The clinical outcomes of percutaneous coronary intervention in chronic total coronary occlusion.

The objective of the present study was to investigate the effects of percutaneous coronary intervention (PCI) on the development of major cardiac events in patients with chronic total coronary occlusion (CTO). Patients determined to have CTO in at least one coronary artery with stable coronary artery disease were retrospectively enrolled in this study. Among 262 patients (197 males, 65 females), PCI was attempted in 172 while 90 were followed-up conservatively because they had unsuitable angiographic lesions for PCI. PCI was successful in 117 (68.0%) patients. Thirty of the remaining 55 patients, who had multivessel coronary artery disease, underwent coronary artery bypass surgery. The remaining 25 patients were added to the conservative group. Mean follow-up time was 32 +/- 12 months. Although a slight degree of development of non-ST elevation acute coronary syndrome was observed in the PCI group (34 [29.1%] versus 21 [18.3%] patients, P = 0.053) mostly because of restenosis (14 of 34 patients, [41.2%]), a significant mortality benefit was observed in patients who underwent successful PCI (17 [14.5%] versus 32 [27.8%] patients, P = 0.013). This benefit was mainly due to the lower number of deaths from heart failure (7 [6.0%] versus 17 [14.8%] patients, P = 0.028) and sudden death (6 [5.1%] versus 12 [10.4%] patients, P = 0.131). In conclusion, despite the low success rate and high restenosis rate of PCI for CTO, it is worthwhile to deal with the revascularization of a CTO for its mortality benefit.