Abstract 16658: Long-term Clinical Outcome following Successful Percutaneous Revascularization in Chronic Total Occlusions in the context of Multivessel Disease: The Milan Experience
Background: It is not yet clearly defined if successful percutaneous revascularization of chronic total occlusions (CTOs) in multivessel disease leads to long term survival improvement. Aim of the study is to evaluate the impact on survival that successful CTO treatment will have in multivessel disease patients.
Methods and Results: From January of 1998 till December 2008, we included 1445 consecutive patients with at least one CTO and multivessel disease and compared the survival rates between successful and unsuccessful or not CTO treated by PCI. Successful CTO revascularization was performed in 804 patients (CTO-revascularization-group,CTO-R group).Unsuccessful revascularization occurred in 307 patients and in 334 subjects PCI was not attempted (641 total CTO non-revascularization-group, CTO-NR group). CTO-NR patients that underwent Coronary Artery Bypass Graft surgery during follow-up were excluded from the analysis on survival. The mean clinical follow up days of CTO-R group and CTO-NR group were 1161±805 versus 1270±896, respectively (p=ns). Cardiac survival rate was significantly higher in the CTO-R group compared with the CTO-NR group (94.7% versus 89.5% respectively, p<0.01). Furthermore, according to the Kaplan-Meier analysis we found that revascularization of CTO in patients with low ejection fraction (EF) and LAD-CTO lesions obtain more benefit in term of survival freedom from death. Finally, a better outcomes in survival rates was found in the Drug Eluting Stent era (2002–2008) versus the Bare Metal Stent era (1998–2001), with higher attempt and success rates in CTO's during the last years.
Conclusions: CTO-R in multivessel disease showed better clinical outcomes compared to patients with CTO-NR. The greatest benefit in terms of survival was noticed in patients with low EF and also in that with revascularization of LAD-CTO lesion.
- © 2010 by American Heart Association, Inc.