Impact of Successful Chronic Total Occlusion Percutaneous Coronary Interventions on Subsequent Clinical Outcomes

Iosif Xenogiannis, Ilias Nikolakopoulos, Oleg Krestyaninov, Dmitrii Khelimskii, Jaikirshan J. Khatri, Anthony H. Doing, Phil Dattilo, Khaldoon Alaswad, Catalin Toma, Abdul M. Sheikh, Farouc A. Jaffer, Brian K. Jefferson, Taral Patel, Raj H. Chandwaney, Wissam Jaber, Habib Samady, Mitul Patel, Ehtisham Mahmud, James Choi, Michalis KoutouzisIoannis Tsiafoutis, Michael Megaly, Mohamed Omer, Evangelia Vemmou, Bavana Venkata Rangan, Santiago Garcia, Shuaib Abdullah, Subhash Banerjee, Nicholas Burke, Emmanouil S. Brilakis, Dimitri Karmpaliotis

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The impact of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on angina and subsequent incidence of major adverse cardiovascular event (MACE) rate remains controversial. METHODS: We compared patient- reported angina change and the incidence of MACE (defined as death, myocardial infarction [MI], target-vessel revascularization) between successful vs failed CTO-PCI in 1612 patients participating in a large, multicenter registry. RESULTS: CTO-PCI was successful in 1387 patients (86%). Compared with failed CTO-PCI, successful CTO-PCI patients were less likely to have history of heart failure (33% vs 41%; P=.02), prior MI (49% vs 62%; P<.01), or prior coronary revascularization (63% vs 71% [P=.03] for PCI and 30% vs 40% [P<.01] for coronary artery bypass graft surgery). Patients in the successful CTO-PCI group had lower J-CTO scores (2.4 ± 1.3 vs 3.1 ± 1.1; P<.01) and lower PROGRESS-CTO Complications scores (1.1 ± 1.0 vs 1.6 ± 1.0; P<.01). After a mean follow-up of 181 ± 153 days, patients with successful PCI were more likely to have angina improvement (83% vs 38%; P<.01) and had lower incidence of 1-year MACE (8% vs 15%; P<.01), death (3% vs 7%; P<.01), and MI (2% vs 4%; P=.02). On multivariable analysis, however, CTO-PCI success was not independently associated with MACE. CONCLUSION: Compared with failed CTO-PCI, successful CTO-PCI is associated with better angina improvement and lower incidence of MACE (on univariable analysis) during follow-up.

Original languageEnglish (US)
Pages (from-to)433-439
Number of pages7
JournalThe Journal of invasive cardiology
Volume32
Issue number11
StatePublished - Nov 1 2020

Keywords

  • chronic total occlusion
  • follow-up
  • major adverse cardiovascular events
  • percutaneous coronary intervention
  • symptom improvement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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