Chronic Total Occlusions of Coronary Arteries-Medical versus Surgical Treatment

Coronary artery bypass grafting (CABG) is an established treatment of patients with angina pectoris and chronic total coronary occlusion of major coronary arteries. However, in patients with mild or absent angina and chronic total coronary occlusion, optimal treatment is unsettled. We compared the prognosis of patients with chronic total coronary occlusion treated medically because of mild or absent angina with a matched group of patients undergoing CABG. In a retrospective design we evaluated all coronary angiographies performed in our department over a 5-year period. We identified 77 patients with chronic total occlusion of major coronary arteries eligible for CABG but treated medically because of mild or absent angina. The medically treated patients were matched on age, sex and ejection fraction with 77 patients with occluded major coronary arteries and angina pectoris who were treated surgically. The main outcome measures were death, acute myocardial infarction (AMI) and CABG. At baseline, CABG patients demonstrated an increased duration and severity of angina pectoris and an increased consumption of anti-anginal drugs. No differences were found with regard to angiographic parameters. The 5-year event rates (medically treated versus CABG) were: death, 14% vs 7% (p = 0.08); death or AMI; 27% vs 16% (p = 0.10); death, AMI or CABG, 34% vs 16% (p = 0.03) (log-rank statistics). In conclusion, our data indicate that patients with chronic total coronary occlusions and mild or absent anginal symptoms may benefit from surgical treatment.