title: Successful versus unsuccessful antegrade recanalization of single chronic coronary occlusion: eight-year experience and outcomes by a propensity score ascertainment.
abstract: OBJECTIVE
  The effectiveness of revascularization of chronic total occlusion (CTO) remains intriguing. Thus, we sought to investigate whether a successful PCI for single CTO improves outcomes in a setting of stable angina and chronic occlusion of single coronary artery.
  
  
  RESULTS
  Of 11 957 consecutive patients referred for nonurgent PCI between 2003 and 2010, 1110 displayed single CTO and were enrolled to the central CTO-registry database. The primary end-point included all-cause mortality, the secondary end-point a composite of safety outcome measure of all-cause death, nonfatal-MI, the need for urgent revascularization and stroke. The major adverse cardiovascular event (MACE) records were extracted from the national administrative database and all patients were linked to the long-term follow-up. Since the patient assignment was not random, we performed the propensity scoring to minimize selection bias; 734 patients (66%) had a successful PCI-CTO. Compared with successful procedures, unsuccessful procedures had similar rates of all-cause death both in crude (HR, 0.78; 95%CI, 0.49-1.25; P = 0.30) and adjusted analysis (HR, 0.80; 95%CI, 0.50-1.28; P = 0.34). A similar, significant reduction in overall MACE was noted with successful PCI-CTO compared with unsuccessful procedure in unadjusted (HR, 0.74; 95%CI, 0.56-0.96; P = 0.020) and adjusted calculation (HR, 0.73; 95%CI, 0.56-0.96; P = 0.019). Patients after successful PCI-CTO as compared with failed recanalization less frequently underwent surgical revascularization. The benefit was sustained at 3 years follow-up.
  
  
  CONCLUSIONS
  Successful PCI for single CTO does not improve long-term survival, nonetheless, is associated with reduced overall MACE and the need for surgical revascularization.
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.|Department of Cardiology, Campus Benjamin Franklin, Charite, Berlin, Germany.
authors.forename: Milosz
authors.initials: M
authors.lastname: Jaguszewski
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Ciecwierz
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.
authors.forename: Natasza
authors.initials: N
authors.lastname: Gilis-Malinowska
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Fijalkowski
authors.affiliation: Cardiology, Pomeranian Cardiology Centres, Gdansk, Poland.
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Targonski
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.
authors.forename: Emilia
authors.initials: E
authors.lastname: Masiewicz
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.
authors.forename: Aneta
authors.initials: A
authors.lastname: Strozyk
authors.affiliation: Department of Cardiac Surgery, Medical University of Gdansk, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Duda
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Chmielecki
authors.affiliation: Cardiology, Pomeranian Cardiology Centres, Gdansk, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Lewicki
authors.affiliation: Cardiology, Pomeranian Cardiology Centres, Gdansk, Poland.
authors.forename: Witold
authors.initials: W
authors.lastname: Dubaniewicz
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.
authors.forename: Slawomir
authors.initials: S
authors.lastname: Burakowski
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Drewla
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Skarzynski
authors.affiliation: Cardiology, Pomeranian Cardiology Centres, Gdansk, Poland.|Department of Cardiology and Cardiac Surgery, University of Warmia and Mazury, Olsztyn, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Rynkiewicz
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Alibegovic
authors.affiliation: Department of Cardiology, Campus Benjamin Franklin, Charite, Berlin, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.affiliation: Department of Cardiology, Medical University of Gdansk, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Gruchala
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D057216:Propensity Score; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: major adverse cardiovascular event; percutaneous coronary intervention; single chronic total occlusion