Robustness of Percutaneously Completed Coronary Revascularization in Stable Coronary Artery Disease: Obstructive Versus Occlusive Lesions

Abstract

Our study sought to assess long-term outcomes of percutaneously completed coronary revascularization (CCR) in patients with obstructive coronary artery disease (CAD) comprising chronic total occlusions (CTOs). Between 2010 and 2014, percutaneous coronary interventions (PCIs) of the CTOs were attempted in 213 patients: the CCR was achieved in 125 patients (group 1), while the PCI failed in 88 patients (group 2). They were matched against 252 patients (group 3) with the CCR obtained by the non-CTO PCIs. In the 5-year follow-up, more adverse cardiovascular (CV) events occurred in group 2 (29.5% vs 4.8% in group 1 vs 3.5% in group 3, P = .0001), mainly due to recurrent severe symptoms and additional revascularization of the CTOs; CV mortality did not seem to be significantly affected. Survival curves for the successful CTO and non-CTO PCIs appeared indistinguishable. Stent thromboses were infrequent in the CCR groups. In conclusion, long-term outcomes of the patients with the obstructive CAD containing the CTOs showed a favorable outcome if the CCR had been achieved percutaneously.

Reply to the Letter to the Editor: “Accurate Patient Selection for Percutaneous Coronary Intervention for Coronary Chronic Total Occlusions”

“…8 In a previous issue of Angiology, we presented our experience with stable patients in whom a complete coronary revascularization (CCR) was percutaneously achieved. 9 Our study was a single-center registry analysis with related pitfalls and, as such, adequately mirrored the real-world situation. We enrolled 465 patients assigned into 3 groups (group 1: successful CTO PCI, group 2: failed CTO PCI, and group 3: successful non-CTO PCI).…”

Improved Angina Symptoms Following Coronary Sinus Flow Reducer Implantation in a Patient with Refractory Angina and Chronic Total Occlusion: A Case Report

“…There is an ongoing discussion concerning the possibility of using CFR in patients with chronic angina who are candidates for percutaneous revascularization of CTOs. There are data from our CTO registry confirming the clinical efficacy of successful PCI of LAD, RCA, LCX in reducing RA in 6-year follow-up (55%, 35%, less than 5%, respectively) [23]. However, in the light of the recent CTO studies' conflicting results, there is still a debate regarding the clinical efficacy of CTO interventions at improving angina frequency, physical limitation and quality of life [24] [25].…”

Accurate Patient Selection for Percutaneous Coronary Intervention for Coronary Chronic Total Occlusions

“…5,6 Additionally, in the absence of a large burden of ischemia or viable myocardium, there is lack of evidence regarding prognostic benefit of CTO PCI. 7 Therefore, in the study by Kranjec et al, 3 arbitrary patient selection and failed CTO PCI-related adverse events may have an effect on higher frequency of MACE, irrespective of revascularization.…”

“…1,2 PCI may provide prognostic benefit in accurately selected patients with CTO; however, routine treatment with PCI may not be useful and may even be harmful in most cases. 2 Recently, Kranjec et al 3 concluded that performing a successful CTO PCI may be associated with similar clinical outcomes in patients with single-vessel non-CTO successful PCI and provides better long-term clinical outcomes compared with patients in whom CTO PCI failed. On the other hand, patients undergoing CTO PCI carry a risk of hazardous complications that may affect prognosis, irrespective of procedure success.…”

“…8 Hence, prognostic value of successful and failed CTO PCI should be compared with optimal medical therapy. The authors 3 should provide information regarding treatment with essential medications and optimal medical therapy for each group.…”