Long-term clinical outcomes after percutaneous coronary intervention for chronic total occlusions in elderly patients (≥75 years): five-year outcomes from a 1,791 patient multi-national registry.

To investigate procedural success rates and long-term clinical outcome of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in elderly patients. Little is known about procedural success and long-term clinical outcome of PCI for CTO in the elderly. A total of 1,791 consecutive patients with 1,852 CTO underwent PCI at three large centers in USA, Italy, and South Korea. Outcomes included procedural success and major adverse cardiac events (MACE, composite of mortality, myocardial infarction, or coronary artery bypass graft surgery [CABG]).Time-to-event analyses were performed using Kaplan-Meier statistics, and the log-rank statistic was used to test for differences between patients aged ≥75 and patients aged <75 years. Two hundred and thirteen patients (12%) were aged ≥75 years. Procedural success rates were similar in elderly patients compared with patients <75 years (63.8% vs. 69.1%, P = 0.12). Median follow-up was 890 days (IQR: 380-1,480 days). MACE rates after successful versus failed PCI were 25.8% versus 42.3% in the elderly (P = 0.02) and 11.2 versus 20.8% in younger patients (P < 0.01). In elderly patients, this reduction in MACE after successful PCI was mainly driven by a reduction in CABG (0.0% vs. 20.4%, P < 0.01), there were no significant differences in terms of mortality (19.6% vs. 24.6%, P = 0.13) or MI (11.5% vs. 8.0%, P = 0.87). CTO PCI in patients ≥75 years has similar success as in patients <75 years. In elderly patients undergoing CTO PCI, MACE rates were relatively high but successful revascularization is associated with a reduction in MACE at 5-year follow-up in both elderly and younger patients.

Hoebers LP ，Claessen BE ，Dangas GD ，Park SJ ，Colombo A ，Moses JW ，Henriques JP ，Stone GW ，Leon MB ，Mehran R ，Multinational CTO Registry ... -  《-》

Gender differences in long-term clinical outcomes after percutaneous coronary intervention of chronic total occlusions.

Claessen BE ，Chieffo A ，Dangas GD ，Godino C ，Lee SW ，Obunai K ，Carlino M ，Chantziara V ，Apostolidou I ，Henriques JP ，Leon MB ，Di Mario C ，Park SJ ，Stone GW ，Moses JW ，Colombo A ，Mehran R ，Multinational CTO Registry ... -  《-》

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

The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. 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). 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. 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.

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 ，Multinational Chronic Total Occlusion Registry ... -  《-》

Impact of target vessel on long-term survival after percutaneous coronary intervention for chronic total occlusions.

This study sought to investigate whether there is a differential prognostic effect of successful percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) according to the target vessel the CTO is located in. Between 1998 and 2007, a total of 1,791 patients underwent PCI of a CTO at three tertiary care centers in the US, Italy, and South Korea. Patients with CTOs in multiple target vessels or the left main stem were excluded (n = 57). Of the remaining 1,734 patients, 609 had a CTO in the left anterior descending (LAD, 35.1%), 391 in the left circumflex (LCX, 22.5%), and 734 in the right coronary artery (RCA, 42.3%). Five-year mortality and the need for coronary artery bypass grafting (CABG) were compared between patients with successful vs. unsuccessful PCI stratified by target vessel. Procedural success was obtained in 71.1% of LAD patients, 69.1% of LCX patients, and 65.1% of RCA patients (P = 0.06). The mean follow-up duration was 1,178 days. Kaplan-Meier estimates of long-term mortality were 6.7% vs. 11.0% (P = 0.03), 5.5% vs. 13.9% (P < 0.01), and 6.6% vs. 4.1% (P = 0.80) in successful vs. unsuccessful LAD, LCX, and RCA patients, respectively. After multivariate analysis, successful CTO PCI remained associated with lower mortality in the LAD (HR 0.41, P = 0.02) and LCX groups (HR 0.32, P < 0.01). The need for CABG was lower after successful CTO PCI in all three groups (LAD 4.6% vs. 16.0%, P < 0.01; LCX 2.9% vs. 18.2%, P < 0.01, RCA 2.3% vs. 8.4%, P < 0.01). The results from this large contemporary cohort of patients suggest that successful PCI of a CTO in the LAD and the LCX, but not the RCA, is associated with improved long-term survival.

Claessen BE ，Dangas GD ，Godino C ，Henriques JP ，Leon MB ，Park SJ ，Stone GW ，Moses JW ，Colombo A ，Mehran R ，Multinational CTO Registry ... -  《-》

Successful versus unsuccessful antegrade recanalization of single chronic coronary occlusion: eight-year experience and outcomes by a propensity score ascertainment.

The effectiveness of revascularization of chronic total occlusion (CTO) remains intriguing. Thus, we sought to investigate whether a successful PCI for single CTO improves outcomes in a setting of stable angina and chronic occlusion of single coronary artery. Of 11 957 consecutive patients referred for nonurgent PCI between 2003 and 2010, 1110 displayed single CTO and were enrolled to the central CTO-registry database. The primary end-point included all-cause mortality, the secondary end-point a composite of safety outcome measure of all-cause death, nonfatal-MI, the need for urgent revascularization and stroke. The major adverse cardiovascular event (MACE) records were extracted from the national administrative database and all patients were linked to the long-term follow-up. Since the patient assignment was not random, we performed the propensity scoring to minimize selection bias; 734 patients (66%) had a successful PCI-CTO. Compared with successful procedures, unsuccessful procedures had similar rates of all-cause death both in crude (HR, 0.78; 95%CI, 0.49-1.25; P = 0.30) and adjusted analysis (HR, 0.80; 95%CI, 0.50-1.28; P = 0.34). A similar, significant reduction in overall MACE was noted with successful PCI-CTO compared with unsuccessful procedure in unadjusted (HR, 0.74; 95%CI, 0.56-0.96; P = 0.020) and adjusted calculation (HR, 0.73; 95%CI, 0.56-0.96; P = 0.019). Patients after successful PCI-CTO as compared with failed recanalization less frequently underwent surgical revascularization. The benefit was sustained at 3 years follow-up. Successful PCI for single CTO does not improve long-term survival, nonetheless, is associated with reduced overall MACE and the need for surgical revascularization.

Jaguszewski M ，Ciecwierz D ，Gilis-Malinowska N ，Fijalkowski M ，Targonski R ，Masiewicz E ，Strozyk A ，Duda M ，Chmielecki M ，Lewicki L ，Dubaniewicz W ，Burakowski S ，Drewla P ，Skarzynski P ，Rynkiewicz A ，Alibegovic J ，Landmesser U ，Gruchala M ... -  《-》