Abstract 19387: Angioplasty of Chronic Total Coronary Occlusions is Not Associated with Improved Survival Compared With Elective Medical Therapy: a Propensity Matched Retrospective Cohort Study

Abstract

Introduction: Although an association between improved survival and successful PCI of chronic total coronary occlusions (CTO) compared with failed PCI has been widely reported, there is little published data reporting outcomes for those found to have a CTO which is electively treated medically versus those treated by PCI; a comparison which is more pertinent to clinical decision making. Our aim was to compare long-term clinical outcomes in a cohort of patients with an identified CTO on angiography between these two treatment groups. We hypothesised there would be a significant difference in all-cause mortality at 5 year follow-up. Methods: Patients found to have a CTO on angiography between 2002 and 2008, without prior CABG or important structural heart disease in a single tertiary centre were identified using a dedicated database. Patients undergoing CTO PCI and elective medical therapy to the CTO were propensity matched to adjust for baseline clinical and angiographic differences. Events at follow-up were identified using national death certification records and national registries for myocardial infarction, CABG and PCI. Comparisons were stratified by matched pair. Results: In total 1957 patients were identified, a CTO was treated by PCI in 405(20.7%) and medical therapy in 667(34.1%), 885(45.2%) patients underwent CABG. Of those treated by PCI or medical therapy, propensity score matching identified 389 pairs of patients. PCI was successful in 238 patients (61.2%). There was no difference in the primary study objective of 5 year mortality between the propensity matched treatment groups (CTO PCI: 10.8%, medical therapy: 15.7%; HR 0.74; 95% CI 0.49 to 1.11; p=0.146). There remained no difference if only the 238 matched pairs in which CTO PCI was successful were included (HR 0.83; 95% CI 0.48 to 1.42; p=0.493). There was an increase in repeat revascularization associated with CTO PCI (HR 2.18; 95% CI 1.49-3.18; p<0.001). This difference was not present in the successful PCI matched pair subgroup (HR 0.79; 95% CI 0.45-1.37; p=0.397). Conclusions: Using an alternative approach to much of the existing literature, we did not demonstrate an associated difference in survival between patients with a CTO treated by PCI versus those in whom the CTO was treated medically.