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Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
Long-Term Outcomes in Patients With Chronic Total Occlusion
Daniel A Gold1, Pratik B Sandesara1, Vardhmaan Jain1
1Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Insights
Patients with chronic total occlusions (CTOs) and stable coronary artery disease (CAD) face higher cardiovascular event rates. Revascularization significantly reduces this risk, making non-treated CTOs particularly dangerous.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Chronic total occlusions (CTOs) in acute coronary syndromes increase risk, but prognosis in stable coronary artery disease (CAD) is unclear.
- Understanding the impact of CTOs on stable CAD patients is crucial for risk stratification and treatment guidance.
Purpose of the Study:
- To investigate adverse event rates in patients with stable CAD, comparing those with and without CTOs.
- To assess the impact of CTO revascularization on cardiovascular outcomes.
Main Methods:
- Analysis of 3,597 patients with stable CAD (>50% stenosis) undergoing cardiac catheterization.
- Evaluation of all-cause mortality, cardiovascular mortality, and major adverse cardiac events (MACE).
- Utilized Cox proportional hazards and Fine and Gray subdistribution hazard models for adjusted survival analysis.
Main Results:
- Patients with CTOs exhibited higher adjusted cardiovascular death rates (HR 1.29) compared to those without CTOs.
- Revascularization of CTOs was associated with significantly lower event rates (cardiovascular death HR 0.43).
- Non-revascularized CTOs posed the greatest risk (cardiovascular death HR 1.52) compared to patients without CTOs.
Conclusions:
- CTOs in stable CAD patients are associated with increased adverse cardiovascular events.
- Revascularization of CTOs mitigates this elevated risk, leading to outcomes similar to patients without CTOs.
- Non-revascularized CTOs represent a high-risk subgroup requiring careful management.
Abstract:
Although a chronic total occlusion (CTO) in the setting of an acute coronary syndrome is associated with greater risk, the prognosis of patients with a CTO and stable coronary artery disease (CAD) remains unknown. This study aimed to investigate adverse event rates in patients with stable CAD with and without a CTO. In 3,597 patients with stable CAD (>50% coronary luminal stenosis) who underwent cardiac catheterization, all-cause mortality, cardiovascular mortality, and the composite major adverse cardiac event (MACE) rates for cardiovascular death, myocardial infarction, and heart failure hospitalization were evaluated. Cox proportional hazards and Fine and Gray subdistribution hazard models were used to compare event-free survival in patient subsets after adjustment for covariates. Event rates were higher in patients with CTOs than in those without CTOs after adjusting for demographic and clinical characteristics (cardiovascular death hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.05 to 1.57, p = 0.012). Patients with CTO revascularization had lower event rates than those of patients without CTO revascularization (cardiovascular death HR 0.43, CI 0.26 to 0.70, p = 0.001). Those with nonrevascularized CTOs were at particularly great risk when compared with those without CTO (cardiovascular death HR 1.52, CI 1.25 to 1.84, p <0.001). Moreover, those with revascularized CTOs had similar event rates to those of patients with CAD without CTOs. Patients with CTO have higher rates of adverse cardiovascular events than those of patients with significant CAD without CTO. This risk is greatest in patients with nonrevascularized CTO.
