title: Recanalization of isolated chronic total occlusions in patients with stable angina.
abstract: BACKGROUND
  Despite procedural advances, recanalization of chronic total occlusions (CTOs) with percutaneous coronary intervention (PCI) remains controversial, particularly given that its long-term benefits are unclear. We assessed the association between successful PCI and symptom improvement as well as outcomes in patients with CTO and stable angina.
  
  
  METHODS
  We performed a retrospective study of 386 consecutive patients undergoing attempted PCI of an isolated CTO (i.e., no other angiographically-significant disease was present). We analyzed prospectively the change in Canadian Cardiovascular Society (CCS) classification system and occurrence of major adverse cardiovascular events (death, myocardial infarction or target vessel revascularization), after stratifying patients by procedural success. To understand which patients might benefit most from attempted PCI, multivariable models were constructed to predict: likelihood of successful PCI and symptom improvement, defined as resolution of angina or improvement of ≥ 2 CCS classes.
  
  
  RESULTS
  A total of 247 (64%) patients had successful PCI. Greater symptom improvement was noted after successful PCI at both 6 months (79.8% versus 34.5% with resolution of angina or improvement of ≥ 2 CCS classes, p<0.01) and 24 months (71.7% and 20.9%, respectively, p<0.01). No differences were noted in MACE (11.3% vs. 10.0% at 6 months, p=0.70; and 18.6% vs. 19.4% at 24 months, p=0.84). Multivariable analysis identified several factors associated with successful PCI, but not predictive of symptom improvement. In conclusion, successful PCI of an isolated CTO improves symptom burden, but is not associated with MACE at 6 or 24 months.
  
  
  CONCLUSIONS
  Several factors are associated with successful PCI, but identifying those most likely to have symptom improvement remains challenging.
authors.affiliation: First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland. milosz.jaguszewski@usz.ch
authors.forename: Milosz
authors.initials: M
authors.lastname: Jaguszewski
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Targonski
authors.forename: Marcin
authors.initials: M
authors.lastname: Fijalkowski
authors.forename: Emilia
authors.initials: E
authors.lastname: Masiewicz
authors.forename: Witold
authors.initials: W
authors.lastname: Dubaniewicz
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
authors.forename: Andrzej
authors.initials: A
authors.lastname: Koprowski
authors.forename: Dariusz
authors.initials: D
authors.lastname: Ciecwierz
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.forename: Andrzej
authors.initials: A
authors.lastname: Rynkiewicz
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies