Abstract
ObjectiveThere is little published data reporting outcomes for those found to have a chronic total coronary occlusion (CTO) that is electively treated medically versus those treated by percutaneous coronary intervention...
Highlights
A chronic total coronary occlusion(CTO) is present in between one fifth and half of patients who have significant coronary artery disease[1,2]
What does this study add? we did not identify a statistically significant difference in 5-year all-cause mortality between groups, we demonstrate a significant associated reduction in the composite of death or myocardial infarction at 5 years if a CTO is treated by PCI rather than medical therapy, analysed by intention to treat
The difference appears to be driven by the increased rates of CTO territory revascularisation during the study period in the CTO PCI group
Summary
A chronic total coronary occlusion(CTO) is present in between one fifth and half of patients who have significant coronary artery disease[1,2]. There is a large body of observational data suggesting an association between successful CTO percutaneous coronary intervention(PCI) and improved clinical outcomes, including survival[3,4]. These findings are contrary to the findings of randomized trials comparing medical therapy with PCI of stable non-occlusive coronary disease, where except for reduced urgent revascularization in the FAME-2 trial5(which did include a very small proportion of CTOs), no overall outcome benefit has been demonstrated[6,7,8,9,10]. Important confounding variables such as overall angiographic complexity cannot be accounted for if registries from which data is collected do not include them[4]
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