title: Impact of multi-vessel versus single-vessel disease on outcomes after percutaneous coronary interventions for chronic total occlusions.
abstract: BACKGROUND
  Successful chronic total occlusion (CTO) revascularization has been associated with prognostic benefits. Whether the extent of coronary artery disease interferes with these benefits has not been investigated yet.
  
  
  OBJECTIVE
  We sought to compare the survival after percutaneous coronary intervention (PCI) for CTO between patients with multi- (MVD) and single-vessel disease (SVD).
  
  
  METHODS
  A total of 2002 consecutive patients undergoing CTO PCI between 01/2005 and 12/2013 were identified and stratified according to the presence/absence of MVD. The primary endpoint was all-cause mortality. Median follow-up was 2.6 (interquartile range 1.1-3.1) years.
  
  
  RESULTS
  A total of 1634 (81.6%) patients had MVD. Procedural success rates were 81.5 and 89.7% in the MVD and SVD groups (p < 0.001). All-cause mortality during entire follow-up was higher in MVD as compared to SVD patients (13.5 versus 5.7%, p < 0.001), and differences were attenuated after multivariable adjustment for baseline characteristics [adjusted hazard ratio (HR) 1.51, 95% CI 0.98-2.33, p = 0.06]. The effect of successful CTO PCI on all-cause mortality was consistent among patients with MVD [11.0 versus 24.5%; adjusted HR 0.60, 95% CI 0.45-0.80, p < 0.001] and SVD [5.2 versus 10.5%; adjusted HR 0.74, 95% CI 0.24-2.26, p = 0.59, Pint= 0.65]. However, due to the greater baseline risk in the former group, the absolute survival benefit after successful CTO PCI was higher.
  
  
  CONCLUSIONS
  Successful recanalization of a CTO is a strong independent predictor for reduced long-term mortality. Due a higher baseline risk, the absolute benefit in patients with MVD is substantially larger than in patients with SVD.
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: Department of Cardiology, Campus Benjamin Franklin, Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Stähli
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: Cathérine
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: Thomas
authors.initials: T
authors.lastname: Nührenberg
authors.affiliation: Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Kambis
authors.initials: K
authors.lastname: Mashayekhi
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: 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; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Chronic total occlusion; Coronary artery disease; Multi-vessel disease; Percutaneous coronary intervention; Single-vessel disease