Woo Jin Jang1, Jeong Hoon Yang1, Seung-Hyuk Choi2, Young Bin Song1, Joo-Yong Hahn1, Jin-Ho Choi1, Wook Sung Kim3, Young Tak Lee3, Hyeon-Cheol Gwon1. 1. Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2. Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: sh1214.choi@samsung.com. 3. Department of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Abstract
OBJECTIVES: The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy. BACKGROUND: Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation. METHODS: We screened 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram. Of these, we analyzed data from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization. RESULTS: During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p < 0.01) and MACE (HR: 0.32; 95% CI: 0.21 to 0.49; p < 0.01) in the revascularization group compared with the medication group. After propensity score matching, the incidence of cardiac death (HR: 0.27; 95% CI: 0.09 to 0.80; p = 0.02) and MACE (HR: 0.44; 95% CI: 0.23 to 0.82; p = 0.01) were still significantly lower in the revascularization group than in the medication group. CONCLUSIONS: In patients with coronary CTO and well-developed collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE.
OBJECTIVES: The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy. BACKGROUND: Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation. METHODS: We screened 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram. Of these, we analyzed data from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization. RESULTS: During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p < 0.01) and MACE (HR: 0.32; 95% CI: 0.21 to 0.49; p < 0.01) in the revascularization group compared with the medication group. After propensity score matching, the incidence of cardiac death (HR: 0.27; 95% CI: 0.09 to 0.80; p = 0.02) and MACE (HR: 0.44; 95% CI: 0.23 to 0.82; p = 0.01) were still significantly lower in the revascularization group than in the medication group. CONCLUSIONS: In patients with coronary CTO and well-developed collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE.
Authors: Marcelo Harada Ribeiro; Carlos M Campos; Lucio Padilla; Antonio Carlos B da Silva; João Eduardo T de Paula; Marco Alcantara; Ricardo Santiago; Franklin Hanna; Franciele R da Silva; Karlyse C Belli; Lorenzo Azzalini; Pedro P de Oliveira; Gustavo N Araujo; Vincenzo Sucato; Kambis Mashayekhi; Alfredo R Galassi; Alexandre Abizaid; Alexandre Quadros Journal: J Am Heart Assoc Date: 2022-06-03 Impact factor: 6.106
Authors: Kai-Ze Wu; Ze-Han Huang; Zhi-An Zhong; Hong-Tao Liao; Yi Zhou; Bing-Zheng Luo; Mahesh Anantha-Narayanan; Rami N Khouzam; Aakash Garg; Vladan Vukcevic; Nicholas G Kounis; Bin Zhang Journal: Ann Transl Med Date: 2019-05