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Updated: May 23, 2026
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Successful recanalization of chronic total occlusions is associated with improved long-term survival
Daniel A Jones1, Roshan Weerackody, Krishnaraj Rathod
1Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom.
Insights
Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) significantly improves long-term survival. Achieving successful CTO PCI reduces mortality and the need for coronary artery bypass grafting (CABG).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Many patients with chronic total occlusions (CTOs) do not undergo percutaneous coronary intervention (PCI) despite technological advancements.
- CTO-PCI aims to revascularize complex coronary lesions, but procedural success rates and long-term outcomes require further investigation.
Purpose of the Study:
- To evaluate the impact of procedural success in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on patient mortality.
- To assess the association between successful CTO recanalization and 5-year all-cause mortality and major adverse cardiac events (MACE).
Main Methods:
- A cohort of 6,996 patients undergoing elective PCI for stable angina was analyzed, with 836 (11.9%) treated for CTO.
- Outcomes, including all-cause mortality and MACE (myocardial infarction, urgent revascularization, stroke, death), were tracked for 5 years post-procedure.
- Patients were stratified based on successful CTO (sCTO) or unsuccessful CTO (uCTO) recanalization.
Main Results:
- Procedural success was achieved in 69.6% of CTO PCI cases, with drug-eluting stents used in 73%.
- Five-year all-cause mortality was significantly lower in the sCTO group (4.5%) compared to the uCTO group (17.2%) (p < 0.0001).
- Successful CTO PCI was independently associated with reduced mortality (HR: 0.32) and decreased need for subsequent CABG.
Conclusions:
- Successful CTO PCI is linked to substantially improved 5-year survival rates.
- Enhancing techniques and technologies to improve CTO PCI success rates may significantly improve patient prognosis.
Objectives:
This study investigated the impact of procedural success on mortality following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a large cohort of patients in the drug-eluting stent era.
Background:
Despite advances in expertise and technologies, many patients with CTO are not offered PCI.
Methods:
A total of 6,996 patients underwent elective PCI for stable angina at a single center (2003 to 2010), 836 (11.9%) for CTO. All-cause mortality was obtained to 5 years (median: 3.8 years; interquartile range: 2.0 to 5.4 years) and stratified according to successful chronic total occlusion (sCTO) or unsuccessful chronic total occlusion (uCTO) recanalization. Major adverse cardiac events (MACE) included myocardial infarction (MI), urgent revascularization, stroke, or death.
Results:
A total of 582 (69.6%) procedures were successful. Stents were implanted in 97.0% of successful procedures (mean: 2.3 ± 0.1 stents per patient, 73% drug-eluting). Prior revascularization was more frequent among uCTO patients: coronary artery bypass grafting (CABG) (16.5% vs. 7.4%; p < 0.0001), PCI (36.0% vs. 21.2%; p < 0.0001). Baseline characteristics were otherwise similar. Intraprocedural complications, including coronary dissection, were more frequent in unsuccessful cases (20.5% vs. 4.9%; p < 0.0001), but did not affect in-hospital MACE (3% vs. 2.1%; p = NS). All-cause mortality was 17.2% for uCTO and 4.5% for sCTO at 5 years (p < 0.0001). The need for CABG was reduced following sCTO (3.1% vs. 22.1%; p < 0.0001). Multivariate analysis demonstrated that procedural success was independently predictive of mortality (hazard ratio [HR]: 0.32 [95% confidence interval (CI): 0.18 to 0.58]), which persisted when incorporating a propensity score (HR: 0.28 [95% CI: 0.15 to 0.52]).
Conclusions:
Successful CTO PCI is associated with improved survival out to 5 years. Adoption of techniques and technologies to improve procedural success may have an impact on prognosis.
