Impact of residual chronic total occlusion of right coronary artery on the long-term outcome in patients treated for unprotected left main disease the milan and new-tokyo registry

Kensuke Takagi, Alfonso Ielasi, Alaide Chieffo, Sandeep Basavarajaiah, Azeem Latib, Matteo Montorfano, Mauro Carlino, Hiroyuki Mizuno, Tasuku Hasegawa, Cosmo Godino, Filippo Figini, Joanne Shannon, Ahmed Rezq, Santo Ferrarello, Chiara Bernelli, Toru Naganuma, Yusuke Fujino, Sunao Nakamura, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

Background-The presence of chronic total occlusion of the right coronary artery (CTO-RCA) in patients undergoing percutaneous interventions for unprotected left main (ULM) disease may affect the prognosis. In this study, we evaluated the immediate results and follow-up of patients with ULM-percutaneous interventions and with or without associated CTO-RCA. Methods and Results-Between March 2002 and December 2008, a total of 568 consecutive patients with ULM stenosis treated with drug-eluting stent were included in this analysis. The mean EuroScore and SYNTAX scores were 4.05±2.62 and 28.12±10.82, respectively. Of these, 522 had ULM lesions without residual CTO-RCA (493 ULM without CTORCA+ 29 ULM with treated CTO-RCA), and 46 patients had residual CTO-RCA. At 1466 days (interquartile range, 1150-1917) follow-up, the cardiac-death occurred in 41 patients (7.2%). Cardiac-death was more frequently observed in patients with ULM and residual CTO-RCA as compared with those without residual CTO-RCA (adjusted hazard ratios, 2.163 [95% confidence interval, 1.018-4.597]; P=0.045). However, target lesion revascularization occurred less frequently in patients with residual CTO-RCA (adjusted hazard ratios, 0.321 [95% confidence interval, 0.13-0.794]; P=0.014), resulting in the similar major adverse cardiovascular events rates between the 2 groups. When we analyzed patients with concomitant ULM and CTO-RCA, cardiac-death was significantly higher in patients with residual as compared with treated CTO-RCA (log-rank P=0.01) despite no difference in baseline characteristics. Conclusions-Cardiac-death occurred more frequently in patients with residual CTO-RCA as compared with those without residual CTO-RCA. These findings suggest that recanalization of CTO-RCA has significant impact on the longterm cardiac-mortality in patients undergoing ULM-percutaneous interventions probably by offering reserve coronary circulation, if in-stent restenosis were to occur in the treated left main.

Original languageEnglish
Pages (from-to)154-160
Number of pages7
JournalCirculation: Cardiovascular Interventions
Volume6
Issue number2
DOIs
Publication statusPublished - Apr 2013

Keywords

  • Chronic total coronary occlusion
  • Drug-eluting stent
  • Left main coronary artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Takagi, K., Ielasi, A., Chieffo, A., Basavarajaiah, S., Latib, A., Montorfano, M., Carlino, M., Mizuno, H., Hasegawa, T., Godino, C., Figini, F., Shannon, J., Rezq, A., Ferrarello, S., Bernelli, C., Naganuma, T., Fujino, Y., Nakamura, S., & Colombo, A. (2013). Impact of residual chronic total occlusion of right coronary artery on the long-term outcome in patients treated for unprotected left main disease the milan and new-tokyo registry. Circulation: Cardiovascular Interventions, 6(2), 154-160. https://doi.org/10.1161/CIRCINTERVENTIONS.112.000079