Impact of Successful Chronic Total Occlusion Percutaneous Coronary Interventions on Subsequent Clinical Outcomes.

Abstract

BACKGROUND:

The impact of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on angina and subsequent incidence of major adverse cardiovascular event (MACE) rate remains controversial.

METHODS:

We compared patient- reported angina change and the incidence of MACE (defined as death, myocardial infarction [MI], target-vessel revascularization) between successful vs failed CTO-PCI in 1612 patients participating in a large, multicenter registry.

RESULTS:

CTO-PCI was successful in 1387 patients (86%). Compared with failed CTO-PCI, successful CTO-PCI patients were less likely to have history of heart failure (33% vs 41%; P=.02), prior MI (49% vs 62%; P<.01), or prior coronary revascularization (63% vs 71% [P=.03] for PCI and 30% vs 40% [P<.01] for coronary artery bypass graft surgery). Patients in the successful CTO-PCI group had lower J-CTO scores (2.4 ± 1.3 vs 3.1 ± 1.1; P<.01) and lower PROGRESS-CTO Complications scores (1.1 ± 1.0 vs 1.6 ± 1.0; P<.01). After a mean follow-up of 181 ± 153 days, patients with successful PCI were more likely to have angina improvement (83% vs 38%; P<.01) and had lower incidence of 1-year MACE (8% vs 15%; P<.01), death (3% vs 7%; P<.01), and MI (2% vs 4%; P=.02). On multivariable analysis, however, CTO-PCI success was not independently associated with MACE.

CONCLUSION:

Compared with failed CTO-PCI, successful CTO-PCI is associated with better angina improvement and lower incidence of MACE (on univariable analysis) during follow-up.

• Authors: Iosif Xenogiannis, Ilias Nikolakopoulos, Oleg Krestyaninov, Dmitrii Khelimskii, Jaikirshan J Khatri, Anthony H Doing, Phil Dattilo, Khaldoon Alaswad, Catalin Toma, Abdul M Sheikh, Farouc A Jaffer, Brian K Jefferson, Taral Patel, Raj H Chandwaney, Wissam Jaber, Habib Samady, Mitul Patel, Ehtisham Mahmud, James Choi, Michalis Koutouzis, Ioannis Tsiafoutis, Michael Megaly, Mohamed Omer, Evangelia Vemmou, Bavana V Rangan, Santiago Garcia, Shuaib Abdullah, Subhash Banerjee, Nicholas Burke, Emmanouil S Brilakis, Dimitri Karmpaliotis
• Journal: The Journal of invasive cardiology (J Invasive Cardiol) Vol. 32 Issue 11 Pg. 433-439 (Nov 2020) ISSN: 1557-2501 [Electronic] United States
• PMID: 32568095 (Publication Type: Journal Article, Multicenter Study)

Topics

• Chronic Disease
• Coronary Occlusion (diagnosis, surgery)
• Humans
• Myocardial Infarction
• Percutaneous Coronary Intervention (adverse effects)
• Registries
• Risk Factors
• Treatment Outcome