title: Long-term clinical outcomes after successful and failed recanalization to native chronic Total occlusion: Insights from the Busan chronic Total occlusion (B-CTO) Registry.
abstract: OBJECTIVE
  To assess hard major adverse clinical events (HMACE) after successful versus failed percutaneous coronary intervention for chronic total occlusion (PCI-CTO).
  
  
  BACKGROUND
  There are limited data regarding long-term HMACE risks based on PCI-CTO success.
  
  
  METHODS
  First-time PCI was performed in 438 consecutive patients with 473 target CTO lesions. Patients after procedural success (n=355; 378 CTO lesions) and failure (n=83; 95 CTO lesions) were followed for an average 40months (7-77months range). We compared HMACE (composite of cardiac death, non-fatal myocardial infarction (MI), and stroke) dependent on the success of PCI.
  
  
  RESULTS
  The incidence of HMACE was low, with a total of 16 events, and did not differ {6% vs.3.1%, HR=0.47; CI [0.16-1.35; p=0.162} dependent on the success of PCI-CTO. There were less cardiac deaths {0.3% vs. 1.2%, RR=0.22; CI [0.01-3.50];p=0.283}, non fatal MI {1.1% vs.3.6%, RR=0.27; CI [0.06-1.22], p=0.089}, but more strokes {1.7% vs.1.2%, RR=1.32; CI [0.16-10.99], p=0.795} after successful PCI-CTO.
  
  
  CONCLUSIONS
  The risks of HMACE after PCI-CTO over long-term follow-up were minimal, and do not depend on the procedure success. This unexpected finding somewhat challenge the aggressive interventional approach, and should be confirmed in the adequately powered randomized trial.
authors.affiliation: Department of Cardiology, College of Medicine, Dong-A University, Busan, Republic of Korea; Global Clinical Trial Center, Dong-A University Hospital, Busan, Republic of Korea. Electronic address: kimmh@dau.ac.kr.
authors.forename: Moo Hyun
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Kurashiki General Hospital, Okayama, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
authors.affiliation: Department of Cardiology, College of Medicine, Dong-A University, Busan, Republic of Korea; Global Clinical Trial Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Cai De
authors.initials: CD
authors.lastname: Jin
authors.affiliation: Global Clinical Trial Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Tae Hyung
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: Young-Rak
authors.initials: YR
authors.lastname: Cho
authors.affiliation: Department of Cardiology, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: Jong-Sung
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Cardiology, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: Kyungil
authors.initials: K
authors.lastname: Park
authors.affiliation: Department of Cardiology, College of Medicine, Dong-A University, Busan, Republic of Korea.
authors.forename: Tae-Ho
authors.initials: TH
authors.lastname: Park
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Serebruany
mesh_terms: D000368:Aged; D002423:Cause of Death; D016009:Chi-Square Distribution; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D017211:Treatment Failure
keywords: chronic total occlusion; long-term outcome; registry; successful recanalization