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Impact of residual chronic total occlusion of right coronary artery on the long-term outcome in patients treated for

Kensuke Takagi1, Alfonso Ielasi, Alaide Chieffo

  • 1Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.

Circulation. Cardiovascular Interventions
|April 11, 2013
PubMed

Insights

Treating chronic total occlusion (CTO) of the right coronary artery in patients with unprotected left main (ULM) disease significantly impacts long-term cardiac mortality. Recanalization of CTO-RCA offers reserve circulation, potentially reducing mortality in ULM interventions.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Medicine
  • Vascular Surgery

Background:

  • Unprotected left main (ULM) disease poses significant risks during percutaneous interventions.
  • The presence of concomitant chronic total occlusion of the right coronary artery (CTO-RCA) may influence patient prognosis after ULM interventions.

Purpose of the Study:

  • To evaluate the immediate outcomes and long-term follow-up of patients undergoing ULM percutaneous interventions.
  • To compare outcomes between patients with and without associated CTO-RCA.

Main Methods:

  • Analysis of 568 consecutive patients with ULM stenosis treated with drug-eluting stents between March 2002 and December 2008.
  • Comparison of outcomes in patients with residual CTO-RCA versus those without residual CTO-RCA.
  • Assessment of cardiac death, target lesion revascularization, and major adverse cardiovascular events.

Main Results:

  • Cardiac death was significantly higher in patients with residual CTO-RCA compared to those without (adjusted hazard ratio, 2.163; P=0.045).
  • Target lesion revascularization occurred less frequently in patients with residual CTO-RCA (adjusted hazard ratio, 0.321; P=0.014).
  • Major adverse cardiovascular events rates were similar between groups, despite higher cardiac mortality in the residual CTO-RCA group.

Conclusions:

  • Residual CTO-RCA is associated with increased long-term cardiac mortality following ULM percutaneous interventions.
  • Recanalization of CTO-RCA may improve long-term outcomes by providing collateral circulation.
  • Intervention on CTO-RCA should be considered in patients undergoing ULM interventions to mitigate cardiac mortality risk.
Abstract

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