title: Does occlusion duration influence procedural and clinical outcome of patients who underwent percutaneous coronary intervention for chronic total occlusion?
abstract: BACKGROUND
  Previous studies have reported that the indeterminable aging and long-duration occlusion are associated with procedural failure and adverse long-term outcome. We aimed to investigate the clinical impact of occlusion duration in a consecutive series of patients who underwent percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions.
  
  
  RESULTS
  From October 2005 to June 2009, a total of 303 patients with 328 CTO lesions were consecutively treated achieving a success rate of 86.3%. The average of occlusion duration estimated in 62.5% of cases (known occlusion duration [KOD] patients, n = 188) was 29.8 ± 41.3 months. In the remaining 37.5% of cases, the occlusion duration was indeterminate (indetermination of occlusion duration [IOD] patients, n = 115). No influence of duration in procedural outcome was observed. Moreover, no differences of 1-year major adverse cardiac events (MACE) were observed between KOD and IOD patients. The multivariate COX regression analysis identified diabetes mellitus and multivessel coronary disease as independent predictors of 12-month MACE (HR 5.023; 95% CI 0.164-9.653; P = 0.025 and HR 0.801; 95% CI 0.109-0.909, P = 0.033). The analysis did not show any influence of IOD and long occlusion duration in the occurrence of MACE. Predictors of angiographic failure recognized with multivariate binary logistic were vessel diameter <2.5 mm (OR 5.3; 95% CI 1.19-8.91; P = 0.02), CTO length >20 mm (OR 6.3; 95% CI 1.22-9.54; P = 0.02), and severe calcification (OR 3.2; 95% CI 1.62-5.51; P = 0.03).
  
  
  CONCLUSIONS
  IOD and long duration of CTO do not affect procedural and clinical outcome of patients who underwent CTO PCI. This marks the importance of considering PCI treatment, a reliable strategy in cases of IOD or long occlusion duration.
authors.affiliation: Department of Internal Medicine and Systemic Disease, Clinical Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy. davtomasello@gmail.com
authors.forename: Salvatore D
authors.initials: SD
authors.lastname: Tomasello
authors.forename: Luca
authors.initials: L
authors.lastname: Costanzo
authors.forename: Maria B
authors.initials: MB
authors.lastname: Campisano
authors.forename: Giombattista
authors.initials: G
authors.lastname: Barrano
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Alfredo R
authors.initials: AR
authors.lastname: Galassi
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome