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Percutaneous coronary interventions and cardiovascular outcomes for patients with chronic total occlusions

E Marc Jolicœur1, Micheal J Sketch, Daniel M Wojdyla

  • 1Duke University Medical Center, Durham, North Carolina, USA. marc.jolicoeur@icm-mhi.org

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 2, 2011
PubMed

Insights

Successful recanalization of coronary chronic total occlusions (CTOs) did not improve survival in patients with stable coronary artery disease. Further analysis confirmed no significant association between CTO intervention success and patient outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • The clinical benefits of percutaneous recanalization for coronary chronic total occlusions (CTOs) remain debated.
  • Assessing the true impact of CTO intervention requires careful adjustment for patient characteristics and procedural success.

Purpose of the Study:

  • To evaluate the benefits of coronary chronic total occlusion (CTO) recanalization in stable coronary artery disease.
  • To adjust for patient case-mix and propensity for CTO intervention when assessing outcomes.

Main Methods:

  • A propensity score was derived from 1,602 patients undergoing percutaneous coronary intervention (PCI), comparing those who attempted CTO recanalization (n=346) versus those who did not (n=1,256).
  • The primary analysis examined the association between successful CTO recanalization and survival free of death and cardiovascular rehospitalizations.
  • Sensitivity analyses adjusted for propensity score, anatomical predictors of failure, and extent of revascularization.

Main Results:

  • Successful CTO recanalization was not significantly associated with improved survival free of death and cardiovascular rehospitalization (Hazard Ratio = 0.90, 95% CI 0.64-1.25).
  • Sensitivity analyses yielded even more conservative estimates, reinforcing the primary finding.

Conclusions:

  • Percutaneous recanalization of coronary chronic total occlusions (CTOs) is not linked to improved survival in contemporary patients with symptomatic coronary artery disease.
  • These findings suggest that the benefits of successful CTO recanalization on long-term survival may be limited in this patient population.
Abstract

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