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Long-Term Follow-Up of Elective Chronic Total Coronary Occlusion Angioplasty: Analysis From the U.K. Central Cardiac Audit Database
Study Questions:
What are the outcomes of patients with successful versus unsuccessful percutaneous coronary intervention (PCI) to a chronic total occlusion (CTO)?
Methods:
The investigators analyzed the U.K. Central Cardiac Audit Database for all CTO PCI cases carried out in England and Wales between January 1, 2005, and December 31, 2009. Vital status in September 2010 was obtained from the Medical Research Information Service. A Cox proportional hazards model was used to identify those variables that were independent predictors of mortality. For assessment of the impact of revascularization success on subsequent mortality and allowing for patients undergoing several procedures, success of revascularization was entered as a time-updated covariate.
Results:
A total of 13,443 patients (78.8% male) had a mean age of 63.5 years and underwent 14,439 CTO procedures. CTO PCI was successful in 10,199 cases (70.6%). During follow-up of 2.65 years (interquartile range, 1.59-3.83 years), successful PCI of at least one CTO was associated with improved survival (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.62-0.83; p < 0.001). Complete revascularization was associated with improved survival compared with partial revascularization (HR, 0.70; 95% CI, 0.56-0.87; p = 0.002) or failed revascularization (HR, 0.61; 95% CI, 0.50-0.74; p < 0.001).
Conclusions:
The authors concluded that successful CTO PCI was associated with improved long-term survival.
Perspective:
This observational, multicenter registry of consecutive CTO recanalizations across all U.K. PCI centers reports a strong association between successful CTO revascularization and improved survival over a median follow-up of 2.65 years. The improvement in survival remained after multivariate analysis, suggesting that it is independent of measurable confounding factors. Furthermore, the survival outcome of successful revascularization did not vary between the different epicardial vessels and was greatest in patients with complete revascularization. Because the groups were not randomized into treatment strategies, no formal conclusions about cause and effect can be drawn from this study. The Randomized Multicenter EuroCTO study will assess revascularization or optimal medical therapy for the treatment of chronic total coronary occlusions and will provide additional insight when completed.
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