Abstract 20246: Temporal Trends in Percutaneous Coronary Intervention for Chronic Total Occlusions: a Report from the 1,781 Patient Multinational CTO Registry
Introduction: Many innovations in the field of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) have been introduced in recent years. We sought to identify if this translated to increased procedural success rates and reduced clinical event rates after CTO PCI.
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 success rates (residual stenosis <50%) and clinical event rates among patients treated between 1998-november 2002 and November 2002–2007.
Results: A total of 683 patients underwent PCI in the first half of the inclusion period and 1098 patients in the second half. Patients treated during the first half of the inclusion period were more likely to be men (88.9% vs. 84.9%, p=0.01), and to be smokers (89.3% vs 60.9%, p<0.01), and less likely to have diabetes mellitus (60.9% vs. 89.3%, p<0.01). Procedural success improved significantly over time and was 60.4% in the first half vs. 73.4% in the second half (p<0.01). Kaplan-Meier estimates of mortality (1st half 2.4% vs. 2nd half 2.7%, p=0.66), MI (1st half 4.7% vs. 2nd half 3.6%, p=0.29) and death or MI (1st half 6.4% vs. 2nd half 5.7%, p=0.56) were comparable at 2 years after successful CTO PCI (figure 1a). The 2-year rate of target vessel revascularization (TVR) declined significantly in the second half of the inclusion period (21.5% vs. 12.3%, p<0.01). Kaplan-Meier estimates of mortality (1st half 4.2% vs. 2nd half 7.0%, p=0.16), MI (1st half 3.5% vs. 2nd half 3.8%, p=0.98) and death or MI (1st half 7.3% vs. 2nd half 10.3%, p=0.26) were comparable at 2 years after nonsuccessful CTO PCI (figure 1n).
Conclusions: Volumes and success rates of patients undergoing CTO PCI increased significantly over time. Furthermore, the TVR rate after successful CTO PCI was significantly lower in the second half of the inclusion period when drug-eluting stents were introduced.
- © 2010 by American Heart Association, Inc.