title: The impact of right coronary artery chronic total occlusion on clinical outcome of patients undergoing percutaneous coronary intervention for unprotected left main disease.
abstract: OBJECTIVE
  The aim of the present study was to investigate whether right coronary artery chronic total occlusion (CTO) carries prognostic implications in patients undergoing drug-eluting stent-supported percutaneous coronary intervention (PCI) for unprotected left main disease (ULMD).
  
  
  BACKGROUND
  No data exist on the prognostic implication of CTO in patients undergoing PCI for ULMD.
  
  
  METHODS
  Prospective registry of consecutive patients undergoing PCI for ULMD. Patients with ST-segment elevation myocardial infarction were excluded. Primary endpoints were 6-month and long-term cardiac mortality.
  
  
  RESULTS
  From January 2004 to December 2009, 330 patients underwent PCI for ULMD. Of the 330 patients, 78 (24%) had CTO of the right coronary artery, 22 (7%) had CTO of the left anterior descending artery, and 16 (5%) had CTO of the left circumflex artery. Patients with right coronary artery CTO had a higher risk profile compared with patients without right coronary artery CTO. The 6-month mortality rate was 12.8% in patients with right coronary artery CTO, and 3.6% in patients without right coronary artery CTO (p < 0.002), and the 3-year cardiac survival rate was 76.4 ± 6.8% and 89.7 ± 2.7% (p < 0.003), respectively. By multivariable analysis, the only 2 independent predictors of 3-year cardiac mortality were right coronary artery CTO (hazard ratio: 2.15, 95% confidence interval: 1.02 to 4.50; p = 0.043) and EuroSCORE (hazard ratio: 1.03, 95% confidence interval: 1.02 to 1.05; p < 0.001).
  
  
  CONCLUSIONS
  Right coronary artery CTO occurs frequently and is a significant predictor of mortality in patients with ULMD undergoing PCI.
authors: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors: Angela
authors: A
authors: Migliorini
authors: Renato
authors: R
authors: Valenti
authors: Guido
authors: G
authors: Parodi
authors: Piergiovanni
authors: P
authors: Buonamici
authors: Giampaolo
authors: G
authors: Cerisano
authors: Nazario
authors: N
authors: Carrabba
authors: Ruben
authors: R
authors: Vergara
authors: David
authors: D
authors: Antoniucci
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology* / Q000601:surgery; D003402:Creatine Kinase / Q000378:metabolism; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome
chemical_list: D003402:Creatine Kinase