Reviews in Cardiovascular Medicine (Dec 2021)

Treatment of chronic total occlusion with percutaneous coronary intervention is associated with improved survival as compared to medical treatment alone: insights from a single-centre registry

  • Povilas Budrys,
  • Vilhelmas Bajoras,
  • Michael Rees,
  • Ieva Marija Saule,
  • Giedrius Davidavicius,
  • Andrius Berukstis,
  • Arvydas Baranauskas

DOI
https://doi.org/10.31083/j.rcm2204169
Journal volume & issue
Vol. 22, no. 4
pp. 1629 – 1632

Abstract

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Symptom relief is currently the main indication to perform percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). So far, none of the randomized trials for CTO treatment have demonstrated improved survival after PCI compared to optimal medical treatment (OMT) alone. We investigated whether CTO PCI in addition to OMT could improve survival over OMT alone. Data of 1004 patients with a treated CTO was analysed. Patients with acute coronary syndrome and who underwent coronary artery bypass graft surgery (CABG) were excluded, thus final study population was 378. According to the treatment received, patients were divided into two groups: CTO PCI + OMT (n = 163) and OMT alone (n = 215). The primary endpoint was all-cause mortality during follow-up. The incidence of myocardial infarction (MI), revascularization (both CTO artery and non-CTO artery related) and stroke were also analysed as a secondary outcome. The mean follow-up period was 3.55 ± 0.93 years. Multiple regression analysis was performed to identify independent predictors of all-cause mortality. Occurrence of MI and repeat revascularization (both CTO vessel related and non-CTO vessel) and stroke did not differ significantly between groups. However, all-cause mortality was more frequent in OMT (19.1%) patients than PCI (10.4%). Patients age ≤70 years (odds ratio (OR) 0.47 [0.26; 0.84], p = 0.01) and CTO PCI (OR 0.51 [0.27; 0.94], p = 0.03) were independent predictors of reduced likelihood of all-cause death. The data from our centre registry demonstrates that CTO PCI is associated with reduced all-cause mortality as compared to medical treatment alone in a real-life setting.

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