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

Roxana Mehran, MD,* Bimmer E. Claessen, MD, Cosmo Godino, MD, George D. Dangas, MD, PHD,* Kotaro Obunai, MD, Sunil Kanwal, MD, Mauro Carlino, MD, José P. S. Henriques, MD, PHD, Carlo Di Mario, MD, Young-Hak Kim, MD, Seung-Jung Park, MD, Gregg W. Stone, MD, Martin B. Leon, MD, Jeffrey W. Moses, MD, Antonio Colombo, MD, on behalf of the Multinational Chronic Total Occlusion Registry

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. (J Am Coll Cardiol Intv 2011;4: 952–61) © 2011 by the American College of Cardiology Foundation

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