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Effect of complete percutaneous revascularization on improving long-term outcomes of patients with chronic total

Zeya Li1, Ziru Zhou2, Lei Guo2

  • 1Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Xuan Wu District, Beijing 100050, China.

Chinese Medical Journal
|April 4, 2023
PubMed

Insights

Complete percutaneous coronary intervention (PCI) significantly reduces major adverse cardiovascular events (MACEs) and unstable angina in patients with chronic total occlusion (CTO) and multi-vessel disease (MVD). This approach offers improved long-term prognosis compared to incomplete PCI or optimal medical treatment alone.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Limited comparative data exist for clinical outcomes of complete versus incomplete percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) and multi-vessel disease (MVD).
  • Understanding the impact of PCI completeness is crucial for optimizing treatment strategies in complex coronary artery disease.

Purpose of the Study:

  • To compare the clinical outcomes of complete versus incomplete PCI in patients diagnosed with both CTO and MVD.
  • To evaluate the long-term efficacy of different revascularization strategies, including optimal medical treatment (OMT), incomplete PCI, and complete PCI.

Main Methods:

  • A cohort of 558 patients with CTO and MVD was analyzed, stratified into OMT (n=86), incomplete PCI (n=327), and complete PCI (n=145) groups.
  • Propensity score matching (PSM) was employed for sensitivity analysis comparing complete and incomplete PCI groups.
  • The primary endpoint was major adverse cardiovascular events (MACEs); unstable angina served as the secondary outcome.

Main Results:

  • At a median 21-month follow-up, complete PCI demonstrated significantly lower rates of MACEs (20.0%) and unstable angina (10.3%) compared to incomplete PCI (30.6% MACEs, 19.3% unstable angina) and OMT (43.0% MACEs, 24.4% unstable angina).
  • Complete PCI was independently associated with reduced MACE risk versus OMT (adjusted HR=2.00) and incomplete PCI (adjusted HR=1.58).
  • PSM confirmed these findings, showing significantly lower MACE (20.5% vs 32.6%) and unstable angina (10.7% vs 20.5%) rates in the complete PCI group compared to the incomplete PCI group.

Conclusions:

  • Complete PCI significantly reduces the long-term risk of MACEs and unstable angina in patients with CTO and MVD when compared to incomplete PCI and OMT.
  • Achieving complete revascularization, encompassing both CTO and non-CTO lesions, appears to improve patient prognosis in this complex population.
Abstract

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