title: Impact of multivessel coronary disease on long-term outcome after percutaneous recanalization of coronary chronic total occlusions.
abstract: OBJECTIVE
  Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is common even with concomitant multivessel disease. We aimed to investigate the impact of multivessel disease on long-term outcome after PCI for CTO.
  
  
  METHODS
  We collected baseline, procedural and follow-up data on patients undergoing successful PCI with stenting for CTO. We divided our population into three groups: patients with 1 vessel disease (1VD), those with 2-vessel disease (2VD) and subjects with 3-vessel disease (3VD). The primary end-point was the occurrence of major adverse cardiac events (MACE), i.e. death, myocardial infarction or target vessel revascularization.
  
  
  RESULTS
  A total of 111 patients were included: 24 (21%) in group 1VD, 28 (25%) in group 2VD, and 59 (53%) in group 3VD. Clinical follow-up was available in 109 (98%) of them after a median of 27 months (range 6-68), yielding MACE rates of 1 (4%) in group 1VD, 5 (18%) in group 2VD, and 17 (29%) in group 3VD, respectively (P=0.03). No statistically significant difference was found comparing the 3 groups for the individual rates of death, myocardial infarction or target vessel revascularization (all P>0.05). No case of definite or probable stent thrombosis was adjudicated, despite use of DES in 99 (89%) patients.
  
  
  CONCLUSIONS
  Patients with diffuse coronary disease undergoing PCI for a CTO fare a significantly worse prognosis. Nonetheless, despite liberal use of DES, stent thrombosis is rare in this setting, without differences according to the initial severity of disease, thus supporting the long-term safety of DES, even if used in this "off-label" context.
authors.affiliation: Division of Cardiology, University of Turin, Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: La Spina
authors.forename: G
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: C
authors.initials: C
authors.lastname: Moretti
authors.forename: F
authors.initials: F
authors.lastname: Sciuto
authors.forename: P
authors.initials: P
authors.lastname: Omedè
authors.forename: M
authors.initials: M
authors.lastname: Bollati
authors.forename: R
authors.initials: R
authors.lastname: Siliquini
authors.forename: S
authors.initials: S
authors.lastname: Chiadò
authors.forename: G P
authors.initials: GP
authors.lastname: Trevi
authors.forename: I
authors.initials: I
authors.lastname: Sheiban
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000150:complications; D023921:Coronary Stenosis / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome