Impact of successful recanalisation of chronically occluded coronary arteries on clinical outcomes in patients with coronary artery disease

Abstract

<p><strong>Background. </strong>Chronically occluded coronary arteries (CTO) are a common finding in coronary angiography. The technical success rate of endovascular recanalisation of CTO is high; however, the effect of technical success on long-term clinical results remains unclear.<strong></strong></p><p><strong>Aim. </strong>To evaluate long-term outcomes of CTO recanalisation according to technical success of the procedure.<strong></strong></p><p><strong>Methods. </strong>We evaluated 1073 patients who underwent endovascular recanalisation of CTO from 2013 to 2019. Assessment of clinical results was performed via phone call or follow-up visit at years 1, 2, 3, 4 and 5. Survival was evaluated using the Kaplan–Meier method and compared between the technical success and technical failure groups using the log-rank test. The initial clinical and angiographic characteristics and procedural results of recanalisation were included as probable predictors of adverse cardiovascular events in uni- and multivariate regression analyses.</p><p><strong>Results. </strong>Mean follow-up was 2.7 ± 1.9 years. The incidence of adverse cardiovascular events, including death from all causes, nonfatal myocardial infarction, stroke and unplanned myocardial revascularisation was 11.4% in the technical success group and 24% in the technical failure group (p = 0.0001). The difference was mainly due to the higher prevalence of repeat revascularisation in the technical failure group (6.7% vs. 18.1%, p = 0.0001). Differences in mortality (2.7% vs. 3.8%, p = 0.38), stroke (0.6% vs. 0.4%, p = 0.99) and myocardial infarction (2% vs. 4%, p = 0.13) were not observed. Multivariate regression analysis found that ejection fraction of the left ventricle, calcification of the coronary arteries and technical success were independent predictors of adverse events.</p><p><strong>Conclusion. </strong>Successful recanalisation of CTO is associated with fewer adverse cardiovascular events over the long term. Technical failure, calcification and low ejection fraction are independent predictors of adverse events.</p><p>Received 10 June 2020. Revised 10 July 2020. Accepted 13 July 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions<br /></strong>Conception and design: O.V. Krestyaninov, A.M. Chernyavskiy<br />Data collection and analysis: O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian<br />Statistical analysis: D.N. Ponomarev, A.G. Badoian, D.A. Khelimskii<br />Drafting the article: O.V. Krestyaninov, D.A. Khelimskii, K.A. Rzaeva<br />Critical revision of the article: O.V. Krestyaninov, A.M. Chernyavskiy<br />Final approval of the version to be published: O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, K.A. Rzaeva, D.N. Ponomarev, A.M. Chernyavskiy</p>

Predictors of unsuccessful endovascular recanalization of coronary chronic total occlusion

“…Ранее выполненные исследования убедительно показали, что успешная реканализация ХОКА приводит к облегчению симптомов стенокардии, улучшению фракции выброса левого желудочка и увеличивает продолжительность жизни [15][16][17][18][19]. Принимая во внимание отсутствие в настоящее время единого подхода к лечению ХОКА и крайне изменчивые показатели успешной ЧКВ ХОКА (от 60 до 90%), важно, чтобы у клиницистов было средство для стратификации риска успешного вмешательства [20][21][22].…”