Stenting of nonacute total coronary occlusions: predictors of late angiographic outcome

Center for Cardiology Othmarschen, University Hospital Eppendorf, Hamburg, Germany.

OBJECTIVES: This study was designed to determine and assess factors predictive of the intermediate-term outcome of stenting of nonacute total coronary occlusions. BACKGROUND: Balloon angioplasty of recanalized coronary occlusions is associated with a combined restenosis/reocclusion rate of up to 65%. Adjunctive stenting holds the potential to reduce this rate significantly. However, variables affecting the late angiographic outcome of coronary stenting in the setting of a total occlusion have not been elucidated sufficiently. METHODS: Coronary stenting was performed in 143 consecutive patients with a nonacute total occlusion; 120 of these patients (84%), with a total of 121 occlusions, underwent repeat angiography within 6 months and comprised the study group. High pressure stent implantation aimed to cover the site of the occlusion as well as adjacent diameter stenoses > or = 70% and all possibly induced dissections. Pertinent angiographic and procedural variables obtained at the time of the intervention were entered into a multivariate logistic regression analysis model to assess their influence on the angiographic outcome at follow-up. RESULTS: Mean preinterventional reference lumen diameter for the 121 vessels was 2.99 +/- 0.53 mm (mean +/- SD); occlusion length ranged from 4 to 44 mm (median of 7.7). After balloon angioplasty, dissections were found in 80% of patients. Lesions were covered with stents a median of 16 mm in length (range 8 to 53). The minimal lumen diameter (MLD) achieved after stenting was 2.89 +/- 0.48 mm. After a median follow-up period of 4.5 months, mean MLD was assessed at 1.91 +/- 0.90 mm, corresponding to a loss index of 0.34 +/- 0.31. There were 27 vessels with a nonocclusive restenosis > or = 50% and 8 with a reocclusion, for a combined restenosis/reocclusion rate of 29%. Factors found to adversely influence angiographic outcome were a post-stenting MLD < or = 2.54 mm, a stented vessel segment length > 16 mm, a balloon/vessel diameter ratio for final stent expansion < or = 1.00 and the presence of a dissection after balloon angioplasty. CONCLUSIONS: Compared with previous reports on stand-alone balloon angioplasty, stenting of nonacute total coronary occlusions lowers the 6-month restenosis/reocclusion rate to approximately 30%. The late procedural outcome is independently and statistically significantly influenced by the MLD after stenting, the length of the stented vessel segment, the balloon/vessel diameter ratio for final stent expansion and the incidence of dissections after balloon angioplasty.

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