Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion

Valenti, Renato
Migliorini, Angela
Signorini, Umberto
Vergara, Ruben
Parodi, Guido
Carrabba, Nazario
Cerisano, Giampaolo
Antoniucci, David

Division of Cardiology, Careggi Hospital, Viale Pieraccini, I-50134 Florence, Italy

Received 7 January 2008; revised 5 June 2008; accepted 17 July 2008; online publish-ahead-of-print 5 August 2008

^*Corresponding author. Tel: +39 (0) 55 7947966, Fax: +39 (0) 55 410752, Email: [email protected]

European Heart Journal 29(19):p 2336-2342, October 2008.

Aims

This study sought to determine the impact on survival of successful drug-eluting stent-supported percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).

Methods and results

Comparison of long-term cardiac survival of consecutive patients who underwent PCI for at least one CTO and who were stratified into successful and failure procedures. From 2003 to 2006, 486 patients underwent PCI for 527 CTO. CTO–PCI was successful in 344 patients (71%) and 361 lesions (68%). Multivessel PCI was performed in 62% in the CTO–PCI failure group and in 71% in the CTO–PCI success group (P=0.062). Cardiac survival rate was higher in the CTO–PCI success group compared with CTO–PCI failure group (91.6 ± 2.0 vs. 87.4 ± 2.9%; P=0.025), in patients with multivessel disease and CTO–PCI success compared with CTO–PCI failure (91.4 ± 2.2 vs. 86.6 ± 3.1%; P=0.021), and in patients with complete revascularization when compared to patients with incomplete revascularization (94.0 ± 1.7 vs. 83.8 ± 3.6%; P < 0.001).

Conclusion

Successful CTO–PCI confers a long-term survival benefit. Improvement in survival is driven by the differences in the outcome of patients with multivessel disease and who were completely revascularized.