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Cardiac and sudden death after chronic total occlusion percutaneous coronary intervention: Prognostic role of the target vessel
Author(s) -
Scotti Andrea,
Godino Cosmo,
Munafò Andrea,
Pivato Carlo A.,
Chiarito Mauro,
Fiore Giorgio,
Di Maio Silvana,
Vergara Pasquale,
Della Bella Paolo,
Carlino Mauro,
Margonato Alberto,
Colombo Antonio
Publication year - 2021
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.29425
Subject(s) - medicine , cardiology , percutaneous coronary intervention , conventional pci , myocardial infarction , revascularization , sudden cardiac death , circumflex , clinical endpoint , coronary arteries , artery , coronary artery disease , randomized controlled trial
Abstract Background The role of the target vessel in percutaneous revascularization of chronic total occlusion (CTO) is unclear. Objective We sought to assess the long‐term results of percutaneous coronary intervention (PCI) for CTO lesions in each coronary artery and to investigate the impact of successful revascularization and previous myocardial infarction (MI) in the territory of the target vessel. Methods and Results Cohort observational study on 1,124 patients who have undergone CTO PCI attempt: 371 on left anterior descending artery (LAD), 485 right coronary artery, and 268 left circumflex. Patients were further stratified by successfully revascularized and not‐revascularized CTO (CTO‐NR). Vessels affected by a previous MI were defined as infarct‐related artery (IRA). The primary endpoint was cardiac death; the secondary endpoint was the combined rate of sudden cardiac‐death and sustained ventricular‐arrhythmias (SCD/SVAs). Propensity score‐matching was performed to evaluate LAD versus NON‐LAD CTO. Up to 12‐year follow‐up, the clinical benefit associated with successful PCI was consistent across the three groups. CTO‐NR had the greatest association with cardiac death and SCD/SVAs in each coronary artery and in IRA‐CTO patients. Conclusions Unsuccessful percutaneous CTO revascularization was associated with lower cardiac survival and freedom from SCD/SVAs, irrespective of the vessel treated. This result was mainly driven by patients with an IRA CTO.