October 1, 2021Clinical Interventions in AgingOpen Access

Predictors of Adverse Events Among Chronic Total Occlusion Patients Undergoing Successful Percutaneous Coronary Intervention and Medical Therapy

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Why the study?

Limited data are available on the predictors of MACE after successful coronary CTO PCI and medical therapy.

What are the predictors of major adverse cardiac events in patients with chronic total occlusions undergoing successful percutaneous coronary intervention or medical therapy?

Structured PICO

What are the predictors of major adverse cardiac events in patients with chronic total occlusions undergoing successful percutaneous coronary intervention or medical therapy?

Population

2,015 patients with coronary chronic total occlusions (CTOs)

Outcome

Major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and target-vessel revascularizationcomposite

Heart failure is a significant independent predictor of major adverse cardiac events in patients with chronic total occlusions, regardless of whether they are treated with successful recanalization or medical therapy.

Implication

Heart failure predicts MACE after successful CTO recanalization; hypothesis-generating for risk stratification in observational CTO cohorts.

Abstract

Objective: Limited data are available on the predictors of major adverse cardiac events (MACE) after a successful coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and medical therapy. This study aimed to identify predictors of MACE in CTO patients undergoing successful recanalization and medical therapy. Methods: A total of 2015 patients with CTOs were enrolled. About 718 patients underwent successful CTO recanalization, and 1297 patients received medical therapy. The primary outcome was the frequency of MACE, defined as a composite of cardiac death, myocardial infarction, and target-vessel revascularization. Multivariate models were used to determine predictors of MACE. Results: In successful CTO recanalization group, MACE occurred in 123 (17.1%) patients. In multivariate analysis, heart failure (hazard ratio [HR] 1.77, 95% confidence interval [CI]: 1.04– 3.04, p = 0.036) was identified as independent predictors for MACE in successful CTO recanalization. Additionally, in medical therapy group, the significant predictors of MACE were male gender (HR 1.53, 95% CI: 1.13– 2.05, p = 0.005), diabetes mellitus (HR 1.39, 95% CI: 1.11– 1.74, p = 0.003), heart failure (HR 1.44, 95% CI: 1.10– 1.87, p = 0.007), J-CTO score (HR 1.17, 95% CI: 1.07– 1.28, p = 0.001) and multivessel disease (HR 2.20, 95% CI: 1.42– 3.39, p < 0.001). Conclusion: Heart failure was predictor for composite cardiovascular events in patients with CTO after successful recanalization. Male gender, diabetes mellitus, heart failure, J-CTO score and multivessel disease were predictors of MACE in CTO patients with medical therapy.