Key result
Patients with coronary chronic total occlusions not revascularised by PCI had a significantly higher rate of cardiac death compared to those successfully revascularised (13% vs 6%; p<0.001).
Why the study?
The study was conducted to evaluate the long-term risk of cardiac death and sudden cardiac death and/or sustained ventricular arrhythmias in patients with coronary chronic total occlusions revascularised versus not revascularised by percutaneous coronary intervention.
Does successful PCI revascularisation reduce cardiac death and sudden cardiac death/sustained ventricular arrhythmias in patients with coronary chronic total occlusions?
Cohort (n=1,162)
Does successful PCI revascularisation reduce cardiac death and sudden cardiac death/sustained ventricular arrhythmias in patients with coronary chronic total occlusions?
Absolute Event Rate: 6% vs 13%
p-value: p=<0.001
Successful PCI of chronic total occlusions is associated with a >2-fold lower risk of cardiac death and a 3-fold lower risk of sudden cardiac death/sustained ventricular arrhythmias at long-term follow-up.
May support CTO PCI to lower cardiac death risk; leaves open causality without randomized trials.
OBJECTIVE: The aim of this study is to evaluate the long-term risk of cardiac death and sudden cardiac death (SCD) and/or sustained ventricular arrhythmias (SVAs) in patients with coronary chronic total occlusions (CTO) revascularised versus those with CTO not revascularised by percutaneous coronary intervention (PCI). METHODS: From a cohort of 1357 CTO-PCI patients, 1162 patients who underwent CTO PCI attempt were included in this long-term analysis: 837 patients were revascularised by PCI (CTO-R group) and 325 were not revascularised (CTO-NR group). Primary adverse endpoint was the incidence of cardiac death; secondary endpoint was the cumulative incidence of SCD/SVAs. RESULTS: Up to 12-year follow-up (median 6 year), compared with CTO-R patients, those with CTO-NR had significantly higher rate of cardiac death (13%[43/325]vs6%[48/837]; p<0.001) and SCD/SVAs (7.5%[24/325]vs2.5%[20/837]; p<0.001). The risk of cardiac death and SCD/SVAs was mainly driven by the subgroup of infarct-related artery (IRA) CTO patients and was significantly higher only in IRA CTO-NR patients (18%vs7%, p<0.001, 14%vs5%, p=0.001; IRA CTO-NR vs IRA CTO-R, respectively). At multivariable Cox hazards regression analysis, CTO-NR remains one of the strongest independent predictors of higher risk of cardiac death and of SCD/SVAs in the overall population and in IRA CTO patients. CONCLUSIONS: At long-term follow-up, patients with CTO not revascularised by PCI had worse outcomes compared with those with CTO revascularised, with >2-fold risk of cardiac death and threefold risk of SCD/SVAs. The presence of an infarct-related artery (IRA CTO) not revascularised identified the category of patients with the highest rate of adverse events .
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Godino et al. (2019) conducted a cohort in Coronary chronic total occlusions (CTO) (n=1,162). Revascularisation by percutaneous coronary intervention (PCI) vs. Not revascularised by PCI was evaluated on Incidence of cardiac death (p=<0.001). Patients with coronary chronic total occlusions not revascularised by PCI had a significantly higher rate of cardiac death compared to those successfully revascularised (13% vs 6%; p<0.001).
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