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Survival after percutaneous coronary intervention for chronic total occlusion

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Abstract

Background

There is limited data on prognosis after percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) in the era of drug-eluting stents (DES).

Aims

This study investigates the specific contribution of CTO recanalization to the survival benefit of complete revascularization.

Methods

Consecutive patients who underwent PCI of a CTO at our center between 01/2005 and 12/2013 were followed for a median of 2.6 years (interquartile range 1.1–3.1 years). All-cause mortality was compared between patients with successful and failed PCI of CTO without and with adjustment for pertinent co-variables by the Cox models.

Results

The study comprised 2002 patients with attempted PCI of CTO (mean age 65.2 ± 11 years, 17 % female), 82 % had multivessel disease. The CTO PCI was successful in 1662 (83 %) patients with a DES rate of 94 %. All-cause mortality was significantly lower in patients with successful PCI of CTO compared to failed PCI of CTO (15.3 vs. 25.9 % at 4 years; P < 0.001). In the multivariable model, both successful CTO PCI and complete revascularization were strong independent predictors of reduced long-term mortality (adjusted hazard ratio (HR) 0.72; 95 % confidence interval (CI) 0.53–0.97; P = 0.03 and adjusted HR 0.59; 95 % CI 0.42–0.82; P = 0.002). Also within the subset of incomplete revascularization, successful PCI of CTO was associated with reduced mortality (adjusted HR: 0.67; 95 % CI: 0.50–0.92; P = 0.012).

Conclusion

Successful CTO recanalization is an independent predictor for improved long-term survival. Persistent CTO lesions are associated with significantly worse survival than persistent non-occlusive coronary lesions.

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References

  1. Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S, Gannot S, Samuel M, Weisbrod M, Bierstone D, Sparkes JD, Wright GA, Strauss BH (2012) Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol 59(11):991–997. doi:10.1016/j.jacc.2011.12.007

    Article  PubMed  Google Scholar 

  2. Jeroudi OM, Alomar ME, Michael TT, El Sabbagh A, Patel VG, Mogabgab O, Fuh E, Sherbet D, Lo N, Roesle M, Rangan BV, Abdullah SM, Hastings JL, Grodin J, Banerjee S, Brilakis ES (2014) Prevalence and management of coronary chronic total occlusions in a tertiary veterans affairs hospital. Catheter Cardiovasc Interv 84(4):637–643. doi:10.1002/ccd.25264

    Article  PubMed  Google Scholar 

  3. Kirschbaum SW, Baks T, van den Ent M, Sianos G, Krestin GP, Serruys PW, de Feyter PJ, van Geuns RJ (2008) Evaluation of left ventricular function 3 years after percutaneous recanalization of chronic total coronary occlusions. Am J Cardiol 101(2):179–185. doi:10.1016/j.amjcard.2007.07.060

    Article  PubMed  Google Scholar 

  4. Cheng AS, Selvanayagam JB, Jerosch-Herold M, van Gaal WJ, Karamitsos TD, Neubauer S, Banning AP (2008) Percutaneous treatment of chronic total coronary occlusions improves regional hyperemic myocardial blood flow and contractility: insights from quantitative cardiovascular magnetic resonance imaging. JACC Cardiovasc Interv 1(1):44–53. doi:10.1016/j.jcin.2007.11.003

    Article  PubMed  Google Scholar 

  5. Wijeysundera HC, Norris C, Fefer P, Galbraith PD, Knudtson ML, Wolff R, Wright GA, Strauss BH, Ko DT (2014) Relationship between initial treatment strategy and quality of life in patients with coronary chronic total occlusions. EuroIntervention 9(10):1165–1172. doi:10.4244/EIJV9I10A197

    Article  PubMed  Google Scholar 

  6. Borgia F, Viceconte N, Ali O, Stuart-Buttle C, Saraswathyamma A, Parisi R, Mirabella F, Dimopoulos K, Di Mario C (2012) Improved cardiac survival, freedom from MACE and angina-related quality of life after successful percutaneous recanalization of coronary artery chronic total occlusions. Int J Cardiol 161(1):31–38. doi:10.1016/j.ijcard.2011.04.023

    Article  PubMed  Google Scholar 

  7. 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 (2011) Long-term outcome of percutaneous coronary intervention for chronic total occlusions. JACC Cardiovasc Interv 4(9):952–961. doi:10.1016/j.jcin.2011.03.021

    Article  PubMed  Google Scholar 

  8. Joyal D, Afilalo J, Rinfret S (2010) Effectiveness of recanalization of chronic total occlusions: a systematic review and meta-analysis. Am Heart J 160(1):179–187. doi:10.1016/j.ahj.2010.04.015

    Article  PubMed  Google Scholar 

  9. Suero JA, Marso SP, Jones PG, Laster SB, Huber KC, Giorgi LV, Johnson WL, Rutherford BD (2001) 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 38(2):409–414

    Article  CAS  PubMed  Google Scholar 

  10. Garcia S, Sandoval Y, Roukoz H, Adabag S, Canoniero M, Yannopoulos D, Brilakis ES (2013) Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol 62(16):1421–1431. doi:10.1016/j.jacc.2013.05.033

    Article  PubMed  Google Scholar 

  11. Hannan EL, Racz M, Holmes DR, King SB 3rd, Walford G, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH (2006) Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era. Circulation 113(20):2406–2412. doi:10.1161/circulationaha.106.612267

    Article  PubMed  Google Scholar 

  12. George S, Cockburn J, Clayton TC, Ludman P, Cotton J, Spratt J, Redwood S, de Belder M, de Belder A, Hill J, Hoye A, Palmer N, Rathore S, Gershlick A, Di Mario C, Hildick-Smith D (2014) Long-term follow-up of elective chronic total coronary occlusion angioplasty: analysis from the UK Central Cardiac Audit Database. J Am Coll Cardiol 64(3):235–243. doi:10.1016/j.jacc.2014.04.040

    Article  PubMed  Google Scholar 

  13. Sianos G, Werner GS, Galassi AR, Papafaklis MI, Escaned J, Hildick-Smith D, Christiansen EH, Gershlick A, Carlino M, Karlas A, Konstantinidis NV, Tomasello SD, Di Mario C, Reifart N, Club E (2012) Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club. EuroIntervention 8(1):139–145. doi:10.4244/EIJV8I1A21

    Article  PubMed  Google Scholar 

  14. Ferenc M, Buettner HJ, Gick M, Comberg T, Rothe J, Khoury F, Valina C, Toma A, Kuebler P, Riede F, Neumann FJ (2016) Clinical outcome after percutaneous treatment of de novo coronary bifurcation lesions using first or second generation of drug-eluting stents. Clin Res Cardiol 105(3):230–238. doi:10.1007/s00392-015-0911-7

    Article  CAS  PubMed  Google Scholar 

  15. Cassese S, Kufner S, Xhepa E, Byrne RA, Kreutzer J, Ibrahim T, Tiroch K, Valgimigli M, Tolg R, Fusaro M, Schunkert H, Laugwitz KL, Mehilli J, Kastrati A (2015) Three-year efficacy and safety of new- versus early-generation drug-eluting stents for unprotected left main coronary artery disease insights from the ISAR-LEFT MAIN and ISAR-LEFT MAIN 2 trials. Clin Res Cardiol. doi:10.1007/s00392-015-0953-x

    Google Scholar 

  16. Valenti R, Migliorini A, Signorini U, Vergara R, Parodi G, Carrabba N, Cerisano G, Antoniucci D (2008) Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion. Eur Heart J 29(19):2336–2342. doi:10.1093/eurheartj/ehn357

    Article  PubMed  Google Scholar 

  17. Farooq V, Serruys PW, Garcia-Garcia HM, Zhang Y, Bourantas CV, Holmes DR, Mack M, Feldman T, Morice MC, Stahle E, James S, Colombo A, Diletti R, Papafaklis MI, de Vries T, Morel MA, van Es GA, Mohr FW, Dawkins KD, Kappetein AP, Sianos G, Boersma E (2013) The negative impact of incomplete angiographic revascularization on clinical outcomes and its association with total occlusions: the SYNTAX (synergy between percutaneous coronary intervention with Taxus and cardiac surgery) trial. J Am Coll Cardiol 61(3):282–294. doi:10.1016/j.jacc.2012.10.017

    Article  CAS  PubMed  Google Scholar 

  18. Strauss BH, Shuvy M, Wijeysundera HC (2014) Revascularization of chronic total occlusions: time to reconsider? J Am Coll Cardiol 64(12):1281–1289. doi:10.1016/j.jacc.2014.06.1181

    Article  PubMed  Google Scholar 

  19. Christakopoulos GE, Christopoulos G, Carlino M, Jeroudi OM, Roesle M, Rangan BV, Abdullah S, Grodin J, Kumbhani DJ, Vo M, Luna M, Alaswad K, Karmpaliotis D, Rinfret S, Garcia S, Banerjee S, Brilakis ES (2015) Meta-analysis of clinical outcomes of patients who underwent percutaneous coronary interventions for chronic total occlusions. Am J Cardiol 115(10):1367–1375. doi:10.1016/j.amjcard.2015.02.038

    Article  PubMed  Google Scholar 

  20. Pancholy SB, Boruah P, Ahmed I, Kwan T, Patel TM, Saito S (2013) Meta-analysis of effect on mortality of percutaneous recanalization of coronary chronic total occlusions using a stent-based strategy. Am J Cardiol 111(4):521–525. doi:10.1016/j.amjcard.2012.10.034

    Article  PubMed  Google Scholar 

  21. Yamamoto E, Natsuaki M, Morimoto T, Furukawa Y, Nakagawa Y, Ono K, Mitsudo K, Nobuyoshi M, Doi O, Tamura T, Tanaka M, Kimura T, Investigators C-KPCRC (2013) Long-term outcomes after percutaneous coronary intervention for chronic total occlusion (from the CREDO-Kyoto registry cohort-2). Am J Cardiol 112(6):767–774. doi:10.1016/j.amjcard.2013.05.004

    Article  PubMed  Google Scholar 

  22. Ladwiniec A, Cunnington MS, Rossington J, Mather AN, Alahmar A, Oliver RM, Nijjer SS, Davies JE, Thackray S, Alamgir F, Hoye A (2015) Collateral donor artery physiology and the influence of a chronic total occlusion on fractional flow reserve. Circ Cardiovasc Interv 8(4). doi:10.1161/circinterventions.114.002219

  23. Claessen BE, Dangas GD, Weisz G, Witzenbichler B, Guagliumi G, Mockel M, Brener SJ, Xu K, Henriques JP, Mehran R, Stone GW (2012) Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation myocardial infarction: 3-year results from the HORIZONS-AMI trial. Eur Heart J 33(6):768–775. doi:10.1093/eurheartj/ehr471

    Article  PubMed  Google Scholar 

  24. Nombela-Franco L, Mitroi CD, Fernandez-Lozano I, Garcia-Touchard A, Toquero J, Castro-Urda V, Fernandez-Diaz JA, Perez-Pereira E, Beltran-Correas P, Segovia J, Werner GS, Javier G, Luis AP (2012) Ventricular arrhythmias among implantable cardioverter-defibrillator recipients for primary prevention: impact of chronic total coronary occlusion (VACTO primary study). Circ Arrhythm Electrophysiol 5(1):147–154. doi:10.1161/circep.111.968008

    Article  PubMed  Google Scholar 

  25. Yang ZK, Zhang RY, Hu J, Zhang Q, Ding FH, Shen WF (2013) Impact of successful staged revascularization of a chronic total occlusion in the non-infarct-related artery on long-term outcome in patients with acute ST-segment elevation myocardial infarction. Int J Cardiol 165(1):76–79. doi:10.1016/j.ijcard.2011.07.074

    Article  PubMed  Google Scholar 

  26. Sirnes PA, Myreng Y, Mølstad P, Bonarjee V, Golf S (1998) Improvement in left ventricular ejection fraction and wall motion after successful recanalization of chronic coronary occlusions. Eur Heart J 19(2):273–281

    Article  CAS  PubMed  Google Scholar 

  27. Silva JC, Rochitte CE, Junior JS, Tsutsui J, Andrade J, Martinez EE, Moffa PJ, Menegheti JC, Kalil-Filho R, Ramires JF, Nicolau JC (2005) Late coronary artery recanalization effects on left ventricular remodelling and contractility by magnetic resonance imaging. Eur Heart J 26(1):36–43. doi:10.1093/eurheartj/ehi011

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany

    Aurel Toma, Michael Gick, Jan Minners, Miroslaw Ferenc, Christian Valina, Nikolaus Löffelhardt, Catherine Gebhard, Florian Riede, Franz-Josef Neumann & Heinz Joachim Buettner

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  1. Aurel Toma
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  2. Michael Gick
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Correspondence to Aurel Toma.

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Toma, A., Gick, M., Minners, J. et al. Survival after percutaneous coronary intervention for chronic total occlusion. Clin Res Cardiol 105, 921–929 (2016). https://doi.org/10.1007/s00392-016-1000-2

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