Management strategies in patients affected by chronic total occlusions: results from the Italian Registry of Chronic Total Occlusions.
BACKGROUND
Through contemporary literature, the optimal strategy to manage coronary chronic total occlusions (CTOs) remains under debate.


OBJECTIVE
The aim of the Italian Registry of Chronic Total Occlusions (IRCTO) was to provide data on prevalence, characteristics, and outcome of CTO patients according to the management strategy.


METHODS
The IRCTO is a prospective real world multicentre registry enrolling patients showing at least one CTO. Clinical and angiographic data were collected independently from the therapeutic strategy [optimal medical therapy (MT), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG)]; a comparative 1-year clinical follow-up was performed.


RESULTS
A total of 1777 patients were enrolled for an overall CTO prevalence of 13.3%. The adopted therapeutic strategies were as follows: MT in 826 patients (46.5%), PCI in 776 patients (43.7%), and CABG in the remaining 175 patients (9.8%). At 1-year follow-up, patients undergoing PCI showed lower rate of major adverse cardiac and cerebrovascular events (MACCE) (2.6% vs. 8.2% and vs. 6.9%; P < 0.001 and P < 0.01) and cardiac death (1.4% vs. 4.7% and vs. 6.3%; P < 0.001 and P < 0.001) in comparison with those treated with MT and CABG, respectively. After propensity score-matching analysis, patients treated with PCI showed lower incidence of cardiac death (1.5 vs. 4.4%; P < 0.001), acute myocardial infarction (1.1 vs. 2.9%; P = 0.03), and re-hospitalization (2.3 vs. 4.4% P = 0.04) in comparison with those managed by MT.


CONCLUSIONS
Our data showed how CTO PCI might significantly improve the survival and decrease MACCE occurrence at 1 year follow-up in comparison with MT and/or CABG.
Ospedale Cannizzaro, Università di Catania, Via Antonello da Messina 75, Acicastello, 95021 Catania, Italy.
Salvatore D
SD
Tomasello
Ospedale Cannizzaro, Università di Catania, Via Antonello da Messina 75, Acicastello, 95021 Catania, Italy.
Marouane
M
Boukhris
Ospedale Cannizzaro, Università di Catania, Via Antonello da Messina 75, Acicastello, 95021 Catania, Italy.
Simona
S
Giubilato
Ospedale Cannizzaro, Università di Catania, Via Antonello da Messina 75, Acicastello, 95021 Catania, Italy.
Francesco
F
Marzà
Ospedale G. Bosco, Torino, Italy.
Roberto
R
Garbo
Casa Di Cura S. Maria, Bari, Italy.
Gaetano
G
Contegiacomo
Policlinico S. Orsola Malpigli, Bologna, Italy.
Antonio
A
Marzocchi
Ospedale Policlinico Gemelli, Roma, Italy.
Giampaolo
G
Niccoli
Ospedale Degli Infermi, Rivoli, Italy.
Andrea
A
Gagnor
Ospedale Degli Infermi, Rivoli, Italy.
Ferdinando
F
Varbella
Ospedale S. Giacomo, Castelfranco, Veneto Genova, Italy.
Alessandro
A
Desideri
Ospedale Villa Scassi, Genova, Italy.
Paolo
P
Rubartelli
Casa di Cura Montevergine, Mercogliano, Italy.
Angelo
A
Cioppa
Ospedale S. Croce e Carle, Cuneo, Italy.
Giorgio
G
Baralis
Ospedale Cannizzaro, Università di Catania, Via Antonello da Messina 75, Acicastello, 95021 Catania, Italy argalassi@gmail.com.
Alfredo R
AR
Galassi
D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002908:Chronic Disease; D017023:Coronary Angiography / Q000401:mortality; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data; D054059:Coronary Occlusion / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000628:therapy
D002317:Cardiovascular Agents
CABG; Chronic total occlusion; Optimal medical therapy; PCI; Registry