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Long-term outcome of percutaneous coronary intervention for chronic total occlusions

Roxana Mehran1, Bimmer E Claessen, Cosmo Godino

  • 1Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, New York 10029, USA. rmehran@crf.org

JACC. Cardiovascular Interventions
|September 24, 2011
PubMed

Insights

Successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) reduces cardiac mortality and the need for bypass surgery. Drug-eluting stents (DES) are superior to bare-metal stents (BMS) for reducing revascularization needs with similar safety.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Chronic total occlusions (CTO) remain a challenge in percutaneous coronary intervention (PCI).
  • Limited data exists on the long-term clinical outcomes following PCI for CTO.
  • Advancements in PCI techniques necessitate evaluation of their long-term impact.

Purpose of the Study:

  • To assess the long-term clinical outcomes of patients undergoing PCI for CTO.
  • To compare the effectiveness and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in CTO PCI.
  • To identify predictors of outcomes after successful CTO PCI.

Main Methods:

  • Retrospective analysis of 1,852 CTO PCI procedures in 1,791 patients across 3 international centers (1998-2007).
  • Median follow-up of 2.9 years.
  • Multivariable analysis to determine predictors of mortality and need for coronary artery bypass graft (CABG) surgery.

Main Results:

  • Successful CTO PCI (68% procedural success) was linked to lower cardiac mortality (HR 0.40) and reduced need for CABG (HR 0.21).
  • Drug-eluting stents (DES) demonstrated significantly less target vessel revascularization compared to bare-metal stents (BMS) (17.2% vs. 31.1%, p < 0.01) with similar stent thrombosis rates.
  • Paclitaxel-eluting stents and sirolimus-eluting stents showed comparable long-term safety and efficacy.

Conclusions:

  • Successful CTO PCI significantly reduces long-term cardiac mortality and the need for CABG surgery.
  • Utilizing DES over BMS for CTO PCI improves outcomes by decreasing target vessel revascularization while maintaining safety.
  • Both paclitaxel-eluting and sirolimus-eluting stents offer similar long-term clinical benefits in CTO treatment.
Abstract

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