Sudhakar George1, James Cockburn2, Tim C Clayton3, Peter Ludman4, James Cotton5, James Spratt6, Simon Redwood7, Mark de Belder8, Adam de Belder2, Jonathan Hill9, Angela Hoye10, Nick Palmer11, Sudhir Rathore12, Anthony Gershlick13, Carlo Di Mario14, David Hildick-Smith2. 1. Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom. Electronic address: sudhakargeorge@gmail.com. 2. Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom. 3. London School of Hygiene & Tropical Medicine, London, United Kingdom. 4. University Hospital Birmingham, Birmingham, United Kingdom. 5. Heart and Lung Centre, Wolverhampton, United Kingdom. 6. Edinburgh Royal Infirmary, Edinburgh, United Kingdom. 7. King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, Cardiovascular Division, Rayne Institute, London, United Kingdom. 8. James Cook University Hospital, Middlesbrough, United Kingdom. 9. King's College Hospital, London, United Kingdom. 10. Hull and East Yorkshire Hospitals, Yorkshire, United Kingdom. 11. Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. 12. Frimley Park Hospital and St. George's Hospital, Surrey, United Kingdom. 13. NIHR Cardiovascular Biomedical Unit, University Hospitals of Leicester, Leicester, United Kingdom. 14. NIHR Cardiovascular Biomedical Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Abstract
BACKGROUND: Chronic total occlusion (CTO) is common, being reported in 18% to 30% of patients undergoing coronary angiography. Percutaneous coronary intervention (PCI) is usually performed to relieve anginal symptoms, but data are emerging to suggest that there may also be a mortality benefit. OBJECTIVES: This study aimed to compare outcomes of patients with successful versus unsuccessful PCI to a CTO. METHODS: We 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. 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 to 3.83 years), successful PCI of at least 1 CTO was associated with improved survival (hazard ratio [HR]: 0.72; 95% CI: 0.62 to 0.83; p < 0.001). Complete revascularization was associated with improved survival compared with partial revascularization (HR: 0.70; 95% CI: 0.56 to 0.87; p = 0.002) or failed revascularization (HR: 0.61; 95% CI: 0.50 to 0.74; p < 0.001). CONCLUSIONS: Successful CTO PCI was associated with improved long-term survival. The improvement was greatest in patients when complete revascularization was achieved. The identity of the successfully treated occluded vessel was not associated with differences in outcome.
BACKGROUND:Chronic total occlusion (CTO) is common, being reported in 18% to 30% of patients undergoing coronary angiography. Percutaneous coronary intervention (PCI) is usually performed to relieve anginal symptoms, but data are emerging to suggest that there may also be a mortality benefit. OBJECTIVES: This study aimed to compare outcomes of patients with successful versus unsuccessful PCI to a CTO. METHODS: We 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. 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 to 3.83 years), successful PCI of at least 1 CTO was associated with improved survival (hazard ratio [HR]: 0.72; 95% CI: 0.62 to 0.83; p < 0.001). Complete revascularization was associated with improved survival compared with partial revascularization (HR: 0.70; 95% CI: 0.56 to 0.87; p = 0.002) or failed revascularization (HR: 0.61; 95% CI: 0.50 to 0.74; p < 0.001). CONCLUSIONS: Successful CTO PCI was associated with improved long-term survival. The improvement was greatest in patients when complete revascularization was achieved. The identity of the successfully treated occluded vessel was not associated with differences in outcome.
Authors: Gabriel T R Pereira; Alessio La Manna; Yasuhiro Ichibori; Armando Vergara-Martel; Bruno Ramos Nascimento; Abdul Jawwad Samdani; Davide Capodanno; Guido D'Agosta; Giacomo Gravina; Giuseppe Venuti; Corrado Tamburino; Guilherme F Attizzani Journal: Int J Cardiovasc Imaging Date: 2019-06-07 Impact factor: 2.357
Authors: Aurel Toma; Barbara E Stähli; Michael Gick; Cathérine Gebhard; Thomas Nührenberg; Kambis Mashayekhi; Miroslaw Ferenc; Franz-Josef Neumann; Heinz Joachim Buettner Journal: Clin Res Cardiol Date: 2017-02-24 Impact factor: 5.460