Key result
Successful CTO PCI is linked to ~73% lower cardiac death risk versus no revascularization.
Why the study?
The optimal treatment strategy for coronary chronic total occlusions (CTOs) has not been well established.
Does successful percutaneous coronary intervention reduce cardiac death and MACCE in patients with coronary chronic total occlusions compared to no revascularization?
Cohort (n=563)
No
Does successful percutaneous coronary intervention reduce cardiac death and MACCE in patients with coronary chronic total occlusions compared to no revascularization?
Successful percutaneous coronary intervention for chronic total occlusions is associated with a significantly lower risk of cardiac death and MACCE compared to no revascularization in a real-world cohort.
Answers are grounded in this paper and cite their sources.
CTO PCI may be associated with better outcomes in real-world patients; leaves open need for randomized confirmation before practice change.
Background: Coronary chronic total occlusions (CTOs) are correlated with increased risk of adverse clinical outcomes. The optimal treatment strategy for CTO has not been well established. We sought to examine the impact of CTO percutaneous coronary intervention (PCI) on long-term clinical outcome in the real world.Methods: A total of 592 consecutive patients with CTO in Beijing Friendship Hospital from June 2017 to December 2019 were enrolled, 29 patients were excluded due to Coronary artery bypass grafting (CABG). After exclusion, 563 patients were divided into the no-revascularized group (CTO-NR group, n=263) and successful revascularized group (CTO-R group, n=300). The primary endpoint was cardiac death; Secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, cardiac death, recurrent myocardial infarction, target lesion revascularization, re-hospitalization, heart failure, and stroke.Results: Percent of Diabetes mellitus (53.2% vs 39.7), Chronic kidney disease (8.7% vs 3.7%), CABG history (7.6% vs 1%), three vessel disease(96.2% vs 90%) and left main coronary artery disease (25.1% vs 13.7%) was significantly higher in the CTO-NR group than in success PCI group (all P<0.05). Moreover, the CTO-NR group has lower EF (0.58±0.11 vs 0.61±0.1, p=0.001) and FS (0.31±0.07 vs 0.33±0.07, p=0.002). At a median follow-up of 12 months, CTO revascularization was superior to CTO no-revascularization in terms of cardiac death (adjusted hazard ratio [HR]: 0.27, 95% conference interval [CI] 0.11-0.64). The superiority of CTO revascularization was consistent for MACCE (HR: 0.55, 95% CI 0.35-0.79). At multivariable Cox hazards regression analysis, CTO revascularization remains one of the independent predictors of lower risk of cardiac death and MACCE.Conclusions: Successful revascularization by PCI may bring more clinical benefits. The presence of LVEF＜0.5 and LM-disease was associated with an incidence of cardiac death; CTO revascularization was a protected predictor of cardiac death.
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Gong et al. (2020) conducted a cohort in Coronary chronic total occlusion (CTO) (n=563). Successful percutaneous coronary intervention (PCI) vs. No revascularization (initial no PCI or failed PCI) was evaluated on Cardiac death (HR 0.27, 95% CI 0.11-0.64, p=0.003). Successful percutaneous coronary intervention for chronic total occlusion reduced the risk of cardiac death compared to no revascularization.
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