[Long-term outcome of patients undergoing recanalization procedures for chronic total coronary occlusion]
Jing-Jing Gai1, Lu-Yue Gai, Xue Zhai
1Department of Cardiology, General Hospital of PLA, Beijing 100853, China.
Insights
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) showed no significant long-term benefits over medical therapy for chronic total coronary occlusion (CTO). CABG patients had a trend toward higher stroke incidence.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Chronic total coronary occlusion (CTO) presents complex treatment challenges.
- Long-term outcomes of different revascularization strategies for CTO remain debated.
Purpose of the Study:
- To compare long-term outcomes of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and medical therapy for CTO.
- Evaluate major adverse cardiovascular events (MACE) at 5 years post-treatment.
Main Methods:
- Retrospective analysis of 253 patients with CTO undergoing coronary angiography (CAG) between 2008-2009.
- Patients treated with PCI, CABG, or conservative medication therapy.
- Follow-up for 5 years to assess MACE, including myocardial infarction (AMI), death, stroke, and heart failure.
Main Results:
- No significant differences in MACE, AMI, death, or heart failure were observed among PCI, CABG, and medical therapy groups.
- The CABG group showed a non-significant trend towards a higher incidence of stroke (P=0.06).
- Baseline characteristics were similar, with exceptions in lipid profiles and Syndax scores.
Conclusions:
- Recanalization strategies (PCI, CABG) did not demonstrate superior long-term benefits compared to medical therapy for CTO.
- CABG may be associated with an increased risk of stroke in CTO patients, warranting further investigation.
Objective:
To compare the long-term outcomes of patients receiving percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy for treatment of chronic total coronary occlusion (CTO).
Methods:
The patients with CTO were selected from a consecutive cohort of patients who underwent coronary angiography (CAG) between 2008 and 2009. The patients with multiple CAG were excluded. The patients received treatments with PCI, CABG, or conservative medication therapy and were followed for major adverse cardiovascular events (MACE) within 5 years.
Results:
A total of 253 patients were enrolled in this study, including 192 receiving PCI, 48 receiving CABG, and 13 treated conservatively with medications. The baseline clinical characteristics were similar among the 3 groups except for increased low-density lipoprotein (LDL) and total cholesterol (TC) in the medication group, and increased Syndax score in CABG group. During the follow-up, the incidences of MACE, AMI, death, stroke or heart failure did not differ significantly among the 3 groups (P>0.05). However, CABG group showed a higher incidence of the stroke than the other two groups although this difference did not reach a statistically significantly level (P=0.06).
Conclusion:
Our study did not demonstrate that recanalization offers greater long-term benefits than medications for treatment of CTO, and the patients receiving CABG appeared to have a higher incidence of stroke.
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