title: Improved cardiac survival, freedom from MACE and angina-related quality of life after successful percutaneous recanalization of coronary artery chronic total occlusions.
abstract: BACKGROUND
  Most percutaneous recanalizations of coronary artery chronic total occlusion (CTO) are not attempted because of the skepticism on their long-term clinical benefit. We assessed the effect of percutaneous CTO recanalization procedures on long-term cardiac survival, freedom from MACE and angina-related quality of life (AQL).
  
  
  METHODS
  All consecutive patients who underwent attempt of percutaneous native coronary artery CTO recanalization between 2003 and 2009 were included in the study. MACE was defined as combined cardiac death, myocardial infarction (MI) and target vessel revascularization (TVR). AQL was assessed by the Seattle Angina Questionnaire-UK-version (SAQ-UK).
  
  
  RESULTS
  Among 302 patients who received an attempt of percutaneous CTO recanalization, 237 (78%) had a successful procedure while in 65 (22%) the procedure failed. Overall intra-hospital complication rate was 3.0%, with no difference between the two groups. Median follow-up was 4.0 years, during which 13 patients had a fatal cardiac event. Patients in whom the CTO recanalization procedure failed had a higher risk of cardiac death (HR 3.39; 95% CI 1.14-10.1;p=0.03; after propensity score adjustment, HR 2.83; 95% CI 0.89-8.96;p=0.07) and MACE (HR 5.40; 95% CI 2.71-10.5;p<0.001; adjusted HR 3.34; 95% CI 1.47-7.58;p=0.003) compared to patients with successful procedure. CTO recanalization significantly improved the AQL during follow-up: patients with successful procedure experienced less physical activity limitation (p=0.01), rarer angina episodes (p<0.001) and greater treatment satisfaction (p=0.03) compared to patients with failed procedure.
  
  
  CONCLUSIONS
  Patients with successful CTO recanalization had a trend towards better cardiac survival and significant lower risk of MACE and improvement of AQL compared to patients with failed procedures.
authors: Royal Brompton Hospital & Imperial College, London, UK.
authors: Francesco
authors: F
authors: Borgia
authors: Nicola
authors: N
authors: Viceconte
authors: Omar
authors: O
authors: Ali
authors: Claire
authors: C
authors: Stuart-Buttle
authors: Anjana
authors: A
authors: Saraswathyamma
authors: Rosario
authors: R
authors: Parisi
authors: Francesca
authors: F
authors: Mirabella
authors: Konstantinos
authors: K
authors: Dimopoulos
authors: Carlo
authors: C
authors: Di Mario
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000401:mortality* / Q000601:surgery*; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011788:Quality of Life; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome