Comparison of long-term outcomes of medical therapy and successful recanalisation for coronary chronic total occlusions in elderly patients: a report of 1,294 patients.

Abstract

Little is known about the long-term outcomes of medical therapy (MT) versus successful percutaneous coronary intervention (PCI) in elderly patients with coronary chronic total occlusions (CTOs). There were 1,294 consecutive patients with 1,520 CTOs included (2007 to 2016) and were divided into the younger group (age <65 years; n=664, 51.3%) and the older group (age ≥65 years; n=630, 48.7%). In the older group, 630 patients were divided into MT group (n=421) and successful CTO-PCI group (n=209) according to the initial treatment strategy. In the younger group, they were divided into two groups: 379 patients in the MT group and 285 patients in the successful CTO-PCI group. We performed propensity score matching to minimize any selection bias. The primary end point was cardiac mortality. The secondary end point was major adverse cardiac event (MACE). After 3.6 (IQR, 2.1-5.0) years follow-up, no significant difference was observed between the MT and successful CTO-PCI groups in terms of cardiac mortality (MT vs. successful CTO-PCI: 9.3% vs. 5.0%, P=0.378) and MACE (28.3% vs. 15.1%, P=0.070) in the older group. After propensity score matching analysis (120 pairs), the risk of cardiac mortality (6.7% vs. 8.3%, P=0.624) was found to be comparable between the two groups. In the younger group, the occurrence of cardiac death (MT vs. successful CTO-PCI: 3.7% vs. 1.4%, P=0.072) was similar, whereas the MACE rate (27.7% vs. 17.9%, P=0.003) was significantly higher in MT group. After multivariate analysis, previous myocardial infarction (MI) [hazard ratio (HR) 1.70, 95% confidence interval (CI): 1.16-2.49, P=0.006], CTO in right coronary artery (HR 1.55, 95% CI: 1.07-2.25, P=0.020), multivessel disease (HR 2.02, 95% CI: 1.10-3.72, P=0.024) and calcification (HR 1.61, 95% CI: 1.07-2.42, P=0.023) were independent predictors of MACE in elderly. In the treatment of elderly patients with CTOs, successful CTO-PCI compared with MT alone didn't reduce the risk of cardiac death or MACE.