Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion

Abstract

Successful CTO-PCI confers a long-term survival benefit. Improvement in survival is driven by the differences in the outcome of patients with multivessel disease and who were completely revascularized.

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

“…Some older registries have reported that patients with complete revascularisation have a better prognosis than those with incomplete revascularisation, including the presence of an untreated CTO (Hannan et al, 2006, Valenti et al, 2008. The SCAAR (Swedish Coronary Angiography and Angioplasty) Registry includes data from 2006 and 2010 on 23 342 patients with multivessel disease.…”

To complete, or not to complete, that is the question of revascularization in percutaneous coronary intervention with drug-eluting stents for multivessel disease

“…In 3 (11,13,16) of the 5 studies, C-RV was associated with reduced R-RV. In 8 (6,9-11,13-16) of the 11 studies, C-RV was associated with reduced MAC(C)E. There were a number of important issues, however, in the aforementioned studies (1,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) of C-RV versus IC-RV in DES-PCI for MV-CAD (except for AMI) (Figure 1). First, "angiographic" (successful angioplasty of all diseased lesions in the major epicardial coronary vessels and their first degree side branches) and "proximal" C-RV definitions (successful angioplasty of all diseased proximal arteries) according to a study by Kim et al (18) are more accurate and clinically relevant.…”

“…Our systematic search using keywords including "complete" or "completeness"; "incomplete" or "culprit"; "revascularization"; and "drug-eluting" identified 14 studies (1,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) summarized in Tables 1,2. The design of all studies was a non-randomized observational study, and all but one (13) studies reported adjusted HRs for outcomes of interest in "C-RV vs. IC-RV" or "IC-RV vs. C-RV".…”

“…The design of all studies was a non-randomized observational study, and all but one (13) studies reported adjusted HRs for outcomes of interest in "C-RV vs. IC-RV" or "IC-RV vs. C-RV". Nine (1,5-7,9,11,13-15), 5 (6,8,9,16,17), 3 (1,6,11), 2 (1,6), 5 (1,6,11,13,16), and 11 studies (1,6,(8)(9)(10)(11)(12)(13)(14)(15)(16) provided HRs for all-cause death, cardiac death, MI, stroke, R-RV, and MAC(C)E, respectively. In 5 (5-7,14,15) of the 9 studies, C-RV was associated with reduced all-cause death.…”

Complicated Forms of Coronary Lesions and Their Impact on the Forecast

“…Последующие значимые регистры (ERCTO, IRCTO), касающиеся проблемы эндоваскулярного лечения ХОКА, также подтвердили важность данного ангиографического показателя (протяженность окклюзии) как фактора риска в успехе ЧКВ [22]. По данным European Registry of Chronic Total Occlusion (ERCTO), длина поражения КА более 20 мм ассоциировалась с достоверно низким успехом река-нализации хронической окклюзии (отношение рисков (ОР) 9,6; 95% доверительный интервал (ДИ) 0,35-0,79, p<0,001) [23].…”