title: Long-term outcome of percutaneous transluminal coronary intervention for chronic total occlusion in the BMS era in Japan.
abstract: To investigate the long-term outcome of Percutaneous transluminal intervention (PCI) for chronic total occlusion (CTO). The subjects were 606 patients (1,145 lesions) who were treated for CTO between January 1996 and December 2003 at our institution. Among them, 436 patients with early success and confirmed patency at the CTO by follow-up coronary angiography after 6 months were classified as the patent group (Group P), while 170 patients without early success or with occlusion on follow-up angiography were classified as the occluded group (Group O). In April 2006 (mean: 660 ± 602 days), the outcome of CTO was investigated and the major adverse cardiac events (MACE)-free rate was calculated. Multivariate analysis was performed to identify determinants of death. The early success rate was 76.4% before 2003 when Conquest guidewires were not available. However, it subsequently showed significant improvement to 89%. The cumulative survival rate was significantly higher for Group P (92%) than for Group O (64%) and the MACE-free rate (free from, death, bypass surgery, myocardial infarction, and revascularization) showed a similar trend. The cumulative survival rate of patients without myocardial viability in the territory of the vessel with CTO was significantly higher for Group P (88%) than for Group O (55%). The outcome was significantly worse for patients with occlusion of other vessels (90%) than for patients without additional occlusion (42%). It was significantly better when the left ventricular ejection fraction (LVEF) was ≥40% than when the LVEF was ≤40% (90 vs. 68%). Multivariate analysis identified occluded CTO, other vessel occlusion, low ejection fraction (EF), unimproved EF, and old age as determinants of death from CTO. If early success is obtained and patency is maintained, the long-term outcome after PCI for CTO is significantly better than when failure occurs Occluded CTO, other vessel occlusion, low EF, unimproved EF, and old age are important determinants of the outcome.
authors.affiliation: Saiseikai Yokohama-City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, Japan, t-mura@tj8.so-net.ne.jp.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.forename: Reiko
authors.initials: R
authors.lastname: Tsukahara
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishimori
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Nakano
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Sasao
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sakai
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamawaki
authors.forename: Shinya
authors.initials: S
authors.lastname: Sasaki
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Moriyama
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Orita
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takimura
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Kazuki
authors.initials: K
authors.lastname: Komatsu