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Medical therapy, percutaneous coronary intervention and prognosis in patients with chronic total occlusions
  1. Andrew Ladwiniec1,2,
  2. Victoria Allgar2,
  3. Simon Thackray1,
  4. Farquad Alamgir1,
  5. Angela Hoye1,2
  1. 1Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull, UK
  2. 2Department of Health Sciences, Hull York Medical School, York, UK
  1. Correspondence to Dr Andrew Ladwiniec, Department of Academic Cardiology, Hull York Medical School, Daisy Building, Castle Hill Hospital, Castle Road, Kingston-upon-Hull HU16 5JQ, UK; andrew.ladwiniec{at}nhs.net

Abstract

Objective There is little published data reporting outcomes for those found to have a chronic total coronary occlusion (CTO) that is electively treated medically versus those treated by percutaneous coronary intervention (PCI). We sought to compare long-term clinical outcomes between patients treated by PCI and elective medical therapy in a consecutive cohort of patients with an identified CTO.

Methods Patients found to have a CTO on angiography between January 2002 and December 2007 in a single tertiary centre were identified using a dedicated database. Those undergoing CTO PCI and elective medical therapy to the CTO were propensity matched to adjust for baseline clinical and angiographic differences.

Results In total, 1957 patients were identified, a CTO was treated by PCI in 405 (20.7%) and medical therapy in 667 (34.1%), 885 (45.2%) patients underwent coronary artery bypass graft surgery. Of those treated by PCI or medical therapy, propensity score matching identified 294 pairs of patients, PCI was successful in 177 patients (60.2%). All-cause mortality at 5 years was 11.6% for CTO PCI and 16.7% for medical therapy HR 0.63 (0.40 to 1.00, p=0.052). The composite of 5-year death or myocardial infarction occurred in 13.9% of the CTO PCI group and 19.6% in the medical therapy group, HR 0.64 (0.42 to 0.99, p=0.043). Among the CTO PCI group, if the CTO was revascularised by any means during the study period, 5-year mortality was 10.6% compared with 18.3% in those not revascularised in the medical therapy group, HR 0.50 (0.28–0.88, p=0.016).

Conclusions Revascularisation, but not necessarily PCI of a CTO, is associated with improved long-term survival relative to medical therapy alone.

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