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Improvement in survival following successful percutaneous coronary intervention of coronary chronic total occlusions:

David M Safley1, John A House, Steven P Marso

  • 1Division of Cardiology and Biostatistics, Saint Luke's Health System, Mid America Heart Institute, Kansas City, Missouri 64111, USA. dsafley@cc-pc.com

JACC. Cardiovascular Interventions
|May 26, 2009
PubMed

Insights

Successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) in the left anterior descending artery significantly improves long-term survival. However, PCI for CTOs in the left circumflex or right coronary arteries did not show a survival benefit.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Previous studies indicate improved survival rates after successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs).
  • Understanding the specific survival benefits of CTO PCI across different coronary arteries is crucial for patient selection and treatment planning.

Purpose of the Study:

  • To compare the 5-year survival benefit of successfully opening chronic total occlusions (CTOs) in the left anterior descending (LAD), left circumflex (LCX), or right coronary artery (RCA).
  • To determine if procedural success in CTO PCI translates to improved long-term survival in a vessel-specific manner.

Main Methods:

  • A cohort of 2,608 patients undergoing attempted single-vessel CTO PCI was analyzed.
  • Procedural success rates were calculated for LAD, LCX, and RCA target vessels.
  • The primary endpoint was 5-year survival, compared between procedural success and failure groups, stratified by the target coronary artery.

Main Results:

  • Angiographic success rates were 77% for LAD, 76% for LCX, and 72% for RCA.
  • Procedural success was associated with improved 5-year survival in the LAD group (88.9% vs. 80.2%, p < 0.001).
  • No significant survival benefit was observed for procedural success in the LCX (86.1% vs. 82.1%, p = 0.21) or RCA (87.7% vs. 84.9%, p = 0.23) groups. Multivariable analysis confirmed CTO PCI success in the LAD was linked to reduced mortality (HR: 0.61).

Conclusions:

  • Percutaneous coronary intervention for chronic total occlusions in the left anterior descending artery is associated with improved long-term survival.
  • CTO PCI in the left circumflex or right coronary arteries did not demonstrate a significant survival benefit in this study.
  • These findings may aid in selecting patients who are most likely to benefit from attempted CTO PCI.
Abstract

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