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Percutaneous Coronary Intervention for Chronic Total Occlusion in Single Coronary Arteries

Jah Yeon Choi1, Seung-Woon Rha1, Byoung Geol Choi1

  • 1Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea.

Texas Heart Institute Journal
|June 10, 2021
PubMed

Insights

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in single coronary arteries shows similar major adverse cardiac events (MACE) regardless of the artery. PCI significantly reduced death or myocardial infarction in LCx and RCA CTO compared to optimal medical therapy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Chronic total occlusion (CTO) represents a significant challenge in coronary artery disease management.
  • Treatment strategies for CTO include percutaneous coronary intervention (PCI) and optimal medical therapy (OMT).
  • Outcomes may vary depending on the specific coronary artery affected by CTO.

Purpose of the Study:

  • To compare the clinical outcomes of PCI versus OMT for single-vessel CTO.
  • To determine if outcomes differ based on the target coronary artery: left anterior descending (LAD), left circumflex (LCx), or right coronary artery (RCA).

Main Methods:

  • Retrospective analysis of 731 patients with single-vessel CTO treated between January 2004 and November 2015.
  • Patients were categorized by target vessel (LAD, LCx, RCA) and treatment (PCI or OMT).
  • Comparison of 5-year cumulative incidence of major adverse cardiac events (MACE) and composite of death or myocardial infarction, and left ventricular ejection fraction changes.

Main Results:

  • Overall 5-year MACE incidence was similar between PCI and OMT groups, irrespective of the target vessel.
  • PCI significantly reduced the 5-year composite of death or myocardial infarction compared to OMT in the LCx and RCA territories.
  • PCI was an independent predictor of lower death or myocardial infarction incidence in LCx and RCA CTO.

Conclusions:

  • The specific coronary artery involved does not appear to influence clinical outcomes after successful PCI for single-vessel CTO.
  • PCI offers significant survival benefits over OMT for CTO in the LCx and RCA.
  • Randomized clinical trials are needed to further validate these findings.

Keywords:
Coronary occlusion/therapypercutaneous coronary intervention/adverse effects/mortalityretrospective studiestreatment outcomeventricular function, left

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