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35 Successful recanalisation of chronic total occlusions is associated with increased long term survival
  1. J M Behar1,
  2. D A Jones1,
  3. R Weerackody1,
  4. K Rathod1,
  5. C J Knight1,
  6. A K Kapur1,
  7. A Jain1,
  8. A Wragg1,
  9. C A Thompson2,
  10. A Mathur1,
  11. E J Smith1
  1. 1The London Chest Hospital, Barts and the London NHS Trust, London, UK
  2. 2Department of Cardiology, Yale University, New Haven, Connecticut, USA

Abstract

Introduction Chronic total occlusion (CTO) remains a challenging lesion subset. Despite advances in equipment and expertise, many CTO patients may not be offered PCI as physicians perceive procedural success may be lower, and the anatomy is stable. The aim of this study was to investigate the impact of procedural success on mortality following CTO-PCI in a large cohort of patients in the drug eluting stent era.

Methods 6122 consecutive patients underwent elective PCI at a single centre (October 2003–May 2010), 836 (13.7%) for CTO. Demographic and procedural data were collected at the time of intervention (Abstract 35 table 1). In-hospital MACE (myocardial infarction, urgent revascularisation, stroke or death) was documented at discharge. All cause mortality data was obtained from the Office of National Statistics via the BCIS/CCAD national audit out to 4 years (mean 2.9±1.6) and stratified according to successful or unsuccessful CTO recanalisation.

Abstract 35 Table 1

Results 572 (68.4%) CTO procedures were successful. Coronary stents were implanted in 96.9% (mean 2.3±0.1 stents per patient, 70% drug eluting). Prior revascularisation was more frequent among patients with unsuccessful CTO-PCI than successful; prior CABG 16.5% unsuccessful vs 7.4% successful, (p<0.0001), PCI 36.0% vs 21.2%, (p<0.0001). Baseline characteristics were otherwise similar (Abstract 35 table 1). Intra-procedural complications (coronary dissection, perforation, access site (dissection, haematoma) were more frequent in unsuccessful cases (19% (52) vs 4.1% (20) (p<0.0001) but did not have an impact on in-hospital MACE (2% vs 1.8%, p=0.6). All cause mortality was 8% (21) in the unsuccessful group and 3% (17) in the successful group out to 4 years, (Abstract 35 figure 1). Mortality following successful CTO-PCI was similar to that of the non-CTO elective PCI group (5.1%, p=NS).

Abstract 35 Figure 1

All cause mortality after PCI for elective patients.

Conclusion A successful angiographic outcome following CTO-PCI is associated with a survival advantage out to 4 years following intervention. These data suggest that the adoption of new techniques and technologies to improve procedural success may improve prognosis.

  • Stable angina
  • chronic total occlusion
  • percutaneous coronary intervention

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