Long-term outcomes of coronary chronic total occlusion: Percutaneous coronary intervention versus optimal medical therapy

Abstract

Coronary chronic total occlusion (CTO) are associated with poor prognosis and cardiac death. Successful chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is associated with a clinical benefit. However, in a substantial portion of cases, PCI is not attempted, and patients are treated with optimal medical therapy (OMT). The aim of this study was to compare long-term outcomes of CTO after OMT versus PCI. Between 2006 to 2017, 144 patients with CTO were included. Patients who underwent coronary artery bypass grafting were excluded. We classified patients into the OMT group ( n = 65) or PCI group ( n = 62) according to initial treatment strategy. Endpoint of the study was long-term cardiac death. The median follow-up duration was 44 (interquartile range: 19–74) months. Baselines characteristics did not significantly differ between the two groups: mean age was 62.16 ± 10 vs. 61.52 ± 9 years; Left-ventricular ejection fraction (LVEF) 48 ± 11% vs. 50 ± 13%; Diabetes 48% vs. 46%; Acute coronary syndrome 52% vs. 48%. In the PCI group, 46 patients (74.2%) underwent successful revascularization. Kaplan–Meier plot with log rank analysis shows cumulative death was significantly lower in the PCI group than in the OMT group ( P = 0.023; average follow up duration; PCI vs. OMT group = 131.52 ± 6.8 vs. 96.33 ± 8.2 months). As an initial treatment strategy, PCI reduce cardiac death compared with OMT for the treatment of CTO.