Impact of percutaneous coronary intervention for chronic total occlusion with multivessel disease

Abstract

Background: Multivessel disease is known to be associated with increased adverse clinical outcomes in coronary artery diseases. The impact of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) with multivessel disease is unclear. We evaluated the 12-month clinical outcomes between PCI and optimal medical therapy (OMT) for multi-vessel CTO patients. Methods: A total of 402 consecutive CTO patients were divided into 2 groups according to treatment strategy; the PCI group (n=117) and the Mx group (n=285). 12-month clinical outcomes were compared between the two groups. Results: At baseline, patients in the Mx group showed a higher prevalence of elderly, left main disease, LCX lesion, RCA lesion, and well-developed collateral vessels (≥grade 2). Patients in the PCI group showed a higher prevalence of male gender, hemorrhagic cerebrovascular accidents, current smokers, and non-CTO procedures. Clinical outcomes at 12 months were similar between the 2 groups except higher rates of TVR in the PCI group. Baseline adjustment by multivariate analysis, however, showed no difference. Conclusions: In our study, it seems that intervention may result in increased rates of TVR in multi-vessel CTO. Long-term follow up with a larger study population will be necessary for further determination of the benefit and risks of interventional therapy in multi-vessel CTO patients.