title: Successful recanalisation of isolated chronic total occlusions improves outcomes in long-term observation: a case-control study.
abstract: OBJECTIVE
  The long-term benefit of percutaneous recanalisation of chronic total occlusion (CTO) is still unclear. Given advances in interventional cardiology over the last two decades, we sought to investigate whether a successful percutaneous coronary intervention for CTO (PCI-CTO) improves outcomes in an age- and gender-matched single-centre cohort of stable angina patients.
  
  
  METHODS
  Out of 401 consecutive patients enrolled to the CTO-Registry database, 276 patients were included in the final analysis. Patients with unsuccessful PCI-CTO (n = 138) were age- and gender-matched in a 1:1 ratio with patients who underwent a successful procedure. The primary end-points included hard end-points comprising death and nonfatal myocardial infarction (MI) and a composite safety outcome measure of death, nonfatal MI and ischaemia-driven revascularisation. The secondary end-point was improvement in angina status or complete resolution of angina symptoms. Patients were followed up for six months and at two years.
  
  
  RESULTS
  Patients who underwent a successful recanalisation of CTO, compared to those who underwent an unsuccessful procedure, revealed similar rates of composite death and MI at six months (0.7% vs. 1.4%; hazard ratio [HR], 0.50; 95% confidence interval ratio [CI], 0.05-4.80; p = 0.56) and two years (1.4% vs. 5.8%; HR 0.24; 95% CI 0.07-0.85; p = 0.053). A significant difference in composite safety end-points between subsets, although not recorded after six months of observation (8.7% vs. 15.2%; HR 0.54; 95% CI 0.27-1.07; p = 0.095), was noted at two years follow-up (15.2% vs. 29.7%; HR 0.47; 95% CI 0.29-0.77; p = 0.004). A greater improvement in symptom burden or resolution of angina symptoms was documented after a successful PCI at both six months (68.1% vs. 23.2%, p < 0.001; 80.4% vs. 34.8%, p < 0.001, respectively) and two years (52.2% and 8.0%, p < 0.001; 68.1% vs. 22.5%, p < 0.001, respectively).
  
  
  CONCLUSIONS
  Successful recanalisation of CTO improves outcomes in long-term observation.
authors.affiliation: 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland. cedario@o2.pl.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Ciećwierz
authors.forename: Miłosz
authors.initials: M
authors.lastname: Jaguszewski
authors.forename: Marcin
authors.initials: M
authors.lastname: Fijałkowski
authors.forename: Radosław
authors.initials: R
authors.lastname: Targoński
authors.forename: Emilia
authors.initials: E
authors.lastname: Masiewicz
authors.forename: Maciej
authors.initials: M
authors.lastname: Duda
authors.forename: Natasza
authors.initials: N
authors.lastname: Gilis-Siek
authors.forename: Aneta
authors.initials: A
authors.lastname: Stróżyk
authors.forename: Michal
authors.initials: M
authors.lastname: Chmielecki
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Lewicki
authors.forename: Witold
authors.initials: W
authors.lastname: Dubaniewicz
authors.forename: Marcin
authors.initials: M
authors.lastname: Gruchala
authors.forename: Andrzej
authors.initials: A
authors.lastname: Rynkiewicz
mesh_terms: D060050:Angina, Stable / Q000453:epidemiology / Q000517:prevention & control; D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention; D015996:Survival Rate; D016896:Treatment Outcome