Related Experiment Video
Updated: Jun 14, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Long-term outcomes after revascularization in chronic total and non-total occluded coronary arteries: A regionwide
Emil Nielsen Holck1,2,3, Lars Jakobsen1, Naja Stausholm Winther1
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) shows outcomes similar to non-CTO PCI. However, unsuccessful CTO PCI is linked to significantly worse major adverse cardio- and cerebrovascular events (MACCE).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is a complex procedure.
- Understanding the long-term prognosis after CTO PCI is vital for clinical decision-making.
- Previous research often focused on successful versus unsuccessful CTO PCI, but comparison with non-CTO PCI is also important.
Purpose of the Study:
- To investigate the prognostic impact of successful and unsuccessful CTO PCI.
- To compare outcomes of CTO PCI (both successful and unsuccessful) against non-CTO PCI.
- To evaluate the association between CTO PCI strategies and major adverse cardio- and cerebrovascular events (MACCE).
Main Methods:
- A population-based cohort study included patients undergoing PCI between 2009 and 2019 in Denmark.
- Patients were categorized into three groups: non-CTO PCI, successful CTO PCI, and unsuccessful CTO PCI.
- Major adverse cardio- and cerebrovascular events (MACCE), including death, myocardial infarction, stroke, heart failure hospitalization, and revascularization, were tracked via nationwide registries.
Main Results:
- The study analyzed 10,638 patients (9,065 non-CTO PCI, 1,300 successful CTO PCI, 273 unsuccessful CTO PCI) with a median follow-up of 5.9 years.
- Successful CTO PCI demonstrated a MACCE rate equivalent to non-CTO PCI (Hazard Ratio [HR]: 0.98, 95% Confidence Interval [CI]: 0.90-1.07).
- Unsuccessful CTO PCI was significantly associated with a higher MACCE rate compared to non-CTO PCI (HR: 1.22, 95% CI: 1.04-1.43).
Conclusions:
- The study confirms that successful CTO PCI is associated with long-term outcomes comparable to non-CTO PCI.
- Unsuccessful CTO PCI represents a high-risk group requiring careful management due to associated worse outcomes.
- These findings support the importance of achieving successful CTO revascularization to optimize patient prognosis.
Background:
Understanding the prognostic impact of percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) is crucial for patient management. Previous studies have primarily been studying prognostic impact of successful versus unsuccessful CTO PCI. This study investigated the prognostic impact of successful and unsuccessful percutaneous coronary intervention (PCI) of chronic total occluded coronary arteries (CTO) with non-CTO PCI as reference.
Methods:
Patients treated with PCI from 2009 to 2019 in the Central Region of Denmark were included in a population-based cohort study. We compared successful and unsuccessful CTO PCI with non-CTO PCI. Exclusion criteria was myocardial infarction within 30 days. Primary outcome was difference in a composite major adverse cardio- and cerebrovascular events (MACCE) encompassing all-cause death, any myocardial infarction, stroke, hospitalization for heart failure or revascularization tracked via nationwide registries.
Results:
Of 21,141 screened patients, 10,638 were enrolled: 9,065 underwent non-CTO PCI, 1,300 had successful CTO PCI, and 273 had unsuccessful CTO PCI. Median follow-up time was 5.9 [3.5;9.0] years and 4,750 MACCEs were recorded. Compared to non-CTO PCI, the adjusted MACCE rate for successful CTO PCI was equivalent (Hazard Ratio (HR): 0.98, 95% Confidence Interval (CI): 0.90-1.07, p = 0.71). In contrast, unsuccessful CTO PCI was associated with a higher MACCE rate (HR: 1.22, 95% CI: 1.04-1.43, p<0.01). HR was adjusted for age, body-mass index, previous revascularization, smoking, kidney disease, two or three-vessel disease, left ventricular ejection fraction, diabetes and comorbidities.
Conclusions:
The pre-specified hypothesis was accepted. Successful CTO PCI was associated with equivalent long-term outcomes as non-CTO PCI, and unsuccessful CTO PCI was identified as a high-risk group associated to worse outcomes.
More Related Videos
Related Concept Videos
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies