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Complete vs. incomplete percutaneous revascularization in patients with chronic total coronary artery occlusion

Luis Carlos Maestre-Luque1,2, Rafael Gonzalez-Manzanares1,2,3, Javier Suárez de Lezo1,2,3

  • 1Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain.

Frontiers in Cardiovascular Medicine
|August 7, 2024
PubMed

Insights

Complete percutaneous revascularization (CR-CTO) for chronic total occlusions (CTO) significantly reduces major adverse cardiovascular events (MACE). This study found CR-CTO lowered MACE risk in the mid-term, highlighting its benefit in managing complex coronary artery disease.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains controversial.
  • Evaluating the impact of complete revascularization on clinical outcomes is crucial for patient management.

Purpose of the Study:

  • To assess the effect of complete revascularization of CTO on major adverse cardiovascular events (MACE).
  • To compare outcomes between complete revascularization of CTO (CR-CTO) and incomplete revascularization (ICR-CTO).

Main Methods:

  • Retrospective observational study of 359 patients with CTO undergoing invasive coronary angiography.
  • Patients were categorized into CR-CTO and ICR-CTO groups.
  • Primary endpoint was a composite of MACE, including death, myocardial infarction, stroke, or unplanned revascularization, assessed over mid-term follow-up.

Main Results:

  • Complete revascularization was achieved in 46.5% of patients.
  • After a median follow-up of 42 months, MACE occurred in 23.4% of the CR-CTO group versus 39.1% in the ICR-CTO group (HR 0.50, p < 0.001).
  • The association remained significant after inverse probability weighting (adjusted HR 0.61, p = 0.018), primarily driven by reduced all-cause death.

Conclusions:

  • Complete revascularization of CTO is associated with a significantly lower risk of MACE.
  • The findings support the benefit of achieving complete revascularization in patients with CTO.
  • CR-CTO may improve mid-term survival in patients with complex coronary artery disease.
Abstract

Keywords:
chronic total occlusioncoronary artery diseasemajor adverse cardiovascular eventsmyocardial infarctionpercutaneous coronary intervention

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