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Objectives: The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).

Background: Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO.

Methods: We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years).

Results: Procedural success was obtained in 1,226 (68%) patients. Stents were implanted in 1,160 patients (95%); 396 patients (34%) received bare-metal stents (BMS), and 764 patients (66%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.21 to 0.75, p < 0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95% CI: 0.13 to 0.40, p < 0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2% vs. 31.1%, p < 0.01); definite/probable stent thrombosis rates were similar (DES 1.7%, BMS 2.3%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes.

Conclusions: Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes.

Titel:	Long-term outcome of percutaneous coronary intervention for chronic total occlusions.
Autor/in / Beteiligte Person:	Mehran, R ; Claessen, BE ; Godino, C ; Dangas, GD ; Obunai, K ; Kanwal, S ; Carlino, M ; Henriques, JP ; Di Mario, C ; Kim, YH ; Park, SJ ; Stone, GW ; Leon, MB ; Moses, JW ; Colombo, A
Link:	Full Text Finder (Volltext)
Zeitschrift:	JACC. Cardiovascular interventions, Jg. 4 (2011-09-01), Heft 9, S. 952-61
Veröffentlichung:	New York : Elsevier, 2011
Medientyp:	academicJournal
ISSN:	1876-7605 (electronic)
DOI:	10.1016/j.jcin.2011.03.021
Schlagwort:	Aged Chronic Disease Coronary Occlusion diagnosis Coronary Occlusion mortality Drug-Eluting Stents Female Humans Italy Kaplan-Meier Estimate Male Metals Middle Aged New York City Proportional Hazards Models Prospective Studies Prosthesis Design Registries Republic of Korea Risk Assessment Risk Factors Stents Thrombosis etiology Time Factors Treatment Outcome Angioplasty, Balloon, Coronary adverse effects Angioplasty, Balloon, Coronary instrumentation Angioplasty, Balloon, Coronary mortality Coronary Occlusion therapy
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Corporate Authors: Multinational Chronic Total Occlusion Registry Publication Type: Journal Article; Multicenter Study Language: English [JACC Cardiovasc Interv] 2011 Sep; Vol. 4 (9), pp. 952-61. MeSH Terms: Angioplasty, Balloon, Coronary* / adverse effects ; Angioplasty, Balloon, Coronary* / instrumentation ; Angioplasty, Balloon, Coronary* / mortality ; Coronary Occlusion / *therapy ; Aged ; Chronic Disease ; Coronary Occlusion / diagnosis ; Coronary Occlusion / mortality ; Drug-Eluting Stents ; Female ; Humans ; Italy ; Kaplan-Meier Estimate ; Male ; Metals ; Middle Aged ; New York City ; Proportional Hazards Models ; Prospective Studies ; Prosthesis Design ; Registries ; Republic of Korea ; Risk Assessment ; Risk Factors ; Stents ; Thrombosis / etiology ; Time Factors ; Treatment Outcome Comments: Comment in: JACC Cardiovasc Interv. 2011 Sep;4(9):962-4. (PMID: 21939935) ; Comment in: JACC Cardiovasc Interv. 2012 Jan;5(1):116; author reply 117-8. (PMID: 22230159) ; Comment in: JACC Cardiovasc Interv. 2012 Jan;5(1):116-7; author reply 117-8. (PMID: 22230160) Substance Nomenclature: 0 (Metals) Entry Date(s): Date Created: 20110924 Date Completed: 20120120 Latest Revision: 20220410 Update Code: 20240513

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Long-term outcome of percutaneous coronary intervention for chronic total occlusions.