Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic.
OBJECTIVE
The aim of our study was to examine the trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over the last 25 years from a single PCI registry and to examine the impact of drug-eluting stents.


BACKGROUND
The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and there are limited data available from contemporary practice.


METHODS
We evaluated the outcomes of 1,262 patients from the Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to the time of their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era).


RESULTS
Procedural success rates were 51%, 72%, 73%, and 70% (p < 0.001), respectively, in the 4 groups. In-hospital mortality (2%, 1%, 0.4%, and 0%, p = 0.009), emergency coronary artery bypass grafting (15%, 3%, 2%, and 0.7%, p < 0.001), and rates of major adverse cardiac events (8%, 5%, 3%, and 4%, p = 0.052) decreased over time. During follow-up, the combined end point of death, myocardial infarction, or target lesion revascularization, was significantly lower in the 2 most recent cohorts compared with those patients treated before (p = 0.001 for trend). Technical failure to treat the CTO was not an independent predictor of long-term mortality (hazard ratio 1.16 [95% confidence interval 0.90 to 1.5], p = 0.25).


CONCLUSIONS
Procedural success rates for CTO have not improved over time in the stent era, highlighting the need to develop new techniques and devices. Compared with the prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50%.
Prasad
Abhiram
A
Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota. Electronic address: prasad.abhiram@mayo.edu.
Rihal
Charanjit S
CS
Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Lennon
Ryan J
RJ
Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Wiste
Heather J
HJ
Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Singh
Mandeep
M
Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Holmes
David R
DR
Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
D000046:Academic Medical Centers; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D002423:Cause of Death; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000473:pathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome