Abstract 8886: Five-Year Clinical Outcomes of Patients with Sirolimus-Eluting Stent Implantation for Chronic Total Occlusion: Insihgt from the j-Cypher Registry

Abstract

Introduction Little is known about long-term efficacy and safety of sirolimus-eluting stent (SES) implantation for chronic total occlusion (CTO), compared with for non-CTO. Hypothesis Successful recanalization of CTO with SES confers equally favorable clinical outcome as that of non-CTO. Methods The design of the j-Cypher registry was multicenter prospective enrollment of consecutive patients who underwent SES implantation from 41 centers in Japan. From 5 year follow-up information of the j-Cypher registry, we divided 10759 patients treated exclusively and successfully with SES into 2 groups (CTO group: 1210 patients underwent revascularization for CTO, non-CTO group: 9549 patients for non-CTO only). A CTO was defined as complete obstruction with estimated duration ≥1 month. Baseline characteristics and cumulative incidences of major adverse cardiovascular events were compared between the 2 groups. Furthermore the 2 groups were stratified according to their ejection fraction (EF<40% or ≥40%) and studied on their 5 year overall mortality. Results The median follow-up duration was 1,640 days. The CTO group was younger (67±11 years vs. 69±10 years, p<0.001), had less diabetes mellitus (44% vs. 48%, p=0.023), and had more multivessel disease (61% vs. 49%, p<0.001). The crude event rates through 5 years such as total death (13% vs. 14%, p=0.562), myocardial infarction (4.2% vs. 3.6%, p=0.349), and definite stent thrombosis (1.9% vs.1.6%, p=0.758) did not differ significantly among the 2 groups, though target lesion revascularization was significantly higher in CTO group (21% vs. 15%, p<0.001). In stratified analysis by EF<40%, CTO group showed better overall survival rate (Figure A), despite no significant difference between the 2 groups with EF≥40% (Figure B). Conclusions SES implantation for CTO seems equivalently effective and safe to that for non-CTO. Stratified by EF<40%, SES implantation for CTO could bring better long-term survival.