Abstract
Successful percutaneous coronary intervention (PCI) of chronic total occluded (CTO) coronary arteries in the left anterior descending artery (LAD) is associated with better outcome than unsuccessful PCI. Randomized data have not found invasive treatment of non-CTO LAD lesion to be associated with better outcome. This study aimed to investigate the prognostic impact of CTO revascularization stratified on target treated vessel compared with non-CTO LAD PCI. The hypothesis was that successful PCI of LAD CTO and non-LAD CTO, and unsuccessful non-LAD CTO was associated with the same prognosis as non-CTO LAD lesions, while unsuccessful LAD CTO patients was associated with a poorer prognosis. The study was a population-based cohort study, including consecutive patients undergoing PCI from 2009 to 2019 in the Central Denmark Region. Patients with acute myocardial infarction (MI) within 30 days were excluded. CTO patients were stratified by occluded vessel and procedural success. The primary endpoint was long-term all-cause mortality and was calculated as a hazard ratio (HR) with 95% confidence interval (CI). Secondary endpoints were MI and target vessel revascularization (TVR). In total 21,141 patients were screened, 4,518 had non-CTO LAD PCI, and 1,475 had CTO PCI. Median [IQR] follow-up was 5.8[3.6;8.8] years. In the successful CTO groups the adjusted risk for all-cause mortality was equal to non-CTO LAD patients (LAD CTO HR (95% CI): 1.14 (0.90;1.44), non-LAD CTO: 1.09 (0.95;1.27). Unsuccessful LAD CTO patients had higher risk than non-CTO LAD patients whereas unsuccessful non-LAD CTO had not (unsuccessful LAD: 1.88 (1.33;2.65), unsuccessful non-LAD: 1.26 (0.97;1.63)). In conclusion, successful LAD and non-LAD CTO PCI had same prognosis as non-CTO LAD PCI, while only unsuccessful LAD CTO PCI had a poorer prognosis. LAD CTO patients are a high-risk population, and dedicated CTO trials are needed to confirm this finding and establish guideline recommendations.
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