Comparison of long-term outcomes of medical therapy and successful recanalisation for coronary chronic total occlusions in elderly patients: a report of 1,294 patients

Background: Little is known about the long-term outcomes of medical therapy (MT) versus successful percutaneous coronary intervention (PCI) in elderly patients with coronary chronic total occlusions (CTOs). Methods: There were 1,294 consecutive patients with 1,520 CTOs included (2007 to 2016) and were divided into the younger group (age <65 years; n=664, 51.3%) and the older group (age ≥65 years; n=630, 48.7%). In the older group, 630 patients were divided into MT group (n=421) and successful CTO-PCI group (n=209) according to the initial treatment strategy. In the younger group, they were divided into two groups: 379 patients in the MT group and 285 patients in the successful CTO-PCI group. We performed propensity score matching to minimize any selection bias. The primary end point was cardiac mortality. The secondary end point was major adverse cardiac event (MACE). Results: After 3.6 (IQR, 2.1–5.0) years follow-up, no significant difference was observed between the MT and successful CTO-PCI groups in terms of cardiac mortality (MT vs. successful CTO-PCI: 9.3% vs. 5.0%, P=0.378) and MACE (28.3% vs. 15.1%, P=0.070) in the older group. After propensity score matching analysis (120 pairs), the risk of cardiac mortality (6.7% vs. 8.3%, P=0.624) was found to be comparable between the two groups. In the younger group, the occurrence of cardiac death (MT vs. successful CTO-PCI: 3.7% vs. 1.4%, P=0.072) was similar, whereas the MACE rate (27.7% vs. 17.9%, P=0.003) was significantly higher in MT group. After multivariate analysis, previous myocardial infarction (MI) [hazard ratio (HR) 1.70, 95% confidence interval (CI): 1.16–2.49, P=0.006], CTO in right coronary artery (HR 1.55, 95% CI: 1.07–2.25, P=0.020), multivessel disease (HR 2.02, 95% CI: 1.10–3.72, P=0.024) and calcification (HR 1.61, 95% CI: 1.07–2.42, P=0.023) were independent predictors of MACE in elderly. Conclusions: In the treatment of elderly patients with CTOs, successful CTO-PCI compared with MT alone didn’t reduce the risk of cardiac death or MACE.