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  • Title: Long-term clinical outcomes of successful versus unsuccessful revascularization with drug-eluting stents for true chronic total occlusion.
    Author: Lee SW, Lee JY, Park DW, Kim YH, Yun SC, Kim WJ, Suh J, Cho YH, Lee NH, Kang SJ, Lee CW, Park SW, Park SJ.
    Journal: Catheter Cardiovasc Interv; 2011 Sep 01; 78(3):346-53. PubMed ID: 21452248.
    Abstract:
    OBJECTIVES: The aims of this study were to investigate the long-term clinical outcomes of patients with successful versus unsuccessful revascularization with drug-eluting stents (DES) for chronic total occlusion (CTO). BACKGROUND: The benefits of successful revascularization of CTO remain unclear. METHODS: Consecutive patients (n = 333) with "true" CTO, defined as Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 on angiography and duration ≥3 months, were divided into two groups, those with successful (CTO success group, n = 251) and unsuccessful (CTO failure group, n = 82) revascularization with DES for CTO lesions. The primary endpoint was defined as major adverse cardiac events (MACE) the composite of death, Q-wave myocardial infarction (MI), or target vessel revascularization (TVR). RESULTS: The CTO success group was significantly younger, with a higher involvement of LAD, and lower incidences of renal failure, previous myocardial infarction, and previous coronary intervention than the CTO failure group. After a median follow up of 1,317 days (interquartile range, 1,059-1,590 days), there were no significant between-group differences in rate of MACE, both after crude analysis (9.4% vs. 11.8%, log-rank P = 0.16) and after adjustment (HR 1.17; 95% CI 0.47-2.88, P = 0.53). On multivariate analysis, major predictors of MACE were left ventricle ejection fraction (LVEF) <40% (HR 3.14; 95% CI 1.39-7.09, P = 0.005) and multiple CTO (HR 2.38; 95% CI 1.01-5.71, P = 0.049). CONCLUSIONS: Long-term clinical outcomes were similar in the CTO success and failure groups. Multiple CTOs and LVEF <40% in CTO patients were independent predictors of MACE.
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