title: Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Interventions: Characteristics, Success, and Outcomes.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) has been identified as a beneficial treatment, but there is limited information about its use in everyday practice.
  
  
  RESULTS
  Data from New York's PCI registry between July 1, 2009, and June 30, 2012, were used to examine the utilization and variation in use of CTO PCI, the success rates across providers, the multivariable correlates of success, and the mortality of successful CTO PCI. A total of 4030 (3.1%) patients undergoing PCI underwent CTO PCI with a success rate of 61.3%. Patients with successful CTO PCIs were younger; had higher ejection fractions; were less likely to have had previous revascularization or carotid/cerebrovascular disease; and were more likely to have the CTO in the left anterior descending artery. Operators with annual CTO PCI volumes of at least 48 per year (the top volume quartile) had odds of achieving success that were more than twice as high as the half of all operators who performed <9 CTO PCIs per year. Patients with unsuccessful CTO PCIs had significantly higher 2.5-year mortality (adjusted hazard ratio, 1.63; 95% confidence interval, 1.28-2.08) than patients who had complete revascularization (CR) for all CTOs and other diseased lesions.
  
  
  CONCLUSIONS
  The success rate for CTO is low compared with the rate for other lesions. Successful revascularization of CTO is associated with improved survival compared with procedures with unsuccessful CTO, and higher-volume CTO operators are more successful.
authors.affiliation: From the Department of Health Policy, Management, and Behavior, University at Albany, State University of New York (E.L.H., Y.Z.); Department of Cardiology, Boston Medical Center, MA (A.K.J.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Department of Cardiology, Northwell Health, Danville, PA (P.B.B.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (G.W.); Department of Cardiology, Mt Sinai Medical Center, New York, NY (S.S.); Department of Cardiology, Albany Medical Center, NY (F.J.V.); and Department of Cardiology, St Joseph's Health System, Atlanta, GA (S.B.K.). elh03@health.state.ny.us.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
authors.affiliation: From the Department of Health Policy, Management, and Behavior, University at Albany, State University of New York (E.L.H., Y.Z.); Department of Cardiology, Boston Medical Center, MA (A.K.J.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Department of Cardiology, Northwell Health, Danville, PA (P.B.B.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (G.W.); Department of Cardiology, Mt Sinai Medical Center, New York, NY (S.S.); Department of Cardiology, Albany Medical Center, NY (F.J.V.); and Department of Cardiology, St Joseph's Health System, Atlanta, GA (S.B.K.).
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhong
authors.affiliation: From the Department of Health Policy, Management, and Behavior, University at Albany, State University of New York (E.L.H., Y.Z.); Department of Cardiology, Boston Medical Center, MA (A.K.J.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Department of Cardiology, Northwell Health, Danville, PA (P.B.B.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (G.W.); Department of Cardiology, Mt Sinai Medical Center, New York, NY (S.S.); Department of Cardiology, Albany Medical Center, NY (F.J.V.); and Department of Cardiology, St Joseph's Health System, Atlanta, GA (S.B.K.).
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
authors.affiliation: From the Department of Health Policy, Management, and Behavior, University at Albany, State University of New York (E.L.H., Y.Z.); Department of Cardiology, Boston Medical Center, MA (A.K.J.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Department of Cardiology, Northwell Health, Danville, PA (P.B.B.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (G.W.); Department of Cardiology, Mt Sinai Medical Center, New York, NY (S.S.); Department of Cardiology, Albany Medical Center, NY (F.J.V.); and Department of Cardiology, St Joseph's Health System, Atlanta, GA (S.B.K.).
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Stamato
authors.affiliation: From the Department of Health Policy, Management, and Behavior, University at Albany, State University of New York (E.L.H., Y.Z.); Department of Cardiology, Boston Medical Center, MA (A.K.J.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Department of Cardiology, Northwell Health, Danville, PA (P.B.B.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (G.W.); Department of Cardiology, Mt Sinai Medical Center, New York, NY (S.S.); Department of Cardiology, Albany Medical Center, NY (F.J.V.); and Department of Cardiology, St Joseph's Health System, Atlanta, GA (S.B.K.).
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.affiliation: From the Department of Health Policy, Management, and Behavior, University at Albany, State University of New York (E.L.H., Y.Z.); Department of Cardiology, Boston Medical Center, MA (A.K.J.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Department of Cardiology, Northwell Health, Danville, PA (P.B.B.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (G.W.); Department of Cardiology, Mt Sinai Medical Center, New York, NY (S.S.); Department of Cardiology, Albany Medical Center, NY (F.J.V.); and Department of Cardiology, St Joseph's Health System, Atlanta, GA (S.B.K.).
authors.forename: Gary
authors.initials: G
authors.lastname: Walford
authors.affiliation: From the Department of Health Policy, Management, and Behavior, University at Albany, State University of New York (E.L.H., Y.Z.); Department of Cardiology, Boston Medical Center, MA (A.K.J.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Department of Cardiology, Northwell Health, Danville, PA (P.B.B.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (G.W.); Department of Cardiology, Mt Sinai Medical Center, New York, NY (S.S.); Department of Cardiology, Albany Medical Center, NY (F.J.V.); and Department of Cardiology, St Joseph's Health System, Atlanta, GA (S.B.K.).
authors.forename: Samin
authors.initials: S
authors.lastname: Sharma
authors.affiliation: From the Department of Health Policy, Management, and Behavior, University at Albany, State University of New York (E.L.H., Y.Z.); Department of Cardiology, Boston Medical Center, MA (A.K.J.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Department of Cardiology, Northwell Health, Danville, PA (P.B.B.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (G.W.); Department of Cardiology, Mt Sinai Medical Center, New York, NY (S.S.); Department of Cardiology, Albany Medical Center, NY (F.J.V.); and Department of Cardiology, St Joseph's Health System, Atlanta, GA (S.B.K.).
authors.forename: Ferdinand J
authors.initials: FJ
authors.lastname: Venditti
authors.affiliation: From the Department of Health Policy, Management, and Behavior, University at Albany, State University of New York (E.L.H., Y.Z.); Department of Cardiology, Boston Medical Center, MA (A.K.J.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Department of Cardiology, Northwell Health, Danville, PA (P.B.B.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (G.W.); Department of Cardiology, Mt Sinai Medical Center, New York, NY (S.S.); Department of Cardiology, Albany Medical Center, NY (F.J.V.); and Department of Cardiology, St Joseph's Health System, Atlanta, GA (S.B.K.).
authors.forename: Spencer B
authors.initials: SB
authors.lastname: King
mesh_terms: D000368:Aged; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D044382:Population Groups; D015995:Prevalence; D012042:Registries; D016896:Treatment Outcome; D014481:United States
keywords: cerebrovascular disorders; chronic total occlusion; mortality; outcome; percutaneous coronary intervention