Abstract 15797: Long-Term Clinical Outcome After PCI for Chronic Total Occlusion: Does Procedural Success Matter ?
Background: Whether successful PCI of a coronary CTO is associated with improved survival is the subject of debate.
Objectives: Using a large prospective database of patients treated for CTO, we sought to compare long-term outcome of patients on the basis of success/failure of the index PCI procedure.
Methods: Between 2004 and 2012, a total of 1,343 consecutive patients underwent PCI for CTO in our centre (14 operators). We compared major adverse cardiac events (MACE) including cardiac death, target vessel revascularisation (TVR), and myocardial infarction (MI) in patients with successful versus failed PCI at a median follow up of 4.1 years (IQR: 2.4-6.5 years). Procedural success was defined as achievement of residual stenosis <50% with TIMI-3 flow in the target vessel.
Results: Successful treatment of CTO by PCI was achieved in 1000 (74%) patients. These patients were younger (63±11 vs. 65±11 respectively p=0,02), had lower rates of hypertension (56.1% vs. 66.8% p<0,01), previous MI (19.5 % vs. 29.2% p<0,01) and were more frequently treated for left anterior descending artery CTO (33.2 vs. 23.0%, p<0.01) than those in whom PCI success was not achieved. However, left ventricular ejection fraction and diabetes mellitus were similar between groups. PCI success was associated with significantly lower MACE among patients with successful PCI (16.7 vs. 22.2%, p= 0.0235) driven mainly by lower rate of cardiac death at follow up (4.2 vs. 11%, p<0.0001). Independent predictors of lower cardiac death by multivariate analysis were: successful PCI (HR: 0,42, 95% CI: 0.27-0.67, p < 0.01), absence of previous MI (HR: 1.68, 95% CI: 1.03-2.74, p =0.04) and younger age (HR: 1.05, 95% CI: 1.03-1.08, p < 0.01).
Conclusions: In this large cohort of patients treated by PCI for CTO, successful revascularization was associated with improved clinical outcome at long-term follow-up. This was driven by lower cardiac mortality rates among these patients.
- © 2013 by American Heart Association, Inc.