PT  - JOURNAL ARTICLE
AU  - Andrew Ladwiniec
AU  - Victoria Allgar
AU  - Simon Thackray
AU  - Farquad Alamgir
AU  - Angela Hoye
TI  - Medical therapy, percutaneous coronary intervention and prognosis in patients with chronic total occlusions
AID  - 10.1136/heartjnl-2015-308181
DP  - 2015 Dec 01
TA  - Heart
PG  - 1907--1914
VI  - 101
IP  - 23
4099  - http://heart.bmj.com/content/101/23/1907.short
4100  - http://heart.bmj.com/content/101/23/1907.full
SO  - Heart2015 Dec 01; 101
AB  - 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.