Long-term clinical outcomes of optimal medical therapy vs. successful percutaneous coronary intervention for patients with coronary chronic total occlusions.

Abstract

OBJECTIVES:

There are little data on the long-term clinical outcomes of optimal medical therapy (OMT) compared with successful percutaneous coronary intervention (PCI) in patients with chronic total occlusions (CTOs).

METHODS:

A total of 388 patients with ≥1 CTO were enrolled from January 2008 to December 2010. 62 patients were excluded, and 326 patients were divided into an OMT group (n = 125) and PCI group (n = 201) according to the initial treatment strategy. Propensity-score matching was also done to adjust for baseline characteristics. The primary outcome was major adverse cardiac event (MACE), included cardiac death, recurrent myocardial infarction, and repeated revascularization.

RESULTS:

After a mean follow-up of 47.2 ± 20.0 months, there was no significant difference between the two groups with respect to the prevalence of MACE (successful PCI vs. OMT: 29.6% vs. 21.9%, unadjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 0.95-2.28, p=0.085). After multivariate analyses, there were significant differences in the prevalence of MACE (adjusted HR 1.76, 95% CI 1.09-2.28, p=0.02) and repeated revascularization (2.14; 1.18-3.90, 0.01). In the propensity score-matched population (80 pairs), there were no significant differences in the prevalence of MACE (adjusted HR 1.89, 95% CI 0.96-3.71, p=0.06) and cardiac death (1.30, 0.44-3.80, 0.63) between groups.

CONCLUSION:

In the treatment of patients with CTOs, successful PCI did not reduce the long-term risk of MACE compared with OMT.

• Authors: Lei Guo, Lei Zhong, Kun Chen, Jian Wu, Rong-Chong Huang
• Journal: Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese (Hellenic J Cardiol) 2018 Sep - Oct Vol. 59 Issue 5 Pg. 281-287 ISSN: 2241-5955 [Electronic] Netherlands
• PMID: 29605686 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2018 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Topics

• Aged
• Chronic Disease
• Coronary Angiography (methods)
• Coronary Occlusion (diagnostic imaging, surgery, therapy)
• Death
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (complications, epidemiology)
• Myocardial Revascularization (statistics & numerical data)
• Percutaneous Coronary Intervention (adverse effects, methods)
• Prevalence
• Recurrence
• Treatment Outcome