Despite improving success rate of percutaneous coronary intervention (PCI) for chronic
total occlusion (CTO) lesions, the clinical benefit of recanalization of CTO is still
a matter of debate. Of 13,087 patients who underwent PCI in the CREDO-Kyoto registry
cohort-2, 1,524 patients received PCI for CTO (CTO-PCI). Clinical outcomes were compared
between 1,192 patients with successful CTO-PCI and 332 patients with failed CTO-PCI.
In-hospital death tended to occur less frequently in the successful CTO-PCI group
than in the failed CTO-PCI group (1.4% vs 3.0%, p = 0.053). Through 3-year follow-up,
the cumulative incidence of all-cause death was not significantly different between
the successful and failed CTO-PCI groups (9.0% vs 13.1%, p = 0.18), whereas the cumulative
incidence of cardiac death was significantly less in the successful CTO-PCI group
than in the failed CTO-PCI group (4.5% vs 8.4%, p = 0.03). However, after adjusting
confounders, successful CTO-PCI was associated with lesser risk for neither all-cause
death (hazard ratio 0.93, 95% confidence interval 0.64 to 1.37, p = 0.69) nor cardiac
death (hazard ratio 0.71, 95% confidence interval 0.44 to 1.16, p = 0.16). The cumulative
incidence of coronary artery bypass grafting (CABG) was remarkably less in patients
with successful PCI compared with those with failed PCI (1.8% vs 19.6%, p <0.0001).
In conclusion, successful CTO-PCI compared with failed PCI was not associated with
lesser risk for 3-year mortality. However, successful CTO-PCI was associated with
significantly less subsequent CABG.
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Article info
Publication history
Published online: June 03, 2013
Accepted:
May 2,
2013
Received in revised form:
May 2,
2013
Received:
March 7,
2013
Footnotes
This work was supported by the Pharmaceuticals and Medical Devices Agency (Tokyo, Japan).
See page 773 for disclosure information.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
