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Association of Acute Procedural Results With Long-Term Outcomes After CTO PCI

Changdong Guan1, Weixian Yang2, Lei Song2

  • 1Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

JACC. Cardiovascular Interventions
|February 5, 2021
PubMed

Insights

Suboptimal outcomes in chronic total occlusion percutaneous coronary intervention (CTO PCI) are linked to increased long-term cardiac death and myocardial infarction (MI). Achieving optimal recanalization is crucial for better patient survival after CTO PCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Limited research exists on the association between acute procedural results and long-term outcomes in chronic total occlusion percutaneous coronary intervention (CTO PCI).
  • Understanding these associations is vital for improving patient management and long-term prognosis after complex coronary interventions.

Purpose of the Study:

  • To investigate the relationship between procedural outcomes and long-term mortality and myocardial infarction (MI) following CTO PCI.
  • To assess the impact of different levels of recanalization success on major adverse cardiac events.

Main Methods:

  • A cohort of 2,659 patients undergoing CTO PCI between 2010 and 2013 was analyzed.
  • Procedural results were classified into optimal recanalization (TIMI flow 3), suboptimal recanalization (TIMI flow 1-2, residual stenosis >30%, or side branch occlusion), and procedural failure.
  • The primary endpoint was the 5-year composite of cardiac death and MI.

Main Results:

  • Optimal recanalization was achieved in 58.7% of patients, suboptimal in 15.0%, and failure in 26.3%.
  • The 5-year incidence of cardiac death and MI was significantly higher in the suboptimal recanalization group (10.1%) compared to optimal (6.5%) and failure (6.3%) groups (p=0.046).
  • Subgroup analysis indicated that significant side branch occlusion was associated with a numerically higher risk of 5-year MI.

Conclusions:

  • Suboptimal recanalization during CTO PCI is associated with a significantly increased long-term risk of cardiac death and MI.
  • Achieving optimal procedural success in CTO PCI is critical for improving long-term patient outcomes and reducing adverse cardiovascular events.
Abstract

Keywords:
acute resultschronic total occlusionlong-term outcomespercutaneous coronary interventionsuboptimal recanalization

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