The Impact of Successful Chronic Total Occlusion Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Real World

Abstract

Backgroud: Chronic total occlusions (CTOs) are an important and increasingly recognized subgroup of coronary lesions; 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), 301 patients were revascularized by PCI (CTO-R group) and 262 were not revascularized (CTO-NR group). 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 (53.4% vs 39.5), Chronic kidney disease (8.8% vs 3.7%), CABG history (7.6% vs 1%), three vessel disease(96.2% vs 90%) and LM disease(25.2% vs 13.6%) 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=0.002) and FS (0.32±0.07 vs 0.33±0.07, p=0.003). At a median follow-up of 12 months, CTO-R was superior to CTO-NR in terms of cardiac death (adjusted hazard ratio [HR]: 0.32, 95% conference interval [CI] 0.11-0.94). The superiority of CTO-R was consistent for MACCE (HR: 0.57, 95% CI 0.37-0.87). At multivariable Cox hazards regression analysis, CTO-R remains one of the independent predictors of lower risk of cardiac death and MACCE.Conclusions: Successful revascularization by PCI offered CTO patients more clinical benefits. The presence of LVEF＜0.5 and LM-disease was associated with an incidence of cardiac death; CTO revascularised was a protected predictor of cardiac death.

Drug-coated balloon for the management of coronary chronic total occlusions

“…In a large-scale observational study in 592 patients with treated CTO, Gong et al [17] showed a statistically significant improvement in cardiac death and MACE after successful revascularization with a hazard ratio of 0.239 for cardiac death and 0.541 for MACE.…”

Assessing the Clinical Influence of Chronic Total Occlusions (CTOs) Revascularization and the Impact of Vascularization Completeness on Patients with Left Ventricular (LV) Systolic Dysfunction

“…Flores-Umanzor et al [15] demonstrated that coronary angiogenesis in contrast to merely medical treatment forecasted lower risks of ACD rates in the elderly with CTO (328 patients), irrespective of angiogenesis methods. Gong et al [2] divided 563 CTO patients into the non-angiogenesis group (n � 263) and successfully finished angiogenesis group (n � 300) and revealed that successfully finished CTO-PCI was related to a remarkable amelioration in cardiac mortality and MACCE, and SCR was a protection prediction factor of cardiac mortality (HR: 0.239, 95% CI 0.076-0.751) and MACCE (HR: 0.541, 95% CI 0.353-0.83). Recently, Kook et al [16] have compared revascularization to OMT for treating CTOs and have discovered that PCI causes improved survival benefits in contrast to OMT irrespective of left ventricular systolic function.…”

“…Nevertheless, its bene ts are still controversial. Certain observation-based research studies [2,3] contrasting successful versus unsuccessful PCI for CTO have revealed that successfully nished PCI was related to ameliorated results, whereas a few RCTs' discoveries failed to corroborate the bene ts of CTO-PCI [4,5]. On the contrary, left ventricular ejection fraction (LVEF) is one of the most potent prediction factors of cardiovascular events in patients with CAD [6].…”

Influence of the Single Coronary Vessel on Acute Outcomes of In-Stent CTO Recanalization

“…Due to novel recanalization strategies and emerging devices, percutaneous coronary intervention (PCI) has become a promising treatment option [2][3][4][5][6][7]. CTO revascularization has been shown to be a predictor for the prevention of cardiac death [8].…”