title: Percutaneous coronary intervention to treat chronic total occlusion: predictors of technical success and one-year clinical outcome.
abstract: We investigated the overall success rate of percutaneous coronary intervention (PCI) as a treatment for coronary chronic total occlusion and sought to determine the predictive factors of technical success and of one-year major adverse cardiac events (MACE). These factors have not been conclusively defined. Using data from our single-center PCI registry, we enrolled 269 consecutive patients (mean age, 56.13 ± 10.72 yr; 66.2% men) who underwent first-time PCI for chronic total occlusion (duration, ≥3 mo) from March 2006 through September 2010. We divided them into 2 groups: procedural success and procedural failure. We compared occurrences of in-hospital sequelae and one-year MACE between the groups, using multivariate models to determine predictors of technical failure and one-year clinical outcome. Successful revascularization was achieved in 221 patients (82.2%). One-year MACE occurred in 13 patients (4.8%), with a predominance of target-vessel revascularization (3.7%). The prevalence of MACE was significantly lower in the procedural-success group (1.8% vs 18.8%; P <0.001). In the multivariate model, technical failure was the only predictor of one-year MACE. The predictors of failed procedures were lesion location, multivessel disease, the occurrence of dissection, a Thrombolysis In Myocardial Infarction flow grade of 0 before PCI, the absence of tapered-stump arterial structure, and an increase in serum creatinine level or lesion length. In our retrospective, observational study, PCI was successful in a high percentage of chronic total occlusion patients and had a low prevalence of complications. This suggests its safety and effectiveness as a therapeutic option.
authors: Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
authors: Mojtaba
authors: M
authors: Salarifar
authors: Mohammad-Reza
authors: MR
authors: Mousavi
authors: Sepideh
authors: S
authors: Saroukhani
authors: Ebrahim
authors: E
authors: Nematipour
authors: Seyed Ebrahim
authors: SE
authors: Kassaian
authors: Mohammad
authors: M
authors: Alidoosti
authors: Hamid-Reza
authors: HR
authors: Poorhosseini
authors: Ali-Mohammad
authors: AM
authors: Haji-Zeinali
authors: Younes
authors: Y
authors: Nozari
authors: Kianoush
authors: K
authors: Hosseini
authors: Arash
authors: A
authors: Jalali
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D007492:Iran; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome