Abstract 19992: Impact of Successful Percutaneous Coronary Intervention of a Chronic Total Occlusion: Five-Year Outcomes from a 1,781 Patient Multinational Registry
Background: This study aims to identify the clinical impact of successful percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO).
Methods: Between 1998 and 2007, a total of 1,781 patients with 1,846 CTO underwent PCI at four centers in the US, UK, Italy and South Korea. We compared patients with a successful (residual stenosis <50%) to patients with an unsuccessful procedure. Endpoints were all cause death, myocardial infarction (MI), the need for coronary artery bypass surgery (CABG), and a composite endpoint of death or MI at five years.
Results: Procedural success was obtained in 1,222 (69%) patients. Stents were used in 1159 (95%) patients, including drug-eluting stents in 763 (66%) patients (72.5% sirolimus-eluting stents and 27.5% paclitaxel-eluting stents). In-hospital rates of death (0% vs 0.4%, p=0.09) and MI (2.5% vs. 2.1%, p=0.73) were similar in patients with successful and unsuccessful CTO PCI. Coronary dissection (4.3% vs. 9.4%, p<0.01) and perforation (1.7% vs 7.4%, p<0.01) were more frequent in patients with unsuccessful CTO PCI. Kaplan-Meier estimates of mortality (6.0% vs 8.3%, p=0.01) and the need for CABG (3.4% vs. 11.9%) were lower for patients with successful CTO PCI at 5 years. There were no significant differences between patients with successful and unsuccessful CTO PCI in rates of MI (5.4% vs. 4.5%, p=0.51), or the composite endpoint of death/MI (10.0% vs 11.0%, p=0.18, figure) at 5 years. After multivariate analysis, successful PCI is an independent predictor of freedom of CABG (Hazard ratio 0.21, 95% confidence interval 0.13–0.34, p<0.01), but not of the other endpoints (death, MI, and death/MI) at 5 year follow-up.
Conclusions: Successful CTO PCI was associated with lower mortality and a lower need for CABG at 5 year follow-up. After multivariate analysis, successful CTO PCI was an independent predictor of freedom of CABG but not of death, MI or the composite endpoint of death/MI at 5 years.
- © 2010 by American Heart Association, Inc.