No

Careful implantation strategy and follow-up are necessary forthe good long term result

Ten years outcome of overlapping BMSs in RCA PCI

Ten years outcome of overlapping BMSs in RCA PCI

Ten years outcome of overlapping BMSs in RCA PCI

DES in CTO RevascularizationQuantifying the Relative Benefit of DES: ≥3 Year Follow-up

Saeed, Kandzari, Brilakis et al. CCI 2010

64% RR

62% RR

DES in CTO RevascularizationQuantifying the Relative Benefit of DES: ≥3 Year Follow-up

Saeed, Kandzari, Brilakis et al. CCI 2010

Questions on the use of DES for CTO PCI

• Is there DES use indispensible for CTO recanalization?

• Are there significant differences between te results of each specificDES design?

• Are there any patient- or procedure-related factors influecing thelong-term DES outcome?

• Does BVS better than new generation metallic DES?

1st or 2nd generation?

Patient population:742/7765 CTO PCI (2006-2011)

Single center retrospective analysis