title: Predictors of cardiac death in patients with coronary chronic total occlusion not revascularized by PCI.
abstract: BACKGROUND
  Limited data are available on clinical outcome of patients with previously failed or not attempted chronic total occlusion (CTO) recanalization by percutaneous coronary intervention (PCI). The aim of the study is to determine prevalence and predictors of cardiac death in patients with CTO not revascularized by PCI.
  
  
  METHODS
  Double-center study analyzing data of 1.345 consecutive patients with at least one CTO between 1998 and 2008. Of these, 847 patients were successfully revascularized (Revascularized group) and 498 patients were not revascularized (Not revascularized group) either due to failure of CTO-PCI (n=337) or because no attempt was made (n=161).
  
  
  RESULTS
  At 4-year clinical follow-up, Not revascularized patients had a significantly higher rate of cardiac mortality (8.5% vs. 2.5%, p<0.0001) and sudden cardiac death (2.7% vs. 0.5%, p=0.001) compared to those Revascularized. The separate adjusted Cox-model analysis made for Not revascularized patients showed the most significant independent predictors of cardiac death were: chronic renal failure [HR (CI), 6.0 (2.66-13.80)], low-LVEF [5.7 (2.84-11.58)], insulin-dependent diabetes mellitus (IDDM) 4.6 [(1.96-10.97)]. In the Revascularized group, the presence of 3-vessel disease was the only significant independent predictor of cardiac death [4.4 (1.40-13.70)].
  
  
  CONCLUSIONS
  CTO patients Not revascularized had a significant higher rate of cardiac mortality and sudden cardiac death compared to those Revascularized. Within Not revascularized patients, the presence of low-LVEF, or CRF or IDDM was associated with an incidence of cardiac death at least 4 times higher than those without the same risk factors.
authors: Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy. Electronic address: cosmogodino@gmail.com.
authors: Cosmo
authors: C
authors: Godino
authors: Giorgio
authors: G
authors: Bassanelli
authors: Fotios I
authors: FI
authors: Economou
authors: Kensuke
authors: K
authors: Takagi
authors: Marco
authors: M
authors: Ancona
authors: Stefano
authors: S
authors: Galaverna
authors: Antonio
authors: A
authors: Mangieri
authors: Valeria
authors: V
authors: Magni
authors: Azeem
authors: A
authors: Latib
authors: Alaide
authors: A
authors: Chieffo
authors: Mauro
authors: M
authors: Carlino
authors: Matteo
authors: M
authors: Montorfano
authors: Alberto
authors: A
authors: Cappelletti
authors: Alberto
authors: A
authors: Margonato
authors: Antonio
authors: A
authors: Colombo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality* / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000401:mortality* / Q000639:trends; D011237:Predictive Value of Tests; D016896:Treatment Outcome
keywords: CTO not attempted; CTO not revascularized; Cardiac death; Chronic total occlusion; Sudden death