Percutaneous Coronary Intervention for Chronic Total Occlusion in Single Coronary Arteries.

Abstract

We retrospectively compared the results of percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) for chronic total occlusion (CTO) in single coronary arteries to determine whether outcomes depend on the artery involved. From January 2004 through November 2015, a total of 731 patients were treated at our center for CTO in the left anterior descending coronary artery (LAD) (234 patients, 32%), left circumflex coronary artery (LCx) (184, 25.2%), or right coronary artery (RCA) (313, 42.8%). We further classified patients by treatment (PCI or OMT) and compared the cumulative incidence of major adverse cardiac events (MACE) and the composite of total death or myocardial infarction, as well as change in left ventricular ejection fraction from baseline. The 5-year cumulative incidence of MACE was similar between the treatment groups regardless of target vessel. The 5-year cumulative incidence of the composite of total death or myocardial infarction was significantly lower after PCI than after OMT or failed PCI in the LCx (2.6% vs 11.5%; P=0.020; log-rank) and RCA (5.8% vs 17.2%; P=0.002) groups, but not in the LAD group. Cox proportional hazards regression analysis indicated that PCI independently predicted a lower incidence of the composite of total death or myocardial infarction in the LCx group (hazard ratio [HR]=0.184; 95% CI, 0.0035-0.972; P=0.046) and the RCA group (HR=0.316; 95% CI, 0.119-0.839; P=0.021). The artery involved does not appear to affect clinical outcomes of successful PCI for single-vessel CTO. Further investigation in a randomized clinical trial is warranted.

• Authors: Jah Yeon Choi, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Won Young Jang, Woohyeun Kim, Jin Oh Na, Cheol Ung Choi, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo
• Journal: Texas Heart Institute journal (Tex Heart Inst J) Vol. 48 Issue 2 (06 10 2021) ISSN: 1526-6702 [Electronic] United States
• PMID: 34111277 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2021 by the Texas Heart® Institute, Houston.

Topics

• Chronic Disease
• Coronary Angiography
• Coronary Occlusion (diagnostic imaging, surgery)
• Coronary Vessels (diagnostic imaging, surgery)
• Follow-Up Studies
• Humans
• Percutaneous Coronary Intervention (adverse effects)
• Retrospective Studies
• Risk Factors
• Stroke Volume
• Treatment Outcome
• Ventricular Function, Left