title: Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience.
abstract: OBJECTIVE
  The study compared procedural outcomes and long-term survival for patients undergoing percutaneous coronary intervention (PCI) of a chronic total coronary artery occlusion (CTO) with a matched non-CTO cohort to determine whether successful PCI of a CTO is associated with improved survival.
  
  
  BACKGROUND
  Percutaneous coronary intervention of a CTO is a common occurrence, and the long-term survival for patients with successful PCI of a CTO has not been clearly defined.
  
  
  METHODS
  Between June 1980 and December 1999, a total of 2,007 consecutive patients underwent PCI for a CTO. Utilizing propensity scoring methods, a matched non-CTO cohort of 2,007 patients was identified and compared to the CTO group. The cohorts were stratified into successful and failed procedures.
  
  
  RESULTS
  The in-hospital major adverse cardiac event (MACE) rate was 3.8% in the CTO cohort. Technical success has improved over the last 10 years (overall 74.4%, slope 1.0%/yr, p = 0.02, R2 = 49.9%) as did procedural success (overall 69.9%, slope 1.2%/yr, p = 0.02, R2 = 51.5%) without a concomitant increase in in-hospital MACE rates (slope 0.1%/yr, p = 0.7). There was a distinct 10-year survival advantage for successful CTO treatment compared with failed CTO treatment (73.5% vs. 65.1%, p = 0.001). The CTO versus non-CTO 10-year survival was the same (71.2% vs. 71.4%, p = 0.9). Diabetics in the CTO cohort had a lower 10-year survival compared with nondiabetics (58.3% vs. 74.3%, p < 0.0001).
  
  
  CONCLUSIONS
  These data represent follow-up of the largest reported series of patients undergoing PCI for a CTO. The 10-year survival rates for matched non-CTO and the CTO cohorts were similar. Success rates have continued to improve without an accompanying increase in MACE rates. A successfully revascularized CTO confers a significant 10-year survival advantage compared with failed revascularization.
authors.affiliation: Mid-America Heart Institute, St. Luke's Hospital, Kansas City, Missouri, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Suero
authors.forename: S P
authors.initials: SP
authors.lastname: Marso
authors.forename: P G
authors.initials: PG
authors.lastname: Jones
authors.forename: S B
authors.initials: SB
authors.lastname: Laster
authors.forename: K C
authors.initials: KC
authors.lastname: Huber
authors.forename: L V
authors.initials: LV
authors.lastname: Giorgi
authors.forename: W L
authors.initials: WL
authors.lastname: Johnson
authors.forename: B D
authors.initials: BD
authors.lastname: Rutherford
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002908:Chronic Disease; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome