Myocardial Infarction and All-Cause Mortality Following Percutaneous Coronary Intervention Versus Conservative
Marc Meller Søndergaard1, Sanna Gunnarstein1, Martin Kirk Christensen1
1Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Insights
Percutaneous coronary intervention for chronic coronary total occlusions (CTO-PCI) showed similar myocardial infarction risk but lower all-cause mortality compared to conservative treatment. These findings support CTO-PCI as a viable treatment option.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Chronic coronary total occlusions (CTO) present significant treatment challenges.
- Existing randomized trials and observational studies comparing conservative treatment with percutaneous coronary intervention (PCI) for CTO are underpowered.
Purpose of the Study:
- To evaluate the long-term risks of myocardial infarction (MI) and all-cause mortality in patients with CTO lesions.
- To compare outcomes between patients treated with CTO percutaneous coronary intervention (CTO-PCI) and those receiving conservative management.
Main Methods:
- Utilized data from the West Denmark Heart Registry, identifying 7675 patients with chronic coronary syndrome and 100% occluded vessels.
- Stratified patients into CTO-PCI (within 90 days) and conservative treatment groups.
- Calculated 5-year risks of MI and all-cause mortality using cause-specific Cox-models and g-formula, adjusting for clinical factors and subgroup analyses.
Main Results:
- No significant difference in 5-year MI risk was observed between CTO-PCI (13.1%) and conservative treatment (13.4%).
- CTO-PCI demonstrated a significantly lower 5-year all-cause mortality rate (14.4%) compared to conservative treatment (18.9%).
- Subgroup analyses revealed consistent findings, though CTO-PCI patients with prior cardiac surgery showed a higher MI risk.
Conclusions:
- CTO-PCI is associated with a comparable 5-year risk of myocardial infarction versus conservative management.
- Patients undergoing CTO-PCI experienced significantly lower all-cause mortality over five years compared to those treated conservatively.
Background:
Chronic coronary total occlusions (CTO) represent a therapeutic challenge, and results of randomized clinical trials and observational studies comparing conservative treatment versus percutaneous coronary intervention (PCI) are underpowered.
Aims:
To assess myocardial infarction (MI) and all-cause mortality in consecutive patients with CTO lesions.
Methods:
Using data from the West Denmark Heart Registry, patients with chronic coronary syndrome and a 100% occluded vessel by invasive coronary angiography (ICA) were identified. Patients were stratified according to PCI within 90 days. Five-year risk of MI and all-cause mortality was calculated using cause-specific Cox-models and g-formula methods. Subsequently, models were stratified on sex, diabetes, estimated glomerular filtration rate above 60 mL/min, procedure before 2012, and history of cardiac surgery. The risk was calculated for patients who did not experience MI or death within 30 days of the initial ICA.
Results:
A total of 7675 patients were included in the study, of whom 3129 patients underwent PCI, and 4546 patients were treated conservatively. PCI- and conservatively treated patients had comparable risks of MI (13.1% [95% confidence interval [CI] 12.0%-14.3%] for patients who underwent PCI vs. 13.4% [95% CI 12.4%-13.4%] for patients who received conservative treatment). For all-cause mortality, results were 14.4% (95% CI 13.3%-15.5%) versus 18.9% (95% CI 17.8%-20.0%), respectively. Results were consistent across subgroups. However, CTO-PCI-treated patients with previous heart surgery were at higher risk of MI.
Conclusions:
Patients who underwent CTO-PCI had a comparable 5-year risk of MI and lower all-cause mortality as compared to conservatively treated patients.
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