title: Medical therapy, percutaneous coronary intervention and prognosis in patients with chronic total occlusions.
abstract: OBJECTIVE
  There is little published data reporting outcomes for those found to have a chronic total coronary occlusion (CTO) that is electively treated medically versus those treated by percutaneous coronary intervention (PCI). We sought to compare long-term clinical outcomes between patients treated by PCI and elective medical therapy in a consecutive cohort of patients with an identified CTO.
  
  
  METHODS
  Patients found to have a CTO on angiography between January 2002 and December 2007 in a single tertiary centre were identified using a dedicated database. Those undergoing CTO PCI and elective medical therapy to the CTO were propensity matched to adjust for baseline clinical and angiographic differences.
  
  
  RESULTS
  In total, 1957 patients were identified, a CTO was treated by PCI in 405 (20.7%) and medical therapy in 667 (34.1%), 885 (45.2%) patients underwent coronary artery bypass graft surgery. Of those treated by PCI or medical therapy, propensity score matching identified 294 pairs of patients, PCI was successful in 177 patients (60.2%). All-cause mortality at 5 years was 11.6% for CTO PCI and 16.7% for medical therapy HR 0.63 (0.40 to 1.00, p=0.052). The composite of 5-year death or myocardial infarction occurred in 13.9% of the CTO PCI group and 19.6% in the medical therapy group, HR 0.64 (0.42 to 0.99, p=0.043). Among the CTO PCI group, if the CTO was revascularised by any means during the study period, 5-year mortality was 10.6% compared with 18.3% in those not revascularised in the medical therapy group, HR 0.50 (0.28-0.88, p=0.016).
  
  
  CONCLUSIONS
  Revascularisation, but not necessarily PCI of a CTO, is associated with improved long-term survival relative to medical therapy alone.
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull, UK Department of Health Sciences, Hull York Medical School, York, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ladwiniec
authors.affiliation: Department of Health Sciences, Hull York Medical School, York, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Allgar
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Thackray
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull, UK.
authors.forename: Farquad
authors.initials: F
authors.lastname: Alamgir
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull, UK Department of Health Sciences, Hull York Medical School, York, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Hoye
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D017558:Elective Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D009204:Myocardial Revascularization / Q000379:methods / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology