Effect of PCI on Clinical Prognosis of Chronic Coronary Artery Occlusion

Background Coronary chronic total occlusions (CTOs) are considered to increase the risk of adverse clinical outcomes. The purpose of this study was to evaluate whether long-term clinical outcomes could be improved by successful percutaneous coronary intervention (PCI) over optimal medical therapy (OMT) in CTO patients. Methods 258 consecutive patients with CTO lesions undergoing PCI at the First Affiliated Hospital of Nanjing Medical University from January 2011 to December 2017 were enrolled. After 25 were excluded due to CABG surgery, a total of 233 patients who met the enrollment criteria were divided into successful CTO-PCI group (n=187) and CTO-OMT group (n=46) based on the treatment received. The study primary endpoint was major adverse cardiac cerebrovascular events (MACCE), including cardiac death, recurrent myocardial infarction, unplanned revascularization, and stroke. The secondary endpoint was all-cause death. Results During a median follow-up of 78 months, PCI treatment significantly improved MACCE incidence survival probability compared with OMT (29.55% vs 21.95% p=0.028). There was no difference between these two groups in secondary endpoint (p=0.93). There was also no significant difference in MACCE between single vessel CTO lesions and single vessel CTO combined with multiple vessel lesions(p=0.54). The cumulative survival of LAD is the highest among different branch lesion groups(p=0.044). Elderly patients (≥65 years) in PCI group showed a significant decrease of MACCE incidence compared with OMT (35.00% vs 21.33% p=0.001). Conclusions Successful PCI in CTO patients is associated with a significant decrease of MACCE compared with OMT.