Impact of Successful Chronic Total Occlusion Percutaneous Coronary Interventions on Subsequent Clinical Outcomes
Iosif Xenogiannis, Ilias Nikolakopoulos, Oleg Krestyaninov
1Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, Minnesota 55407 USA. esbrilakis@gmail.com.
Insights
Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) significantly improves angina and reduces major adverse cardiovascular events (MACE). However, CTO-PCI success was not independently linked to MACE in multivariable analysis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- The clinical benefit of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on angina and major adverse cardiovascular events (MACE) remains debated.
- Assessing the impact of successful CTO-PCI versus failed procedures is crucial for patient outcomes.
Purpose of the Study:
- To compare patient-reported angina and MACE incidence between successful and failed CTO-PCI.
- To evaluate the association between CTO-PCI success and cardiovascular outcomes in a large patient cohort.
Main Methods:
- A multicenter registry of 1612 patients undergoing CTO-PCI was analyzed.
- Patient-reported angina and MACE (death, myocardial infarction, target-vessel revascularization) were compared between successful (n=1387) and failed CTO-PCI groups.
Main Results:
- Successful CTO-PCI was associated with significantly lower rates of prior heart failure, myocardial infarction, and coronary revascularization.
- Patients with successful CTO-PCI reported greater angina improvement (83% vs 38%) and had lower 1-year MACE incidence (8% vs 15%) compared to failed procedures.
- Despite univariable associations, CTO-PCI success was not an independent predictor of MACE on multivariable analysis.
Conclusions:
- Successful CTO-PCI is linked to improved angina and reduced MACE incidence on univariable analysis.
- The findings highlight the importance of procedural success for symptom relief and short-term event reduction in CTO-PCI.
Background:
The impact of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on angina and subsequent incidence of major adverse cardiovascular event (MACE) rate remains controversial.
Methods:
We compared patient- reported angina change and the incidence of MACE (defined as death, myocardial infarction [MI], target-vessel revascularization) between successful vs failed CTO-PCI in 1612 patients participating in a large, multicenter registry.
Results:
CTO-PCI was successful in 1387 patients (86%). Compared with failed CTO-PCI, successful CTO-PCI patients were less likely to have history of heart failure (33% vs 41%; P=.02), prior MI (49% vs 62%; P<.01), or prior coronary revascularization (63% vs 71% [P=.03] for PCI and 30% vs 40% [P<.01] for coronary artery bypass graft surgery). Patients in the successful CTO-PCI group had lower J-CTO scores (2.4 ± 1.3 vs 3.1 ± 1.1; P<.01) and lower PROGRESS-CTO Complications scores (1.1 ± 1.0 vs 1.6 ± 1.0; P<.01). After a mean follow-up of 181 ± 153 days, patients with successful PCI were more likely to have angina improvement (83% vs 38%; P<.01) and had lower incidence of 1-year MACE (8% vs 15%; P<.01), death (3% vs 7%; P<.01), and MI (2% vs 4%; P=.02). On multivariable analysis, however, CTO-PCI success was not independently associated with MACE.
Conclusion:
Compared with failed CTO-PCI, successful CTO-PCI is associated with better angina improvement and lower incidence of MACE (on univariable analysis) during follow-up.
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