Abstract
Background: To date, the benefit of successful revascularization of chronic total occlusions (CTOs) on prognosis remains uncertain, and there is a paucity of data on the impact of successful revascularization for CTO patients on long-term cardiovascular survival. This study aimed to investigate the long-term cardiovascular survival for patients with successful and unsuccessful CTO revascularization in a large cohort of patients.Methods: There were 1,655 consecutive patients with at least one CTO included and were grouped into successful revascularization (n = 591) and unsuccessful revascularization (n = 1,064). Propensity score matching (PSM) was carried out to balance the clinical and the angiographic characteristics. Cardiac mortality was defined as the primary endpoint. Major adverse cardiac event (MACE) was assessed as a “secondary endpoint.”Results: After 3.6 years of follow-up, there was no significant difference between the successful and the unsuccessful revascularization groups in the rate of cardiac mortality [adjusted hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.59–1.58, p = 0.865]. After the PSM analysis (371 pairs) between the two groups, the cardiac mortality rate values (HR 0.51, 95% CI 0.23–1.15, p = 0.104) were equivalent, whereas the adjusted risk of MACE (HR 0.43, 95% CI 0.32–0.58, p = 0.001) and target-vessel revascularization (HR 0.41, 95% CI 0.29–0.58, p < 0.001) were significantly higher in patients with unsuccessful revascularization.Conclusion: For the treatment of CTO patients, successful revascularization was not associated with a lesser risk for cardiac mortality as compared with unsuccessful revascularization. However, successful revascularization reduced MACE and target-vessel revascularization.
Highlights
Coronary chronic total occlusion (CTO) revascularization is a challenging obstacle in the field of coronary intervention [1]
Five CTO-dedicated operators performed the procedures during the study period
In the DECISION-CTO and EuroCTO trials, percutaneous coronary intervention (PCI) was not associated with reducing death, repeated revascularization, and major adverse cardiac event (MACE) compared to medical therapy (MT) [22, 23]
Summary
Coronary chronic total occlusion (CTO) revascularization is a challenging obstacle in the field of coronary intervention [1]. Several observational studies demonstrated that better outcomes of successful CTO percutaneous coronary intervention (PCI) included angina reduction and improvement in both longterm survival and left ventricular function in comparison with unsuccessful procedures [2,3,4,5,6]. The prognosis of successful revascularization of CTO remains uncertain, and there is limited data on the impact of successful revascularization for CTO patients on long-term cardiovascular survival. The benefit of successful revascularization of chronic total occlusions (CTOs) on prognosis remains uncertain, and there is a paucity of data on the impact of successful revascularization for CTO patients on long-term cardiovascular survival. This study aimed to investigate the long-term cardiovascular survival for patients with successful and unsuccessful CTO revascularization in a large cohort of patients
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