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Impact of complete percutaneous revascularization in elderly patients with chronic total occlusion
Author(s) -
Valenti Renato,
Migliorini Angela,
De Gregorio Maria Grazia,
Martone Raffaele,
Berteotti Martina,
Bernardini Andrea,
Carrabba Nazario,
Vergara Ruben,
Marchionni Niccolò,
Antoniucci David
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28452
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , revascularization , cardiology , hazard ratio , ejection fraction , proportional hazards model , surgery , myocardial infarction , heart failure , confidence interval
Abstract Objective The aim of the study was to assess the prognostic impact of successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and completeness of revascularization in the elderly. Background Successful CTO‐PCI is associated with clinical benefit. Notwithstanding elderly patients are currently underrepresented in CTO‐PCI randomized controlled trials and registries. Methods From the Florence CTO‐PCI registry 1,405 patients underwent CTO‐PCI between 2004 and 2015; out of these, 460 consecutive patients were ≥75 years. End point of the study was long‐term cardiac survival. The prognostic impact of successful CTO‐PCI and complete revascularization on survival was assessed by Kaplan–Meier estimation and by Cox multivariable regression analysis. Results Patients were stratified according to success (72%) or failure of CTO‐PCI. Completeness of revascularization was achieved in 57% of patients. Five‐year cardiac survival was significantly higher in the successful CTO‐PCI group (84 ± 3% vs. 72 ± 6%; p = .006) and it was further improved if complete coronary revascularization was achieved (90 ± 3% vs. 68 ± 5%; p  < .001). At multivariable analysis, increasing age (hazard ratio [HR] 1.08; p = .001), diabetes (HR 1.55; p = .033), chronic kidney disease (HR 1.96, p = .002), left ventricular ejection fraction <0.40 (HR 2.10; p  < .001), and completeness of revascularization (HR 0.58; p  < .005) resulted independently associated with long‐term cardiac survival. Conclusions In the elderly successful CTO‐PCI is associated with a long‐term survival benefit. The results of this study suggest that, even in the elderly, a CTO‐PCI attempt should be considered to achieve complete coronary revascularization.

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