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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
The Comparison of Long-Term Outcome Between Patients with Single and Multiple Coronary Chronic Total Occlusions After
Miaomiao Cao1, Bolin Li1, Qian Li1
1Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China.
Insights
Patients with multiple chronic coronary total occlusions (CTOs) undergoing percutaneous coronary intervention (PCI) have higher mortality rates. Multiple CTOs, advanced age, and reduced left ventricular ejection fraction (LVEF) predict worse outcomes after PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) has advanced treatment for chronic coronary total occlusions (CTOs).
- Limited data exists on long-term outcomes comparing single versus multiple CTOs in stable coronary artery disease (CAD) patients post-PCI.
Purpose of the Study:
- To compare the long-term outcomes of stable CAD patients with multiple CTOs versus single CTO after PCI.
Main Methods:
- Retrospective cohort study of 670 stable CAD patients treated with CTO-PCI at a single center.
- Primary endpoint was all-cause death; secondary endpoints included cardiac mortality.
- Median follow-up of 33.7 months.
Main Results:
- 131 patients (19.7%) had multiple CTOs; 539 had single CTO.
- Higher cumulative all-cause mortality (p=0.037) and cardiac mortality (p=0.003) in multiple CTO group.
- Multiple CTOs, age >65, and LVEF <40% were independent predictors of mortality.
Conclusions:
- Long-term survival in CTO-PCI patients is influenced by the number of CTOs, age, and LVEF.
- CTO revascularization success did not significantly impact long-term survival in this cohort.
Background:
Rapid advancements in percutaneous coronary intervention (PCI) have improved the outcome of chronic coronary total occlusions (CTOs); however, data regarding the difference in long-term outcomes in stable coronary artery disease (CAD) patients with single and multiple CTOs who underwent PCI are scarce. This study aimed to compare the long-term outcomes of patients with multiple CTOs and single CTO after PCI.
Methods:
This study cohort included stable CAD patients who were diagnosed with CTO and treated with PCI from a single center. The primary endpoint was all-cause death.
Results:
We retrospectively reviewed 670 consecutive patients with CTO-PCI. Among them, 539 patients had a single CTO, and 131 (19.7%) patients had multiple (at least two) CTOs. CTO revascularization was achieved in 470 (70.1%) patients. After a median follow-up duration of 33.7 months, the cumulative all-cause mortality (p = 0.037) and cardiac mortality (p = 0.003) were higher in patients with multiple CTOs than in those with a single CTO. In the multivariable model, multiple CTOs and left ventricular ejection fraction (LVEF) less than 40% were independent predictors for cardiac death (adjusted hazard ratio (HR) 2.53; P = 0.013 and adjusted HR 3.95; P < 0.001), while age older than 65 and LVEF less than 40% were independent predictors for all-cause death in CTO-PCI patients (adjusted hazard ratio (HR) 1.84; P = 0.035 and adjusted HR 2.54; P = 0.001).
Conclusion:
In CTO-PCI patients, long-term survival was associated with multiple CTOs, age and LVEF, but not with CTO revascularization.
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