摘要
Background:The development of the technique has improved the success rate of percutaneous coronary intervention(PCI)for instent chronic total occlusion(IS-CTO).However,long-term outcomes remain unclear.The present study sought to investigate long-term outcomes of PCI for IS-CTO.Methods:A total of 474 IS-CTO patients were enrolled at two cardiac centers from 2015 to 2018 retrospectively.These patients were allocated into either successful or failed IS-CTO PCI groups.The primary endpoint(major adverse cardiac events[MACE])consisted of recurrent angina pectoris(RAP),target-vessel myocardial infarction(MI),heart failure,cardiac death,or ischemia-driven target-vessel revascularization(TVR)at follow-up.Multivariable Cox regression analysis was used to investigate the association between treatment appropriateness and clinical outcomes.Results:A total of 367 patients were successfully treated with IS-CTO PCI while 107 patients had failed recanalization.After a median follow-up of 30 months(interquartile range:17-42 months),no significant difference was observed between the two groups for the following parameters:cardiac death(successful PCIvs.failed PCI:0.9%vs.2.7%;adjusted hazard ratio[HR]:1.442;95%confidence interval[CI]:0.21-9.887;P=0.709),RAP(successful PCIvs.failed PCI:40.8%vs.40.0%;adjusted HR:1.025;95%CI:0.683-1.538;P=0.905),heart failure(successful PCIvs.failed PCI:6.1%vs.2.7%;adjusted HR:0.281;95%CI:0.065-1.206;P=0.088),target-vessel related MI(successful PCIvs.failed PCI:1.5%vs.2.7%;adjusted HR:1.150;95%CI:0.221-5.995;P=0.868),MACE(successful PCIvs.failed PCI:44.2%vs.45.3%;adjusted HR:1.052;95%CI:0.717-1.543;P=0.797).More patients were free of angina in the successful IS-CTO PCI group compared with failed PCI in the first(80.4%vs.60%,P<0.01)and second years(73.3%vs.60.0%,P=0.02)following up.Successful IS-CTO PCI had a lower incidence of MACE in the first and second years(20.2%vs.40.0%,P<0.01;27.9%vs.41.3%,P=0.023)compared with failed PCI.After a median follow-up of 30 months,the reocclusion rate was 28.5%and TV
