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Impact of complete percutaneous revascularization in elderly patients with chronic total occlusion

Renato Valenti1, Angela Migliorini1, Maria Grazia De Gregorio1

  • 1Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 21, 2019
PubMed

Insights

Successful chronic total occlusion percutaneous coronary intervention (CTO-PCI) improves long-term survival in elderly patients. Achieving complete revascularization further enhances cardiac survival, suggesting CTO-PCI should be considered in this population.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Cardiology

Background:

  • Elderly patients are underrepresented in chronic total occlusion percutaneous coronary intervention (CTO-PCI) trials.
  • Successful CTO-PCI is known to provide clinical benefits.
  • The prognostic impact in the elderly remains understudied.

Purpose of the Study:

  • To evaluate the prognostic significance of successful CTO-PCI in elderly patients (≥75 years).
  • To assess the impact of complete revascularization on long-term survival after CTO-PCI.
  • To identify factors associated with long-term cardiac survival in this demographic.

Main Methods:

  • Analysis of 460 elderly patients (≥75 years) from the Florence CTO-PCI registry (2004-2015).
  • Assessment of long-term cardiac survival as the primary endpoint.
  • Kaplan-Meier estimation and Cox multivariable regression for survival analysis.

Main Results:

  • Five-year cardiac survival was significantly higher in successful CTO-PCI patients (84% vs. 72%, p=.006).
  • Complete revascularization further improved survival (90% vs. 68%, p<.001).
  • Independent predictors of survival included age, diabetes, chronic kidney disease, low ejection fraction, and complete revascularization.

Conclusions:

  • Successful CTO-PCI is associated with improved long-term survival in elderly individuals.
  • Complete coronary revascularization following CTO-PCI significantly enhances survival benefits in the elderly.
  • CTO-PCI should be considered in elderly patients to achieve complete revascularization and improve outcomes.
Abstract

Keywords:
CTO-PCIcoronary artery disease

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