In patients with chronic total occlusions, PCI was associated with a lower 1-year rate of MACCE (2.6%) compared to medical therapy (8.2%, P<0.001) and CABG (6.9%, P<0.01).
Observational (n=1,777)
Yes
Does PCI improve survival and decrease MACCE compared to medical therapy or CABG in patients with coronary chronic total occlusions?
In a real-world registry, PCI for chronic total occlusions was associated with significantly lower 1-year rates of MACCE and cardiac death compared to medical therapy or CABG.
Absolute Event Rate: 2.6% vs 8.2%
p-value: p=<0.001
BACKGROUND: Through contemporary literature, the optimal strategy to manage coronary chronic total occlusions (CTOs) remains under debate. OBJECTIVES: The aim of the Italian Registry of Chronic Total Occlusions (IRCTO) was to provide data on prevalence, characteristics, and outcome of CTO patients according to the management strategy. METHODS: The IRCTO is a prospective real world multicentre registry enrolling patients showing at least one CTO. Clinical and angiographic data were collected independently from the therapeutic strategy optimal medical therapy (MT), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG); a comparative 1-year clinical follow-up was performed. RESULTS: A total of 1777 patients were enrolled for an overall CTO prevalence of 13.3%. The adopted therapeutic strategies were as follows: MT in 826 patients (46.5%), PCI in 776 patients (43.7%), and CABG in the remaining 175 patients (9.8%). At 1-year follow-up, patients undergoing PCI showed lower rate of major adverse cardiac and cerebrovascular events (MACCE) (2.6% vs. 8.2% and vs. 6.9%; P < 0.001 and P < 0.01) and cardiac death (1.4% vs. 4.7% and vs. 6.3%; P < 0.001 and P < 0.001) in comparison with those treated with MT and CABG, respectively. After propensity score-matching analysis, patients treated with PCI showed lower incidence of cardiac death (1.5 vs. 4.4%; P < 0.001), acute myocardial infarction (1.1 vs. 2.9%; P = 0.03), and re-hospitalization (2.3 vs. 4.4% P = 0.04) in comparison with those managed by MT. CONCLUSIONS: Our data showed how CTO PCI might significantly improve the survival and decrease MACCE occurrence at 1 year follow-up in comparison with MT and/or CABG.
Tomasello et al. (Wed,) conducted a observational in coronary chronic total occlusions (CTOs) (n=1,777). percutaneous coronary intervention (PCI) vs. optimal medical therapy (MT) or coronary artery bypass grafting (CABG) was evaluated on major adverse cardiac and cerebrovascular events (MACCE) (p=<0.001). In patients with chronic total occlusions, PCI was associated with a lower 1-year rate of MACCE (2.6%) compared to medical therapy (8.2%, P<0.001) and CABG (6.9%, P<0.01).