Impact of target vessel on long-term survival after percutaneous coronary intervention for chronic total occlusions
Bimmer E Claessen1, George D Dangas, Cosmo Godino
1Cardiovascular Research Foundation, New York, New York 10029, USA.
Insights
Successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) in the left anterior descending and left circumflex arteries improves long-term survival. However, PCI success for right coronary artery CTOs did not show a significant impact on mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Chronic total occlusions (CTOs) represent a significant challenge in coronary artery disease management.
- The prognostic impact of successful percutaneous coronary intervention (PCI) for CTOs may vary depending on the specific coronary artery treated.
Purpose of the Study:
- To investigate the differential prognostic effect of successful PCI for CTOs based on the target vessel.
- To compare long-term mortality and the need for coronary artery bypass grafting (CABG) after successful versus unsuccessful CTO PCI across different coronary arteries.
Main Methods:
- A cohort of 1,734 patients undergoing PCI for CTOs between 1998 and 2007 was analyzed.
- Patients were stratified based on the target vessel: left anterior descending (LAD), left circumflex (LCX), or right coronary artery (RCA).
- Five-year mortality and need for CABG were compared between successful and unsuccessful PCI groups.
Main Results:
- Procedural success rates were similar across LAD, LCX, and RCA CTOs (71.1%, 69.1%, 65.1% respectively).
- Successful PCI for LAD and LCX CTOs was associated with significantly lower long-term mortality (P=0.03 and P<0.01, respectively).
- Successful PCI for RCA CTOs did not show a significant difference in long-term mortality (P=0.80), though CABG rates were lower across all vessels.
Conclusions:
- Successful PCI of CTOs in the LAD and LCX arteries is linked to improved long-term survival.
- Successful PCI of CTOs in the RCA does not appear to confer a similar survival benefit in this cohort.
- Successful CTO PCI consistently reduces the need for subsequent CABG, regardless of the target vessel.
Background:
This study sought to investigate whether there is a differential prognostic effect of successful percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) according to the target vessel the CTO is located in.
Methods:
Between 1998 and 2007, a total of 1,791 patients underwent PCI of a CTO at three tertiary care centers in the US, Italy, and South Korea. Patients with CTOs in multiple target vessels or the left main stem were excluded (n = 57). Of the remaining 1,734 patients, 609 had a CTO in the left anterior descending (LAD, 35.1%), 391 in the left circumflex (LCX, 22.5%), and 734 in the right coronary artery (RCA, 42.3%). Five-year mortality and the need for coronary artery bypass grafting (CABG) were compared between patients with successful vs. unsuccessful PCI stratified by target vessel.
Results:
Procedural success was obtained in 71.1% of LAD patients, 69.1% of LCX patients, and 65.1% of RCA patients (P = 0.06). The mean follow-up duration was 1,178 days. Kaplan-Meier estimates of long-term mortality were 6.7% vs. 11.0% (P = 0.03), 5.5% vs. 13.9% (P < 0.01), and 6.6% vs. 4.1% (P = 0.80) in successful vs. unsuccessful LAD, LCX, and RCA patients, respectively. After multivariate analysis, successful CTO PCI remained associated with lower mortality in the LAD (HR 0.41, P = 0.02) and LCX groups (HR 0.32, P < 0.01). The need for CABG was lower after successful CTO PCI in all three groups (LAD 4.6% vs. 16.0%, P < 0.01; LCX 2.9% vs. 18.2%, P < 0.01, RCA 2.3% vs. 8.4%, P < 0.01).
Conclusion:
The results from this large contemporary cohort of patients suggest that successful PCI of a CTO in the LAD and the LCX, but not the RCA, is associated with improved long-term survival.
