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Medical therapy, percutaneous coronary intervention and prognosis in patients with chronic total occlusions

Ladwiniec, Andrew; Allgar, Victoria; Thackray, Simon; Alamgir, Farquad; Hoye, Angela

Authors

Andrew Ladwiniec

Victoria Allgar

Simon Thackray

Farquad Alamgir

Angela Hoye

Abstract

Objective There is little published data reporting outcomes for those found to have a chronic total coronary occlusion (CTO) that is electively treated medically versus those treated by percutaneous coronary intervention (PCI). We sought to compare long-term clinical outcomes between patients treated by PCI and elective medical therapy in a consecutive cohort of patients with an identified CTO. Methods Patients found to have a CTO on angiography between January 2002 and December 2007 in a single tertiary centre were identified using a dedicated database. Those undergoing CTO PCI and elective medical therapy to the CTO were propensity matched to adjust for baseline clinical and angiographic differences. Results In total, 1957 patients were identified, a CTO was treated by PCI in 405 (20.7%) and medical therapy in 667 (34.1%), 885 (45.2%) patients underwent coronary artery bypass graft surgery. Of those treated by PCI or medical therapy, propensity score matching identified 294 pairs of patients, PCI was successful in 177 patients (60.2%). All-cause mortality at 5 years was 11.6% for CTO PCI and 16.7% for medical therapy HR 0.63 (0.40 to 1.00, p=0.052). The composite of 5-year death or myocardial infarction occurred in 13.9% of the CTO PCI group and 19.6% in the medical therapy group, HR 0.64 (0.42 to 0.99, p=0.043). Among the CTO PCI group, if the CTO was revascularised by any means during the study period, 5-year mortality was 10.6% compared with 18.3% in those not revascularised in the medical therapy group, HR 0.50 (0.28–0.88, p=0.016). Conclusions Revascularisation, but not necessarily PCI of a CTO, is associated with improved long-term survival relative to medical therapy alone.

Journal Article Type Article
Publication Date Dec 1, 2015
Journal Heart
Print ISSN 1355-6037
Electronic ISSN 1468-201X
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 101
Issue 23
Pages 1907-1914
Institution Citation Ladwiniec, A., Allgar, V., Thackray, S., Alamgir, F., & Hoye, A. (2015). Medical therapy, percutaneous coronary intervention and prognosis in patients with chronic total occlusions. Heart, 101(23), 1907-1914. https://doi.org/10.1136/heartjnl-2015-308181
DOI https://doi.org/10.1136/heartjnl-2015-308181
Keywords Chronic total occlusions; Percutaneous coronary intervention; Medical therapy; CTO; PCI
Publisher URL http://heart.bmj.com/content/early/2015/11/09/heartjnl-2015-308181
Copyright Statement ©2015 University of Hull
Additional Information Author's accepted manuscript of article published in: Heart, 2015, v.101, issue 23.

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©2015 University of Hull




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