An indeterminate occlusion duration predicts procedural failure in the recanalization of coronary chronic total occlusions.
OBJECTIVE
To identify the impact of occlusion duration (OD) and, in particular, an indeterminate occlusion duration (IOD) on immediate angiographic success and long-term clinical outcomes in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI).


METHODS
From May 2003 to October 2006, all patients having PCI for a CTO were consecutively registered. In addition to an assessment of procedural outcomes, patients were followed long-term for occurrence of major adverse cardiac events (MACE).


RESULTS
202 consecutive patients were included. Of these, 123 (60.9%) had a known OD while in the remaining 79 (39.1%), OD was indeterminate. Overall technical success was 82.7% and was lower in the IOD group (70.9% vs. 90.2%, P = 0.0004). An IOD was a predictor of procedural failure (adjusted OR 4.51, 95% CI 1.7-11.5, P = 0.002). An IOD (HR 2.59, 95%CI 1.08-6.23, P = 0.032) and procedural success (HR 0.26, 95%CI 0.11-0.60, P = 0.002) were the only independent predictors of long-term MACE. Patients with a failed PCI and an IOD had a 5-fold increased risk of MACE compared to those with known OD (37.0% vs. 7.1%, log rank P = 0.0036).


CONCLUSIONS
In addition to the traditional predictors of procedural success and clinical outcome, this study, for the first time uncovered the importance of OD and, in particular, of an IOD. Still, in patients who are successfully recanalized, a long or IOD bears the same low rate of MACE as the general CTO population while in patients with failed PCI, an IOD carries a considerable risk of adverse prognosis.
Barlis
Peter
P
Department of Cardiology and National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom.
Kaplan
Sahin
S
Dimopoulos
Konstantinos
K
Tanigawa
Jun
J
Schultz
Carl
C
Di Mario
Carlo
C
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D002114:Calcinosis / Q000150:complications; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D017023:Coronary Angiography; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
D010975:Platelet Aggregation Inhibitors