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Robustness of Percutaneously Completed Coronary Revascularization in Stable Coronary Artery Disease: Obstructive
Igor Kranjec1, Dinko Zavrl Džananovič1, Miha Mrak1
11 Department of Cardiology, University Medical Centre, Ljubljana, Slovenia.
Insights
Percutaneous coronary revascularization (CCR) for chronic total occlusions (CTOs) leads to favorable long-term outcomes when successful. Unsuccessful CTO interventions result in more adverse cardiovascular events, but survival remains similar to non-CTO procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Obstructive coronary artery disease (CAD) often involves chronic total occlusions (CTOs).
- Percutaneous coronary intervention (PCI) is a common revascularization strategy.
- Long-term outcomes after CTO revascularization require further assessment.
Purpose of the Study:
- To evaluate the long-term cardiovascular outcomes of percutaneously achieved coronary revascularization (CCR) in patients with CTOs.
- To compare outcomes between successful CTO CCR, failed CTO PCI, and non-CTO CCR.
Main Methods:
- Retrospective analysis of 213 patients undergoing CTO PCI between 2010-2014.
- Group 1: Successful CTO CCR (n=125).
- Group 2: Failed CTO PCI (n=88).
- Group 3: Matched non-CTO CCR (n=252).
- 5-year follow-up for adverse cardiovascular events and mortality.
Main Results:
- Higher adverse cardiovascular events in failed CTO PCI group (29.5%) compared to successful CTO CCR (4.8%) and non-CTO CCR (3.5%) (P=.0001).
- Recurrent symptoms and revascularization drove adverse events in the failed group.
- No significant difference in cardiovascular mortality between groups.
- Similar survival curves for successful CTO and non-CTO CCR.
- Low incidence of stent thrombosis in successful CCR groups.
Conclusions:
- Successful percutaneous coronary revascularization of CTOs yields favorable long-term outcomes.
- Achieving CCR in CTOs is crucial for preventing adverse cardiovascular events.
- Intervention for CTOs, when successful, offers comparable long-term survival to non-CTO revascularization.
Abstract:
Our study sought to assess long-term outcomes of percutaneously completed coronary revascularization (CCR) in patients with obstructive coronary artery disease (CAD) comprising chronic total occlusions (CTOs). Between 2010 and 2014, percutaneous coronary interventions (PCIs) of the CTOs were attempted in 213 patients: the CCR was achieved in 125 patients (group 1), while the PCI failed in 88 patients (group 2). They were matched against 252 patients (group 3) with the CCR obtained by the non-CTO PCIs. In the 5-year follow-up, more adverse cardiovascular (CV) events occurred in group 2 (29.5% vs 4.8% in group 1 vs 3.5% in group 3, P = .0001), mainly due to recurrent severe symptoms and additional revascularization of the CTOs; CV mortality did not seem to be significantly affected. Survival curves for the successful CTO and non-CTO PCIs appeared indistinguishable. Stent thromboses were infrequent in the CCR groups. In conclusion, long-term outcomes of the patients with the obstructive CAD containing the CTOs showed a favorable outcome if the CCR had been achieved percutaneously.
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