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

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.

Gender-Based Long-Term Outcomes After Revascularization for Three-Vessel Coronary Disease: A Propensity Score-Matched Analysis of a Large Cohort

“…Additionally, when combined endpoints including repeat revascularizations and re-hospitalizations are adopted, previous study showed different outcomes for PCI vs CABG for patients with complex coronary disease. 23 Thus, we considered the strategy of revascularization as a relevant variable to be included within the multivariable adjustment to reduce the impact of confounding factors, 24 and we found PCI (compared with CABG) was independently associated with a higher MACCE rate in these patients, possibly due to the incomplete revascularization of PCI, which was consistent with prior study. 23 Therefore, with the latest refinement equipment and techniques, in treating patients with TVD, revascularization should be highly preferred as the treatment option and should not be limited by gender.…”

Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Graft: Current Evidence and Future Perspectives

“…This was consistent with the findings of Iglesias and his colleagues ( 85 , 86 ), who found that higher-risk patients were highly likely to benefit from the “treatment-risk paradox”, which is a common procedure in PCI. Since patients with prior CABG represent a significant proportion (37%) of those undergoing CTO PCI ( 87 , 88 ), these findings indicate that this procedure has more clinical benefits in patients with prior compared to those in the non-CABG group. Indeed, those patients with prior CABG are older, with many comorbidities, extensive and complex coronary lesions, and they are more likely to present concurrent cardiovascular risk factors.…”