Long-term incidence and predictors of in-stent restenosis after chronic total occlusion percutaneous coronary intervention: a cohort study.
- 1Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4 (PL 340), Helsinki, 00029, Finland.
- 2Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4 (PL 340), Helsinki, 00029, Finland.
Abstract
Background
In-stent restenosis (ISR) remains a major limitation after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). However, long-term patency data after chronic total occlusion (CTO) PCI are limited despite high ISR risk. We evaluated long-term ISR incidence and predictors after CTO PCI.Methods
This prospective single-centre study (NCT07473596) included patients with successful CTO PCI and DES implantation in 2014-2021. Selected survivors underwent protocol-driven surveillance with coronary computed tomography angiography ≥3 years after the index procedure, with suspected ISR confirmed by invasive coronary angiography (ICA). ISR was also identified through clinically indicated ICA during follow-up in all patients. Patient-, lesion-, and procedure-related ISR predictors were analysed.Results
The study included 294 patients (median age 66 years (IQR 57-74), 79.9% male) and 294 analysed CTO stents. Median clinical and imaging follow-up were 7.1 (IQR 5.1-8.9) and 4.4 (IQR 3.2-6.2) years, respectively. Follow-up imaging covered 186 patients and 186 analysed CTO stents (63.3%). ISR was diagnosed in 40 stents (13.6%). Aalen-Johansen cumulative ISR incidence was 4.8% (95% CI 2.9-7.9), 10.2% (95% CI 7.1-14.5), and 12.9% (95% CI 9.3-18.0) at 3, 5, and 8 years, respectively. Atrial fibrillation (HR 3.71, 95% CI 1.74-7.91, p < 0.001) and in-stent CTO (HR 3.51, 95% CI 1.53-8.04, p = 0.003) were independently associated with ISR.Conclusions
Long-term ISR after CTO PCI was infrequent in this high-risk cohort, although estimates should be interpreted in the context of selected imaging follow-up among survivors. ISR was independently associated with atrial fibrillation and in-stent CTO at the index procedure.
Related
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- The baseline predictive value of the RNA-binding proteins IGF2BP3/IMP3 and UPF1 for in-stent restenosis after percutaneous coronary intervention in acute coronary syndrome: a retrospective cohort study
- Spontaneous Coronary Recanalization After Iatrogenic Type F Dissection: A Chronic Total Occlusion-Like Lesion Requiring Advanced Percutaneous Intervention.
- The impact of the SYNTAX score on the incidence of in-hospital cardiac arrest in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a retrospective cohort study
- Acute Kidney Injury After Percutaneous Left Atrial Appendage Occlusion: Incidence, Risk Factors, Clinical Impact, and Contrast-Sparing Strategies—A Systematic Review
BibTeX
@article{mansikkaniemi2026longterm,
title = {{Long-term incidence and predictors of in-stent restenosis after chronic total occlusion percutaneous coronary intervention: a cohort study.}},
author = {Lauri Mansikkaniemi and Juhani A Stewart and Juha Sinisalo and Miia Holmström and Petri Laine},
journal = {International journal of cardiology. Heart \& vasculature},
year = {2026},
month = oct,
doi = {10.1016/j.ijcha.2026.102028},
url = {https://europepmc.org/article/MED/42926761},
note = {CC BY},
}
RIS
TY - JOUR
TI - Long-term incidence and predictors of in-stent restenosis after chronic total occlusion percutaneous coronary intervention: a cohort study.
AU - Lauri Mansikkaniemi
AU - Juhani A Stewart
AU - Juha Sinisalo
AU - Miia Holmström
AU - Petri Laine
PY - 2026
DA - 2026/10/14
JO - International journal of cardiology. Heart & vasculature
DO - 10.1016/j.ijcha.2026.102028
UR - https://europepmc.org/article/MED/42926761
AB - Background In-stent restenosis (ISR) remains a major limitation after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). However, long-term patency data after chronic total occlusion (CTO) PCI are limited despite high ISR risk. We evaluated long-term ISR incidence and predictors after CTO PCI.Methods This prospective single-centre study (NCT07473596) included patients with successful CTO PCI and DES implantation in 2014-2021. Selected survivors underwent protocol-driven surveillance with coronary computed tomography angiography ≥3 years after the index procedure, with suspected ISR confirmed by invasive coronary angiography (ICA). ISR was also identified through clinically indicated ICA during follow-up in all patients. Patient-, lesion-, and procedure-related ISR predictors were analysed.Results The study included 294 patients (median age 66 years (IQR 57-74), 79.9% male) and 294 analysed CTO stents. Median clinical and imaging follow-up were 7.1 (IQR 5.1-8.9) and 4.4 (IQR 3.2-6.2) years, respectively. Follow-up imaging covered 186 patients and 186 analysed CTO stents (63.3%). ISR was diagnosed in 40 stents (13.6%). Aalen-Johansen cumulative ISR incidence was 4.8% (95% CI 2.9-7.9), 10.2% (95% CI 7.1-14.5), and 12.9% (95% CI 9.3-18.0) at 3, 5, and 8 years, respectively. Atrial fibrillation (HR 3.71, 95% CI 1.74-7.91, p < 0.001) and in-stent CTO (HR 3.51, 95% CI 1.53-8.04, p = 0.003) were independently associated with ISR.Conclusions Long-term ISR after CTO PCI was infrequent in this high-risk cohort, although estimates should be interpreted in the context of selected imaging follow-up among survivors. ISR was independently associated with atrial fibrillation and in-stent CTO at the index procedure.
SN - 2352-9067
ER -