Long-term outcome of percutaneous coronary intervention for chronic total occlusions

Roxana Mehran, Bimmer E. Claessen, Cosmo Godino, George D. Dangas, Kotaro Obunai, Sunil Kanwal, Mauro Carlino, José P S Henriques, Carlo Di Mario, Young Hak Kim, Seung Jung Park, Gregg W. Stone, Martin B. Leon, Jeffrey W. Moses, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Background: Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. Methods: We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years). Results: Procedural success was obtained in 1,226 (68%) patients. Stents were implanted in 1,160 patients (95%); 396 patients (34%) received bare-metal stents (BMS), and 764 patients (66%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.21 to 0.75, p <0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95% CI: 0.13 to 0.40, p <0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2% vs. 31.1%, p <0.01); definite/probable stent thrombosis rates were similar (DES 1.7%, BMS 2.3%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes. Conclusions: Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes.

Original languageEnglish
Pages (from-to)952-961
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume4
Issue number9
DOIs
Publication statusPublished - Sep 2011

Keywords

  • chronic total occlusions
  • drug-eluting stents
  • long-term outcomes
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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