Premium
Association of symptom status, myocardial viability, and clinical/anatomic risk on long‐term outcomes after chronic total occlusion percutaneous coronary intervention
Author(s) -
Song Lei,
Qiao Shubin,
Guan Changdong,
Bai Yinxiao,
Zou Tongqiang,
Wu Fan,
Shi Yanpu,
Xie Lihua,
Sun Zhongwei,
Dou Kefei,
Yang Weixian,
Brilakis Emmanouil S.,
Yang Yuejin,
Yeh Robert W.,
Wu Yongjian,
Kirtane Ajay J.,
Xu Bo
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.29577
Subject(s) - medicine , percutaneous coronary intervention , hazard ratio , conventional pci , confidence interval , cardiology , myocardial infarction , clinical endpoint , surgery , clinical trial
Objectives This study aimed to examine the association of less‐certain indication of chronic total occlusion percutaneous coronary intervention (CTO‐PCI) with subsequent clinical outcomes. Background The impact of patient symptoms, myocardial viability, and clinical and anatomic risk on long‐term outcomes is underdetermined. Methods Consecutive patients undergoing CTO‐PCI at a large‐volume single center between 2010 and 2013 were included. Central adjudication was used to assess the appropriateness of three prespecified indications. The primary outcome was the 5‐year composite endpoint of death or myocardial infarction (MI). Results Of 2,659 patients with 2,735 CTO lesions, the 348 (13.1%) asymptomatic patients, 164 (6.2%) patients without viable myocardium in the CTO territory, and 306 (11.5%) patients in whom the Synergy between PCI with Taxus and Cardiac Surgery Score II favored coronary artery bypass grafting (CABG) had higher 5‐year death or MI compared with the rest patients in each category (12.0% vs. 8.6%, p = .04; 16.3% vs. 8.5%, p < .0001; 12.2% vs. 8.6%, p = .03), respectively. Multivariable regression analysis demonstrated that without symptom (hazard ratio: 1.51; 95% confidence interval: 1.06–2.15; p = .02), non‐viable myocardium in CTO territory (hazard ratio: 1.77; 95% confidence interval: 1.16–2.72; p = .009), and deemed more favorable for CABG (hazard ratio:1.54; 95% confidence interval: 1.04–2.28; p = .03), but not the technical success (hazard ratio:0.85; 95% confidence interval: 0.62–1.18; p = .34), were independent predictors for the primary endpoint. Conclusions In this large cohort of CTO‐PCI, those who were asymptomatic, non‐viable myocardium in the CTO territory, or deemed more favorable for CABG were associated with higher risk of long‐term mortality or MI.