The study compared procedural outcomes and long-term survival for patients undergoing
percutaneous coronary intervention (PCI) of a chronic total coronary artery occlusion
(CTO) with a matched non-CTO cohort to determine whether successful PCI of a CTO is
associated with improved survival.
Percutaneous coronary intervention of a CTO is a common occurrence, and the long-term
survival for patients with successful PCI of a CTO has not been clearly defined.
Between June 1980 and December 1999, a total of 2,007 consecutive patients underwent
PCI for a CTO. Utilizing propensity scoring methods, a matched non-CTO cohort of 2,007
patients was identified and compared to the CTO group. The cohorts were stratified
into successful and failed procedures.
The in-hospital major adverse cardiac event (MACE) rate was 3.8% in the CTO cohort.
Technical success has improved over the last 10 years (overall 74.4%, slope 1.0%/yr,
p = 0.02, R2 = 49.9%) as did procedural success (overall 69.9%, slope 1.2%/yr, p =
0.02, R2 = 51.5%) without a concomitant increase in in-hospital MACE rates (slope
0.1%/yr, p = 0.7). There was a distinct 10-year survival advantage for successful
CTO treatment compared with failed CTO treatment (73.5% vs. 65.1%, p = 0.001). The
CTO versus non-CTO 10-year survival was the same (71.2% vs. 71.4%, p = 0.9). Diabetics
in the CTO cohort had a lower 10-year survival compared with nondiabetics (58.3% vs.
74.3%, p < 0.0001).
These data represent follow-up of the largest reported series of patients undergoing
PCI for a CTO. The 10-year survival rates for matched non-CTO and the CTO cohorts
were similar. Success rates have continued to improve without an accompanying increase
in MACE rates. A successfully revascularized CTO confers a significant 10-year survival
advantage compared with failed revascularization.