Original title: Predictors of Reocclusion After Successful Drug-Eluting Stent–Supported Percutaneous Coronary Intervention of Chronic Total Occlusion. The Florence CTO PCI Registry. Reference: Renato Valenti et al. J Am Coll Cardiol 2013; article in press.

Previous registry data have shown a reduction in mortality rates in patients with successful recanalization of a Chronic Total Occlusion (CTO) compared to patients with failed CTO recanalization or to those not intervened. 

Intuitively, this survival benefit is associated to sustained vessel patency. The goal of this study was to assess reocclusion incidence and identification of predictors of reocclusion after successful DES supported chronic coronary recanalization.

Procedure was indicated when viable myocardium in the occluded vessel territory was objected, when no angiographic characteristic was considered as a contraindication for recanalization. The primary objective was reocclusion of vessel with angiographic follow up. Between 2003 and 2011 at least one CTO in 1035 consecutive patients was attempted. From this total, 802 patients (77%) of procedures were successful. Angiographic follow up was performed to 82% of the eligible population, the rest were free of angina. 

The primary end point (reocclusion rate) was 7.5% in general with a significant difference between 1st generation DES (Cypher and Taxus) vs. Xience V (10.1% vs. 3% respectively; p=0.001). At one year, mortality was 3.2%, infarction 0.9% and revascularization 12.8% for the general population. Major cardiovascular events were significantly less with Xience V vs. 1st generation DES (11.6% vs. 19% respectively; p=0.005) mainly due to a lower revascularization.

Conclusion 

Recanalization of a CTO is associated to a low incidence of reocclusion of the treated vessel.

Editorial Comment:

There are limitations, as in any other registry, the absence of randomization and the fact that the experience involves only one site; on the other hand, this is the largest evaluation of DES supported CTO with angiographic follow up. Initial success was 77% more than acceptable taking into account that no angiographic characteristic was a contraindication and that once success was achieved a revascularization rate of 10.5% with everolimus DES is better yet. This work does not encourage further attempts to gain experience in recanalization.

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