Impact of target vessel on long-term survival after percutaneous coronary intervention for chronic total occlusions.
BACKGROUND
This study sought to investigate whether there is a differential prognostic effect of successful percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) according to the target vessel the CTO is located in.


METHODS
Between 1998 and 2007, a total of 1,791 patients underwent PCI of a CTO at three tertiary care centers in the US, Italy, and South Korea. Patients with CTOs in multiple target vessels or the left main stem were excluded (n = 57). Of the remaining 1,734 patients, 609 had a CTO in the left anterior descending (LAD, 35.1%), 391 in the left circumflex (LCX, 22.5%), and 734 in the right coronary artery (RCA, 42.3%). Five-year mortality and the need for coronary artery bypass grafting (CABG) were compared between patients with successful vs. unsuccessful PCI stratified by target vessel.


RESULTS
Procedural success was obtained in 71.1% of LAD patients, 69.1% of LCX patients, and 65.1% of RCA patients (P = 0.06). The mean follow-up duration was 1,178 days. Kaplan-Meier estimates of long-term mortality were 6.7% vs. 11.0% (P = 0.03), 5.5% vs. 13.9% (P < 0.01), and 6.6% vs. 4.1% (P = 0.80) in successful vs. unsuccessful LAD, LCX, and RCA patients, respectively. After multivariate analysis, successful CTO PCI remained associated with lower mortality in the LAD (HR 0.41, P = 0.02) and LCX groups (HR 0.32, P < 0.01). The need for CABG was lower after successful CTO PCI in all three groups (LAD 4.6% vs. 16.0%, P < 0.01; LCX 2.9% vs. 18.2%, P < 0.01, RCA 2.3% vs. 8.4%, P < 0.01).


CONCLUSIONS
The results from this large contemporary cohort of patients suggest that successful PCI of a CTO in the LAD and the LCX, but not the RCA, is associated with improved long-term survival.
Cardiovascular Research Foundation, New York, New York 10029, USA.
Bimmer E
BE
Claessen
George D
GD
Dangas
Cosmo
C
Godino
José P S
JP
Henriques
Martin B
MB
Leon
Seung-Jung
SJ
Park
Gregg W
GW
Stone
Jeffrey W
JW
Moses
Antonio
A
Colombo
Roxana
R
Mehran
D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D056910:Republic of Korea; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States