Abstract 15859: Do Basal Symptoms Influence the Clinical Outcome in Long-Term Follow-Up of Chronic Total Coronary Occlusions?
Introduction: Chronic total occlusions (CTO) are complex procedures aiming to improve the symptoms and outcomes of patients. Although a significantly positive ischemia test is accepted by guidelines as enough to trigger a CTO attempt, there is controversy whether silent ischemia patients can benefit as much as symptomatic patients from this procedure.
Methods: a total of 1343 patients underwent percutaneous coronary intervention (PCI) at our center between 2004 and 2012. We compared baseline and procedural characteristics as well as mid-term outcome in patients with silent or symptomatic ischemia.
Results: indications for CTO-PCI were mainly: angina in 52.8% of cases, acute coronary syndromes in 13.2%, dyspnea in 3,6%, and silent ischemia in 29.6%. Clinical follow-up was obtained in 92.5% of cases at a mean of 50.2±28.9 months. Patients with silent ischemia were older (64.0±11.8 vs 62.7±10.2 years, p=0.037) and more frequently diabetics (33.2 vs 24.9%, p=0,001). Procedural success rate was similar (72.7 vs 69.3%, p=NS, respectively) as well as all-causes mortality at follow up (12.6 vs 10.8%, p=ns) and cardiac death (7.8 vs 6.6%, p=ns). However, patient oriented major adverse cardiovascular and cerebrovascular events (MACCE) were lower (figure) in asymptomatic patients (14.9 vs 20.1%, p=0,021), mainly due to a lower rate of TVR (10.6 vs 16.0%, p=0,016) at follow-up.
In asymptomatic patients MACCE rate at follow-up was lower in case of procedural success (3.2 vs 18.9%, p=0,10), mainly due to a lower rate of coronary artery bypass graft (1.4 vs 7.9%, p=0.009). Once again, there were no differences in mortality between both groups.
Conclusion: Our study shows that CTO PCI in patients with silent ischemia is associated with better outcomes than in symptomatic patients, and that procedural success is also a predictor of improved outcome in this subgroup of patients. This suggests that patients with asymptomatic ischemia would benefit from more accurate identification.
- © 2013 by American Heart Association, Inc.