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Successful revascularization improves long-term clinical outcome in patients with chronic coronary total occlusion
Tomohiko Teramoto1, Etsuo Tsuchikane1, Masanori Yamamoto1
1Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan.
Insights
Successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) significantly reduces long-term mortality. This study highlights the benefits of CTO revascularization for patient survival.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) techniques for chronic total occlusions (CTOs) have advanced, improving initial success rates.
- Limited data exists on the long-term mortality impact of successful CTO revascularization in Japan.
Purpose of the Study:
- To compare long-term clinical outcomes between successful and failed CTO PCI.
- To identify factors associated with clinical outcomes in CTO revascularization.
Main Methods:
- Retrospective analysis of 738 patients undergoing CTO-PCI between 2006 and 2013.
- Patients were categorized into successful (n=656) and failed (n=82) revascularization groups.
- Exclusion criteria included second-attempt success, small branches, and multi-vessel CTOs. Survival assessed via follow-up.
Main Results:
- Initial angiographic success rate was 88.9%.
- Successful CTO-PCI was associated with significantly lower cumulative all-cause mortality (p=0.0003).
- The rate of evident cardiac death was substantially lower in the success group (3.5% vs. 15.9%, p<0.0001).
Conclusions:
- Successful revascularization of chronic total occlusions significantly improves long-term clinical outcomes.
- CTO revascularization is a crucial strategy for reducing mortality in affected patients.
Background:
Following the development of breakthrough techniques for percutaneous coronary intervention (PCI) in the treatment of chronic total occlusions (CTO), the initial success rate of PCI in CTO lesions (CTO-PCI) has improved; however, there are few reports regarding the effects of successful CTO revascularization on long-term mortality in Japan. The aim of this study was to compare the long-term clinical outcomes of patients with successful versus failed CTO recanalization and to identify related factors.
Methods And Results:
From all PCI procedures performed in our hospital between 2006 and 2013, CTO-PCIs were extracted and classified into two groups: PCI success (n = 656 patients) and PCI failure (n = 82 patients). Patients with successful procedures only on a second attempt, CTO-PCI in small branches, or CTOs in more than one vessel were excluded. Survival was determined from a telephone interview or the consultation history in the outpatient clinic. Initial angiographic success was achieved in 88.9% of the patients. A Kaplan-Meier plot with log-rank analysis showed that cumulative all-cause death was significantly lower in the success group than in the failure group (p = 0.0003; average follow-up duration in success group vs. failure group was 1531.3 ± 33.5 vs. 1565.3 ± 97.5 days, p = 0.7). Moreover, the rate of evident cardiac death was significantly lower in the success group than in the failure group (3.5% [23/656] vs. 15.9% [13/82], p < 0.0001).
Conclusions:
This study suggests that successful revascularization in patients with CTO improves their long-term clinical outcomes.
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