title: Long-term outcome of percutaneous coronary intervention for chronic total occlusions.
abstract: OBJECTIVE
  The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).
  
  
  BACKGROUND
  Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO.
  
  
  METHODS
  We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years).
  
  
  RESULTS
  Procedural success was obtained in 1,226 (68%) patients. Stents were implanted in 1,160 patients (95%); 396 patients (34%) received bare-metal stents (BMS), and 764 patients (66%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.21 to 0.75, p < 0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95% CI: 0.13 to 0.40, p < 0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2% vs. 31.1%, p < 0.01); definite/probable stent thrombosis rates were similar (DES 1.7%, BMS 2.3%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes.
  
  
  CONCLUSIONS
  Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes.
authors.affiliation: Mount Sinai Medical Center and the Cardiovascular Research Foundation, New York, New York 10029, USA. rmehran@crf.org
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Bimmer E
authors.initials: BE
authors.lastname: Claessen
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Kotaro
authors.initials: K
authors.lastname: Obunai
authors.forename: Sunil
authors.initials: S
authors.lastname: Kanwal
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: José P S
authors.initials: JP
authors.lastname: Henriques
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009519:New York City; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals