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Observational Study
. 2017 Sep 13;6(9):e006357.
doi: 10.1161/JAHA.117.006357.

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well-Developed Collaterals

Se Yeon Choi  1 , Byoung Geol Choi  1 , Seung-Woon Rha  2 , Man Jong Baek  3 , Yang Gi Ryu  3 , Yoonjee Park  4 , Jae Kyeong Byun  1 , Minsuk Shim  4 , Hu Li  1 , Ahmed Mashaly  4 , Won Young Jang  4 , Woohyeun Kim  4 , Jah Yeon Choi  4 , Eun Jin Park  4 , Jin Oh Na  4 , Cheol Ung Choi  4 , Hong Euy Lim  4 , Eung Ju Kim  4 , Chang Gyu Park  4 , Hong Seog Seo  4 , Dong Joo Oh  4
Affiliations
Observational Study

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well-Developed Collaterals

Se Yeon Choi et al. J Am Heart Assoc. .

Abstract

Background: The impact of percutaneous coronary intervention (PCI) on chronic total occlusion in patients with well-developed collaterals is not clear.

Methods and results: A total of 640 chronic total occlusion patients with collateral flow grade ≥2 were divided into 2 groups; chronic total occlusion patients either treated with PCI (the PCI group; n=305) or optimal medical therapy (the optimal medical therapy group; n=335). To adjust for potential confounders, a propensity score matching analysis was performed. Major clinical outcomes were compared between the 2 groups up to 5 years. In the entire population, the PCI group had a lower hazard of myocardial infarction (hazard ratio [HR], 0.177; P=0.039; 95% confidence interval [CI], 0.03-0.91) and the composite of total death or myocardial infarction (HR, 0.298; P=0.017; 95% CI, 0.11-0.80); however, it showed higher hazard of target lesion revascularization (HR, 3.942; P=0.003; 95% CI, 1.58-9.81) and target vessel revascularization (HR, 4.218; P=0.001; 95% CI, 1.85-9.60). After propensity score matching, a total of 158 matched pairs were generated. Although the PCI group showed a higher hazard of target lesion revascularization (HR, 2.868; P=0.027; 95% CI, 1.13-7.31) and target vessel revascularization (HR=2.62; P=0.022; 95% CI, 1.15-5.97), it still exhibited a lower incidence of the composite of total death or myocardial infarction (HR, 0.263; P=0.017; 95% CI, 0.087-0.790). The mean ejection fraction was improved from 47.8% to 51.6% (P<0.001) after PCI.

Conclusions: In our study, successful revascularization by PCI for chronic total occlusion lesions with well-developed collaterals was associated with lower incidence of death and myocardial infarction, improved left ventricular function, but increased repeat revascularization rate.

Keywords: chronic total occlusion; collateral circulation; medical therapy; percutaneous coronary intervention.

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Figures

Figure 1
Figure 1
Study flow chart. CTO indicates chronic total occlusion; OMT, optimal medical therapy; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Annual trends in success rate of CTO PCI. CTO indicates chronic total occlusion; PCI, percutaneous coronary intervention.
Figure 3
Figure 3
The composite total death and myocardial infarction free survival by Kaplan–Meier curves. CI indicates confidence interval; HR, hazard ratio; OMT, optimal medical therapy; PCI, percutaneous coronary intervention.
Figure 4
Figure 4
Changes of LVEF using paired t test analysis in the first 1.7 years after revascularization. A through C, Change of LVEF in CTO‐PCI patients after propensity score matching; all CTO‐PCI patients (A), CTO‐PCI patients with reduced LVEF (≤50%, B), and CTO‐PCI patients with near‐normal LVEF (>50%, C). D through F, Change of LVEF in CTO‐OMT patients after propensity score matching; All CTO‐OMT patients (D), CTO‐OMT patients with reduced LVEF (≤50%, E), and CTO‐OMT patients with near‐normal LVEF (>50%, F). G, Comparison for changed LVEF between CTO‐OMT with CTO‐PCI patients using Student t test. CTO indicates chronic total occlusion; LVEF, left ventricular ejection fraction; OMT, optimal medical therapy; PCI, percutaneous coronary intervention.
Figure 5
Figure 5
Subgroup analysis of the composite of total death and myocardial infarction. CCS indicates Canadian Cardiovascular Society class; CI, confidence interval; CTO, chronic total occlusion; LAD, left anterior descending artery; LV, left ventricular; OMT, optimal medical therapy; PCI, percutaneous coronary intervention.
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References

    1. Suero JA, Marso SP, Jones PG, Laster SB, Huber KC, Giorgi LV, Johnson WL, Rutherford BD. Procedural outcomes and long‐term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20‐year experience. J Am Coll Cardiol. 2001;38:409–414. - PubMed
    1. Morino Y, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Morimoto T, Abe M, Hinohara T, Mitsudo K; J‐CTO Registry Investigators . In‐hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J‐CTO Registry (Multicenter CTO Registry in Japan). JACC Cardiovasc Interv. 2010;3:143–151. - PubMed
    1. Wilson WM, Walsh SJ, Yan AT, Hanratty CG, Bagnall AJ, Egred M, Smith E, Oldroyd KG, McEntegart M, Irving J, Strange J, Douglas H, Spratt JC. Hybrid approach improves success of chronic total occlusion angioplasty. Heart. 2016;1–8. - PubMed
    1. 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 . Long‐term outcome of percutaneous coronary intervention for chronic total occlusions. JACC Cardiovasc Interv. 2011;4:952–961. - PubMed
    1. Olivari Z, Rubartelli P, Piscione F, Ettori F, Fontanelli A, Salemme L, Giachero C, Di Mario C, Gabrielli G, Spedicato L, Bedogni F, TOAST‐GISE Investigators . Immediate results and one‐year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST‐GISE). J Am Coll Cardiol. 2003;41:1672–1678. - PubMed

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