Impact of target vessel on long-term cardiac mortality after successful chronic total occlusion percutaneous coronary intervention: Insights from a Japanese multicenter registry

5 years ago

Impact of target vessel on long-term cardiac mortality after successful chronic total occlusion percutaneous coronary intervention: Insights from a Japanese multicenter registry

The impact of successful chronic total occlusion (S-CTO) percutaneous coronary intervention (PCI) on cardiac mortality may differ depending on target CTO vessel; however, to date this has not yet been adequately evaluated. The aim of this study was to investigate the impact of target vessel on cardiac mortality after S-CTO PCI.

Methods

From January 2004 to December 2011, 1517 CTO PCIs were performed in 4 Japanese centers and enrolled in a multicenter registry. Cases were retrospectively analyzed and divided per target vessel treated. The primary endpoint was cardiac mortality during the follow-up period.

Results

During the study period, 1424 CTOs with 1 main vessel CTO per patient were analyzed (left anterior descending artery [LAD]: 487, right coronary artery [RCA]: 599, left circumflex [LCx]: 338). 92.3% (n=1314) of cases were S-CTO PCIs. The median follow-up period was 1677 (interquartile range; 811–2463) days. In LAD and RCA CTOs, S-CTO PCI was associated with a lower cardiac mortality rate at 5-year follow-up when compared with unsuccessful CTO (U-CTO) (2.6% vs 9.7%, p=0.01, 2.6% vs 27.3%, p<0.01, respectively). This finding was not present with LCx CTO PCI (2.2% vs 0.0%, p=0.53). Cox regression analysis demonstrated that LAD and RCA S-CTO PCI were independent predictors of a lower cardiac mortality rate (LAD; HR: 0.18, 95% CI: 0.06–0.56; p<0.01; RCA; HR: 0.24, 95% CI: 0.09–0.65; p<0.01).

Conclusions

S-CTO LAD and RCA PCI were associated with a lower long-term cardiac mortality after CTO PCI. This finding was not observed with LCx CTO PCI.

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DOI: S0167527317320958