title: Long-term follow-up of elective chronic total coronary occlusion angioplasty: analysis from the U.K. Central Cardiac Audit Database.
abstract: BACKGROUND
  Chronic total occlusion (CTO) is common, being reported in 18% to 30% of patients undergoing coronary angiography. Percutaneous coronary intervention (PCI) is usually performed to relieve anginal symptoms, but data are emerging to suggest that there may also be a mortality benefit.
  
  
  OBJECTIVE
  This study aimed to compare outcomes of patients with successful versus unsuccessful PCI to a CTO.
  
  
  METHODS
  We analyzed the U.K. Central Cardiac Audit Database for all CTO PCI cases carried out in England and Wales between January 1, 2005, and December 31, 2009. Vital status in September 2010 was obtained from the Medical Research Information Service.
  
  
  RESULTS
  A total of 13,443 patients (78.8% male) had a mean age of 63.5 years and underwent 14,439 CTO procedures. CTO PCI was successful in 10,199 cases (70.6%). During follow-up of 2.65 years (interquartile range: 1.59 to 3.83 years), successful PCI of at least 1 CTO was associated with improved survival (hazard ratio [HR]: 0.72; 95% CI: 0.62 to 0.83; p < 0.001). Complete revascularization was associated with improved survival compared with partial revascularization (HR: 0.70; 95% CI: 0.56 to 0.87; p = 0.002) or failed revascularization (HR: 0.61; 95% CI: 0.50 to 0.74; p < 0.001).
  
  
  CONCLUSIONS
  Successful CTO PCI was associated with improved long-term survival. The improvement was greatest in patients when complete revascularization was achieved. The identity of the successfully treated occluded vessel was not associated with differences in outcome.
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom. Electronic address: sudhakargeorge@gmail.com.
authors.forename: Sudhakar
authors.initials: S
authors.lastname: George
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Cockburn
authors.affiliation: London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Tim C
authors.initials: TC
authors.lastname: Clayton
authors.affiliation: University Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: Heart and Lung Centre, Wolverhampton, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Cotton
authors.affiliation: Edinburgh Royal Infirmary, Edinburgh, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Spratt
authors.affiliation: King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, Rayne Institute, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.affiliation: James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: de Belder
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: de Belder
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hill
authors.affiliation: Hull and East Yorkshire Hospitals, Yorkshire, United Kingdom.
authors.forename: Angela
authors.initials: A
authors.lastname: Hoye
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Palmer
authors.affiliation: Frimley Park Hospital and St. George's Hospital, Surrey, United Kingdom.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Rathore
authors.affiliation: NIHR Cardiovascular Biomedical Unit, University Hospitals of Leicester, Leicester, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Gershlick
authors.affiliation: NIHR Cardiovascular Biomedical Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000639:trends*; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D016208:Databases, Factual / Q000639:trends*; D017558:Elective Surgical Procedures / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000639:trends*; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000639:trends; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: chronic total occlusions; percutaneous coronary intervention; registry