title: Clinical outcomes of percutaneous coronary intervention for chronic total occlusion lesions in remote hospitals without on-site surgical support.
abstract: BACKGROUND
  The safety of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions in remote hospitals without surgical facilities remains unknown. This study aimed to evaluate three-year outcomes after CTO for PCI in ten centers around China where no on-site coronary artery bypass grafting (CABG) support was available.
  
  
  METHODS
  A total of 152 patients from 10 Chinese hospitals without on-site surgical facilities were prospectively studied. Intra-procedural and in-hospital events were assessed. Angiographic follow-up was indexed eight months after the initial procedure. Clinical follow-up was extended to three years. The primary outcome was the rate of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction and target-vessel revascularization (TVR).
  
  
  RESULTS
  The incidence of CTO was 7.9% in patients who underwent PCI. Successful recanalization was achieved in 132 patients (86.8%). Compared with patients in the PCI success group, patients with PCI procedural failure had longer lesion lengths ((42.32 +/- 22.08) mm vs (27.61 +/- 22.85) mm, P = 0.023), a higher rate of perforation (25.0% vs 0, P = 0.014), and a greater need for pericardial puncture. There were significant differences in MACE in-hospital and at one year and three years between the failure (10.0%, 30.0% and 35.0%) and the success (3.0%, 12.1% and 14.4%) groups (P = 0.037, 0.034 and 0.040, respectively). These led to a significant decrease in the MACE-free survival rate at one and three years in the failure group, compared with the success group (P = 0.031 and 0.023, respectively). Stump was the only predictor of recanalization success (HR 0.158, 95% CI 0.041-0.612, P = 0.008), whereas procedural failure (OR 13.023, 95% CI 6.67-13.69, P = 0.002), incomplete revascularization (OR 9.71, 95% CI 2.93-5.59, P = 0.005), and total stent length (OR 6.02, 95% CI 1.55-11.93, P = 0.027) were three independent predictors of MACE.
  
  
  CONCLUSIONS
  PCI for CTO was unsafe in remote hospitals without CABG facilities. Paying attention to coronary perforation is important for successful procedures.
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China. chmengx@126.com
authors.forename: Shao-liang
authors.initials: SL
authors.lastname: Chen
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.forename: Jun-jie
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Song
authors.initials: S
authors.lastname: Lin
authors.forename: Zhong-sheng
authors.initials: ZS
authors.lastname: Zhu
authors.forename: Nai-liang
authors.initials: NL
authors.lastname: Tian
authors.forename: Zhi-zhong
authors.initials: ZZ
authors.lastname: Liu
authors.forename: Xue-wen
authors.initials: XW
authors.lastname: Sun
authors.forename: Ai-ping
authors.initials: AP
authors.lastname: Zhang
authors.forename: Feng
authors.initials: F
authors.lastname: Chen
authors.forename: Shi-qin
authors.initials: SQ
authors.lastname: Ding
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome