title: Long-term clinical outcomes of successful versus unsuccessful revascularization with drug-eluting stents for true chronic total occlusion.
abstract: OBJECTIVE
  The aims of this study were to investigate the long-term clinical outcomes of patients with successful versus unsuccessful revascularization with drug-eluting stents (DES) for chronic total occlusion (CTO).
  
  
  BACKGROUND
  The benefits of successful revascularization of CTO remain unclear.
  
  
  METHODS
  Consecutive patients (n = 333) with "true" CTO, defined as Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 on angiography and duration ≥3 months, were divided into two groups, those with successful (CTO success group, n = 251) and unsuccessful (CTO failure group, n = 82) revascularization with DES for CTO lesions. The primary endpoint was defined as major adverse cardiac events (MACE) the composite of death, Q-wave myocardial infarction (MI), or target vessel revascularization (TVR).
  
  
  RESULTS
  The CTO success group was significantly younger, with a higher involvement of LAD, and lower incidences of renal failure, previous myocardial infarction, and previous coronary intervention than the CTO failure group. After a median follow up of 1,317 days (interquartile range, 1,059-1,590 days), there were no significant between-group differences in rate of MACE, both after crude analysis (9.4% vs. 11.8%, log-rank P = 0.16) and after adjustment (HR 1.17; 95% CI 0.47-2.88, P = 0.53). On multivariate analysis, major predictors of MACE were left ventricle ejection fraction (LVEF) <40% (HR 3.14; 95% CI 1.39-7.09, P = 0.005) and multiple CTO (HR 2.38; 95% CI 1.01-5.71, P = 0.049).
  
  
  CONCLUSIONS
  Long-term clinical outcomes were similar in the CTO success and failure groups. Multiple CTOs and LVEF <40% in CTO patients were independent predictors of MACE.
authors: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Seung-Whan
authors: SW
authors: Lee
authors: Jong-Young
authors: JY
authors: Lee
authors: Duk-Woo
authors: DW
authors: Park
authors: Young-Hak
authors: YH
authors: Kim
authors: Sung-Cheol
authors: SC
authors: Yun
authors: Won-Jang
authors: WJ
authors: Kim
authors: Jon
authors: J
authors: Suh
authors: Yoon Hang
authors: YH
authors: Cho
authors: Nae-Hee
authors: NH
authors: Lee
authors: Soo-Jin
authors: SJ
authors: Kang
authors: Cheol Whan
authors: CW
authors: Lee
authors: Seong-Wook
authors: SW
authors: Park
authors: Seung-Jung
authors: SJ
authors: Park
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017023:Coronary Angiography; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D057216:Propensity Score; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013927:Thrombosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D017211:Treatment Failure; D016277:Ventricular Function, Left