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Author Spotlight: Enhancing Coronary Artery Revascularization
05:25

Author Spotlight: Enhancing Coronary Artery Revascularization

Published on: September 15, 2023

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Chronic Total Occlusion is Not a Risk Factor for Mortality in Patients With Successful Percutaneous Coronary

Emil N Holck1,2, Naja S Winther1,2, Lone Juul-Hune Mogensen1,2

  • 1Department of Cardiology Aarhus University Hospital Aarhus Denmark.

Journal of the American Heart Association
|October 13, 2023
PubMed

Insights

Percutaneous coronary intervention for chronic total occlusion (CTO PCI) shows similar long-term mortality to non-CTO PCI when successful. However, unsuccessful CTO PCI is linked to significantly higher long-term mortality.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Public Health

Background:

  • Fifteen percent of patients with coronary artery disease (CAD) have chronic total occlusions (CTOs).
  • CTOs pose a challenge in percutaneous coronary intervention (PCI).
  • Long-term outcomes of CTO PCI versus non-CTO PCI require further investigation.

Purpose of the Study:

  • To compare the long-term prognosis of successful and unsuccessful CTO PCI with PCI for non-CTO lesions.
  • To evaluate the impact of CTO revascularization on all-cause mortality.

Main Methods:

  • An observational, region-wide, register-based cohort study.
  • Included patients undergoing PCI in Denmark from 2009 to 2019.
  • Stratified patients into non-CTO, successful CTO PCI, and unsuccessful CTO PCI groups.
  • Primary endpoint: all-cause mortality, followed until January 1, 2022.

Main Results:

  • In 21,141 patients, 2,108 underwent CTO PCI.
  • Long-term all-cause mortality was higher after CTO PCI compared to non-CTO PCI, but not statistically significant after adjustment.
  • Successful CTO PCI showed no difference in mortality compared to non-CTO PCI (adjusted HR, 0.99).
  • Unsuccessful CTO PCI was associated with significantly higher long-term mortality (adjusted HR, 1.35).

Conclusions:

  • Patients undergoing PCI for CTO have higher long-term mortality risk than those without CTO.
  • Successful CTO PCI is associated with comparable long-term mortality to non-CTO PCI.
  • Failed CTO PCI significantly increases long-term mortality, highlighting the need for specialized CTO programs with high success rates.

Keywords:
chronic total occlusioncohort studycoronary artery diseaseoutcomepercutaneous coronary intervention

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