Survival after percutaneous coronary intervention for chronic total occlusion.

BACKGROUND

There is limited data on prognosis after percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) in the era of drug-eluting stents (DES).

AIMS

This study investigates the specific contribution of CTO recanalization to the survival benefit of complete revascularization.

METHODS

Consecutive patients who underwent PCI of a CTO at our center between 01/2005 and 12/2013 were followed for a median of 2.6 years (interquartile range 1.1-3.1 years). All-cause mortality was compared between patients with successful and failed PCI of CTO without and with adjustment for pertinent co-variables by the Cox models.

RESULTS

The study comprised 2002 patients with attempted PCI of CTO (mean age 65.2 ± 11 years, 17 % female), 82 % had multivessel disease. The CTO PCI was successful in 1662 (83 %) patients with a DES rate of 94 %. All-cause mortality was significantly lower in patients with successful PCI of CTO compared to failed PCI of CTO (15.3 vs. 25.9 % at 4 years; P < 0.001). In the multivariable model, both successful CTO PCI and complete revascularization were strong independent predictors of reduced long-term mortality (adjusted hazard ratio (HR) 0.72; 95 % confidence interval (CI) 0.53-0.97; P = 0.03 and adjusted HR 0.59; 95 % CI 0.42-0.82; P = 0.002). Also within the subset of incomplete revascularization, successful PCI of CTO was associated with reduced mortality (adjusted HR: 0.67; 95 % CI: 0.50-0.92; P = 0.012).

CONCLUSION

Successful CTO recanalization is an independent predictor for improved long-term survival. Persistent CTO lesions are associated with significantly worse survival than persistent non-occlusive coronary lesions.