Abstract 922: Impact on Survival of Complete Percutaneous Coronary Revascularization in Patients with Chronic Total Occlusion
Purpose Registries studies have shown improved long-term survival in patients treated with successful PCI (s-PCI) by balloon angioplasty or bare metal stenting for chronic total occlusion (CTO) as compared to patients with unsuccessful PCI (u-PCI). No data exist about the prognostic impact of PCI for CTO in the drug-eluting stent (DES) era.
Methods From 2003 to 2006, 486 patients underwent PCI for 527 CTO (> 3 months). The prognostic impact of s-PCI and a complete coronary revascularization on cardiac survival was assessed by Kaplan-Meier estimation and by multivariable forward stepwise Cox regression analysis.
Results S-PCI was achieved in 344 patients (71%) and 361 CTO (68%). Baseline characteristics in patients treated with s-PCI and u-PCI: mean age 68 ± 11 yrs vs 70 ± 11 yrs (p=.036), male 81% vs 83%, diabetes 24% vs 21%, previous myocardial infarction 45% vs 54% (p=.069), acute coronary syndrome at presentation 39% vs 32%, 3-vessel coronary disease 52% vs 54%, LVEF 42% ± 13% vs 41% ± 14%. No procedural death occurred. All patients with s-PCI received DES. Multivessel PCI was performed in 62% in the u-PCI group and in 71% in the s-PCI success group (p=.062). Complete coronary revascularization was achieved in 301 patients (62%). The clinical follow-up rate was 100% (median F-U rate = 2 yrs, IQ range 1.1–2.8). The cardiac survival rate was higher in the CTO-PCI success group compared to CTO-PCI failure group(91.6 ± 2.0 % vs 87.4 ± 2.9% p=.025) and in patients with complete revascularization as compared to patients with incomplete revascularization (94.0 ± 1.7 % vs 83.8 ± 3.6%, p<.001). At multivariate analysis the independent predictors of mortality were: the completeness of revascularization (HR 0.50, 95% CI 0.25–0.98, p=.043), age >75 yrs (HR 2.92, 95% CI 1.49–5.72, p<.002), and impaired LVEF <40% (HR 4.42, 95% CI 2.11–9.26, p<.001).
Conclusion Successful CTO-PCI confers a long-term survival benefit. The improvement in survival is driven by the differences in the outcome of patients with multivessel disease and who were completely revascularized.