Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions

doi:10.1016/j.jcin.2011.03.021

JACC: Cardiovascular Interventions

Volume 4, Issue 9, September 2011, Pages 952-961

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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.

Key Words

chronic total occlusions

drug-eluting stents

long-term outcomes

percutaneous coronary intervention

Abbreviations and Acronyms

BMS

bare-metal stent(s)

CABG

coronary artery bypass graft surgery

confidence interval

CTO

chronic total occlusion

DES

drug-eluting stent(s)

hazard ratio

LAD

left anterior descending coronary artery

LVEF

left ventricular ejection fraction

MACE

major adverse cardiac event(s)

myocardial infarction

PCI

percutaneous coronary intervention

PES

paclitaxel-eluting stent(s)

SES

sirolimus-eluting stent(s)

TIMI

Thrombolysis In Myocardial Infarction

TVR

target vessel revascularization

Cited by (0)

: Dr. Mehran has received research support from BMS/Sanofi-Aventis; and consulting fees from Abbott Vascular, AstraZeneca, Cerdiva, Cordis, The Medicines Co., and Regado Biosciences. Dr. Dangas is an investigator in a clinical trial sponsored by Medtronic, Boston Scientific, and Abbott; has received speaker honoraria from Cordis; and whose spouse is an advisory board member for Abbott. Dr. Stone is a consultant for Abbott Vascular, Boston Scientific, and Medtronic. Dr. Colombo is a minor shareholder in Cappella Inc. Dr. Leon is on the scientific advisory board for Medtronic, Boston Scientific, and Abbott. Dr. Moses is a consultant for Boston Scientific and Cordis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Mehran and Claessen contributed equally to this work.