Scoring System for Identification of “Survival Advantage” after Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion
Key result
Successful CTO-PCI linked to improved 1-year survival vs failed PCI, with an ~11% high-risk mortality difference.
- P=0.016
- n=2,625
Why the study?
PCI is widely used in patients with CTO, but its benefit in improving long-term outcomes remains controversial.
Does successful CTO-PCI improve one-year mortality compared to failed CTO-PCI in patients with chronic total occlusion?
Population
2625 patients who underwent CTO-PCI at 65 Japanese centers
Comparison
Successful CTO-PCI vs failed CTO-PCI
Design
Multicenter cohort study
Follow-up
12 months
Authors
Discussion
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Overview
Successful CTO-PCI was associated with better 1-year survival; leaves open whether the novel score identifies patients likely to benefit in randomized trials.
Study Design
Type
Observational (n=2,625)
Multicenter
Yes
Structured PICO
Does successful CTO-PCI improve one-year mortality compared to failed CTO-PCI in patients with chronic total occlusion?
P
Population
2,625 patients who underwent percutaneous coronary intervention for chronic total occlusion at 65 Japanese centers, followed for 1 year.
E
Exposure
Successful CTO-PCI (crossing of completely occluded lesion with guidewire and balloon, successful dilation, TIMI 3 flow, <50% residual stenosis, no in-hospital MACCEs)
C
Comparator
Failed CTO-PCI
O
Outcome
All-cause mortality at 1 yearhard clinical
Main Result
p-value: p=0.016
A novel scoring system (HABARA score) incorporating diabetes, angina severity, multivessel disease, and prior MI can predict the survival advantage of successful versus failed CTO-PCI, aiding in preprocedural decision-making.
Limitations
- Nonrandomized, observational registry design prone to bias
- No information on outcomes of patients with CTO managed without PCI
- Data regarding medical therapies and laboratory measurements were not obtained
- No centralized event adjudication or core laboratory assessment
- High loss to follow-up preventing holdout validation
- Nonrandomized observational registry prone to bias
- No information on outcomes of CTO patients managed without PCI
- Primary endpoint limited to all-cause death, missing other benefits like symptom relief
- Lack of data on medical therapies and laboratory measurements
Cite This Study
Nakachi et al. (2020) conducted an observational in Chronic total occlusion (CTO) (n=2,625). Successful percutaneous coronary intervention vs. Failed percutaneous coronary intervention was evaluated on One-year all-cause mortality (p=0.016). Successful percutaneous coronary intervention for chronic total occlusion improved 1-year survival compared to failed procedures (P=0.016), with a novel scoring system identifying a distinct 11.3% mortality difference in high-risk patients.