Satoru Mitomo1, Toru Naganuma1, Richard J Jabbour2, Katsumasa Sato3, Hideo Takebayashi3, Tsuyoshi Kobayashi4, Jun-Ei Obata4, Kenji Sakamoto5, Kenichi Tsujita5, Kiyotaka Kugiyama4, Hisao Ogawa6, Sunao Nakamura7. 1. Department of Cardiology, New Tokyo Hospital, Chiba, Japan. 2. Department of Cardiology, Imperial College London, United Kingdom. 3. Division of Cardiology, Fukuyama Cardiovascular Hospital, Hiroshima, Japan. 4. Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan. 5. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. 6. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. 7. Department of Cardiology, New Tokyo Hospital, Chiba, Japan. Electronic address: boss0606@pluto.plala.or.jp.
Abstract
BACKGROUND: The impact of successful chronic total occlusion (S-CTO) percutaneous coronary intervention (PCI) on cardiac mortality may differ depending on target CTO vessel; however, to date this has not yet been adequately evaluated. The aim of this study was to investigate the impact of target vessel on cardiac mortality after S-CTO PCI. METHODS: From January 2004 to December 2011, 1517 CTO PCIs were performed in 4 Japanese centers and enrolled in a multicenter registry. Cases were retrospectively analyzed and divided per target vessel treated. The primary endpoint was cardiac mortality during the follow-up period. RESULTS: During the study period, 1424 CTOs with 1 main vessel CTO per patient were analyzed (left anterior descending artery [LAD]: 487, right coronary artery [RCA]: 599, left circumflex [LCx]: 338). 92.3% (n=1314) of cases were S-CTO PCIs. The median follow-up period was 1677 (interquartile range; 811-2463) days. In LAD and RCA CTOs, S-CTO PCI was associated with a lower cardiac mortality rate at 5-year follow-up when compared with unsuccessful CTO (U-CTO) (2.6% vs 9.7%, p=0.01, 2.6% vs 27.3%, p<0.01, respectively). This finding was not present with LCx CTO PCI (2.2% vs 0.0%, p=0.53). Cox regression analysis demonstrated that LAD and RCA S-CTO PCI were independent predictors of a lower cardiac mortality rate (LAD; HR: 0.18, 95% CI: 0.06-0.56; p<0.01; RCA; HR: 0.24, 95% CI: 0.09-0.65; p<0.01). CONCLUSIONS: S-CTO LAD and RCA PCI were associated with a lower long-term cardiac mortality after CTO PCI. This finding was not observed with LCx CTO PCI.
BACKGROUND: The impact of successful chronic total occlusion (S-CTO) percutaneous coronary intervention (PCI) on cardiac mortality may differ depending on target CTO vessel; however, to date this has not yet been adequately evaluated. The aim of this study was to investigate the impact of target vessel on cardiac mortality after S-CTO PCI. METHODS: From January 2004 to December 2011, 1517 CTO PCIs were performed in 4 Japanese centers and enrolled in a multicenter registry. Cases were retrospectively analyzed and divided per target vessel treated. The primary endpoint was cardiac mortality during the follow-up period. RESULTS: During the study period, 1424 CTOs with 1 main vessel CTO per patient were analyzed (left anterior descending artery [LAD]: 487, right coronary artery [RCA]: 599, left circumflex [LCx]: 338). 92.3% (n=1314) of cases were S-CTO PCIs. The median follow-up period was 1677 (interquartile range; 811-2463) days. In LAD and RCA CTOs, S-CTO PCI was associated with a lower cardiac mortality rate at 5-year follow-up when compared with unsuccessful CTO (U-CTO) (2.6% vs 9.7%, p=0.01, 2.6% vs 27.3%, p<0.01, respectively). This finding was not present with LCx CTO PCI (2.2% vs 0.0%, p=0.53). Cox regression analysis demonstrated that LAD and RCA S-CTO PCI were independent predictors of a lower cardiac mortality rate (LAD; HR: 0.18, 95% CI: 0.06-0.56; p<0.01; RCA; HR: 0.24, 95% CI: 0.09-0.65; p<0.01). CONCLUSIONS: S-CTO LAD and RCA PCI were associated with a lower long-term cardiac mortality after CTO PCI. This finding was not observed with LCx CTO PCI.