Long-Term Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusion (from the CREDO-Kyoto Registry Cohort-2)

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• 作者：Erika Yamamoto ; Masahiro Natsuaki ; Takeshi Morimoto ; Yutaka Furukawa ; Yoshihisa Nakagawa ; Koh Ono ; Kazuaki Mitsudo ; Masakiyo Nobuyoshi ; Osamu Doi ; Takashi Tamura ; Masaru Tanaka ; Takeshi Kimura ; CREDO-Kyoto PCI/CABG Registry Cohort-2 Investigators
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：15 September, 2013
• 年：2013
• 卷：112
• 期：6
• 页码：767-774
• 全文大小：349 K

文摘

Despite improving success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions, the clinical benefit of recanalization of CTO is still a matter of debate. Of 13,087 patients who underwent PCI in the CREDO-Kyoto registry cohort-2, 1,524 patients received PCI for CTO (CTO-PCI). Clinical outcomes were compared between 1,192 patients with successful CTO-PCI and 332 patients with failed CTO-PCI. In-hospital death tended to occur less frequently in the successful CTO-PCI group than in the failed CTO-PCI group (1.4 % vs 3.0 % , p?= 0.053). Through 3-year follow-up, the cumulative incidence of all-cause death was not significantly different between the successful and failed CTO-PCI groups (9.0 % vs 13.1 % , p?= 0.18), whereas the cumulative incidence of cardiac death was significantly less in the successful CTO-PCI group than in the failed CTO-PCI group (4.5 % vs 8.4 % , p?= 0.03). However, after adjusting confounders, successful CTO-PCI was associated with lesser risk for neither all-cause death (hazard ratio 0.93, 95 % confidence interval 0.64 to 1.37, p?= 0.69) nor cardiac death (hazard ratio 0.71, 95 % confidence interval 0.44 to 1.16, p?= 0.16). The cumulative incidence of coronary artery bypass grafting (CABG) was remarkably less in patients with successful PCI compared with those with failed PCI (1.8 % vs 19.6 % , p <0.0001). In conclusion, successful CTO-PCI compared with failed PCI was not associated with lesser risk for 3-year mortality. However, successful CTO-PCI was associated with significantly less subsequent CABG.