Percutaneous coronary intervention for chronic total occlusions: improved survival for patients with successful revascularization compared to a failed procedure.
BACKGROUND
There are limited data on the impact of successful chronic total occlusion (CTO) revascularization by percutaneous coronary intervention (PCI) on survival. We performed a retrospective study comparing the survival between patients with a successful and a failed CTO revascularization by PCI.


METHODS
Between January 1, 2000 and June 30, 2004, 543 of 5803 (9.4%) patients underwent PCI for a CTO at our center. A CTO was defined as an occlusion of the artery present for at least 3 months with Thrombolysis in Myocardial Infarction flow grade 0 or 1. Patient records were linked to a national database to monitor all deaths during follow up. Propensity matching was used to balance out case mix differences.


RESULTS
Technical success for CTO was 377 of 543 (69.4%). In-hospital mortality was 0.3% and 1.2% for the CTO success and CTO failure patients, respectively. During a mean (SD) follow up of 1.7 (0.5) years, the mortality rate was 2.5% in the CTO success patients and 7.3% in the CTO failure patients. The crude hazard ratio for death with CTO failure was 3.92 (95% confidence intervals 1.56-10.07; P = 0.004). The rates of coronary artery bypass were 3.2% vs. 21.7% (P < 0.001) for the CTO success and CTO failure patients, respectively. Our propensity matched 157 CTO success to CTO failure patients and the associated hazard ratio for death with CTO failure was 4.63 (95% confidence interval 1.01-12.61; P = 0.049). Multivariate analysis showed that CTO failure was an independent predictor of death.


CONCLUSIONS
Patients with a successful revascularization of a CTO by PCI have an increased survival rate compared to patients with a failed CTO procedure.
Aziz
Shahid
S
Department of Cardiology, Royal Blackburn Hospital, Blackburn, Lancashire, United Kingdom. saziz1@bitinternet.com
Stables
Rodney H
RH
Grayson
Antony D
AD
Perry
Raphael A
RA
Ramsdale
David R
DR
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome