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Successful recanalisation of isolated chronic total occlusions improves outcomes in long-term observation: a
Dariusz Ciećwierz1, Miłosz Jaguszewski, Marcin Fijałkowski
11st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland. cedario@o2.pl.
Insights
Successful percutaneous coronary intervention for chronic total occlusion (CTO) significantly improves angina symptoms and long-term outcomes. This procedure offers a better quality of life for patients with stable angina.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Vascular Surgery
Background:
- Long-term benefits of percutaneous recanalisation for chronic total occlusion (CTO) remain uncertain.
- Advances in interventional cardiology necessitate re-evaluation of CTO treatment efficacy.
Purpose of the Study:
- To assess if successful percutaneous coronary intervention for CTO (PCI-CTO) improves outcomes in stable angina patients.
- To compare outcomes between successful and unsuccessful PCI-CTO in an age- and gender-matched cohort.
Main Methods:
- Analysis of 276 patients from the CTO-Registry database, with successful PCI-CTO patients matched 1:1 with unsuccessful PCI-CTO patients.
- Primary endpoints included death, nonfatal myocardial infarction (MI), and a composite safety outcome.
- Secondary endpoint assessed angina symptom improvement; follow-up at six months and two years.
Main Results:
- Successful PCI-CTO showed similar rates of death and MI at six months and two years compared to unsuccessful procedures.
- A significant difference in composite safety endpoints (death, MI, ischaemia-driven revascularisation) was observed at two years favouring successful PCI-CTO (15.2% vs. 29.7%, p=0.004).
- Successful PCI-CTO led to significantly greater improvement or resolution of angina symptoms at both six months and two years.
Conclusions:
- Successful recanalisation of CTO significantly improves angina symptoms.
- Successful PCI-CTO demonstrates improved long-term outcomes, particularly in safety endpoints and symptom relief.
Background And Aim:
The long-term benefit of percutaneous recanalisation of chronic total occlusion (CTO) is still unclear. Given advances in interventional cardiology over the last two decades, we sought to investigate whether a successful percutaneous coronary intervention for CTO (PCI-CTO) improves outcomes in an age- and gender-matched single-centre cohort of stable angina patients.
Methods:
Out of 401 consecutive patients enrolled to the CTO-Registry database, 276 patients were included in the final analysis. Patients with unsuccessful PCI-CTO (n = 138) were age- and gender-matched in a 1:1 ratio with patients who underwent a successful procedure. The primary end-points included hard end-points comprising death and nonfatal myocardial infarction (MI) and a composite safety outcome measure of death, nonfatal MI and ischaemia-driven revascularisation. The secondary end-point was improvement in angina status or complete resolution of angina symptoms. Patients were followed up for six months and at two years.
Results:
Patients who underwent a successful recanalisation of CTO, compared to those who underwent an unsuccessful procedure, revealed similar rates of composite death and MI at six months (0.7% vs. 1.4%; hazard ratio [HR], 0.50; 95% confidence interval ratio [CI], 0.05-4.80; p = 0.56) and two years (1.4% vs. 5.8%; HR 0.24; 95% CI 0.07-0.85; p = 0.053). A significant difference in composite safety end-points between subsets, although not recorded after six months of observation (8.7% vs. 15.2%; HR 0.54; 95% CI 0.27-1.07; p = 0.095), was noted at two years follow-up (15.2% vs. 29.7%; HR 0.47; 95% CI 0.29-0.77; p = 0.004). A greater improvement in symptom burden or resolution of angina symptoms was documented after a successful PCI at both six months (68.1% vs. 23.2%, p < 0.001; 80.4% vs. 34.8%, p < 0.001, respectively) and two years (52.2% and 8.0%, p < 0.001; 68.1% vs. 22.5%, p < 0.001, respectively).
Conclusions:
Successful recanalisation of CTO improves outcomes in long-term observation.
