title: Survival after percutaneous coronary intervention for chronic total occlusion.
abstract: BACKGROUND
  There is limited data on prognosis after percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) in the era of drug-eluting stents (DES).
  
  
  OBJECTIVE
  This study investigates the specific contribution of CTO recanalization to the survival benefit of complete revascularization.
  
  
  METHODS
  Consecutive patients who underwent PCI of a CTO at our center between 01/2005 and 12/2013 were followed for a median of 2.6 years (interquartile range 1.1-3.1 years). All-cause mortality was compared between patients with successful and failed PCI of CTO without and with adjustment for pertinent co-variables by the Cox models.
  
  
  RESULTS
  The study comprised 2002 patients with attempted PCI of CTO (mean age 65.2 ± 11 years, 17 % female), 82 % had multivessel disease. The CTO PCI was successful in 1662 (83 %) patients with a DES rate of 94 %. All-cause mortality was significantly lower in patients with successful PCI of CTO compared to failed PCI of CTO (15.3 vs. 25.9 % at 4 years; P < 0.001). In the multivariable model, both successful CTO PCI and complete revascularization were strong independent predictors of reduced long-term mortality (adjusted hazard ratio (HR) 0.72; 95 % confidence interval (CI) 0.53-0.97; P = 0.03 and adjusted HR 0.59; 95 % CI 0.42-0.82; P = 0.002). Also within the subset of incomplete revascularization, successful PCI of CTO was associated with reduced mortality (adjusted HR: 0.67; 95 % CI: 0.50-0.92; P = 0.012).
  
  
  CONCLUSIONS
  Successful CTO recanalization is an independent predictor for improved long-term survival. Persistent CTO lesions are associated with significantly worse survival than persistent non-occlusive coronary lesions.
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany. toma.aurel@gmail.com.
authors.forename: Aurel
authors.initials: A
authors.lastname: Toma
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gick
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Minners
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Ferenc
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Valina
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Löffelhardt
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Catherine
authors.initials: C
authors.lastname: Gebhard
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Riede
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Heinz Joachim
authors.initials: HJ
authors.lastname: Buettner
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chronic total occlusion; Coronary artery; Drug-eluting stent; Survival