Key result
Complete revascularization with CTO-PCI significantly reduced the 10-year risk of death, MI, stroke, or repeat revascularization compared to deferred CTO-PCI (HR 0.57; 95% CI 0.46-0.72; P<0.001).
Why the study?
The impact of complete revascularization achieved through recanalization of coronary chronic total occlusions on long-term clinical outcomes remains uncertain.
Does complete revascularization through CTO-PCI reduce the 10-year risk of death, myocardial infarction, stroke, or repeat revascularization in patients with coronary chronic total occlusion?
Cohort (n=2,746)
No
Does complete revascularization through CTO-PCI reduce the 10-year risk of death, myocardial infarction, stroke, or repeat revascularization in patients with coronary chronic total occlusion?
Hazard Ratio: 0.57 (95% CI 0.46–0.72)
p-value: p=< 0.001
Complete revascularization via CTO-PCI significantly reduces the 10-year incidence of major adverse cardiac events compared to deferred CTO-PCI in patients with chronic total occlusions.
May support complete CTO revascularization; hypothesis-generating and requires RCTs before practice change.
The impact of complete revascularization (CR), achieved through the recanalization of coronary chronic total occlusions (CTOs), on long-term patient outcomes remains uncertain. To evaluate this in patients who achieved CR after CTO-PCI with those who did not due to deferred CTO-PCI, the Asan Medical Center Registry was reviewed to identify coronary artery disease (CAD) patients with CTOs treated between January 2003 and December 2018. Patients were included with single-vessel disease with CTO and with multivessel disease who had undergone revascularization for non-CTO lesions. These subjects were divided into those who achieved CR with CTO-PCI and those who did not due to deferred CTO-PCI. Their outcomes were compared following 1:1 propensity score matching. Of the 2746 enrolled CAD patients with CTOs, 1837 achieved CR with CTO-PCI and 909 did not. Propensity score matching yielded 653 patient pairs. The CR-achieving group had a significantly lower 10-year risk of the primary composite outcome of death, myocardial infarction, stroke, or repeat revascularization (hazard ratio [HR]: 0.57; 95 % confidence interval [CI]: 0.46-0.72; P < 0.001), as well as significantly lower risks of death (HR: 0.66; 95 % CI: 0.51-0.87; P = 0.003) and repeat revascularization (HR: 0.67; 95 % CI: 0.48-0.95; P = 0.023). CR was beneficial in all subgroups, including patients with major cardiovascular risk factors such as older age, hypertension, diabetes, and advanced CAD. Compared with incomplete revascularization, CR may significantly reduce the 10-year incidence of major adverse cardiac events in patients with CTO.
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Kim et al. (2024) conducted a cohort in Coronary artery disease with chronic total occlusions (n=2,746). Complete revascularization with CTO-PCI vs. Deferred CTO-PCI (incomplete revascularization) was evaluated on Composite outcome of death, myocardial infarction, stroke, or repeat revascularization (HR 0.57, 95% CI 0.46-0.72, p=< 0.001). Complete revascularization with CTO-PCI significantly reduced the 10-year risk of death, MI, stroke, or repeat revascularization compared to deferred CTO-PCI (HR 0.57; 95% CI 0.46-0.72; P<0.001).
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