Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions

Roxana Mehran; Bimmer E. Claessen; Cosmo Godino; George D. Dangas; Kotaro Obunai; Sunil Kanwal; Mauro Carlino; José P. S. Henriques; Carlo Di Mario; Young-Hak Kim; Seung-Jung Park; Gregg W. Stone; Martin B. Leon; Jeffrey W. Moses; Antonio Colombo

doi:10.1016/j.jcin.2011.03.021

Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions

Roxana Mehran
, Bimmer E. Claessen
, Cosmo Godino
, George D. Dangas
, Kotaro Obunai
, Sunil Kanwal
, Mauro Carlino
, José P. S. Henriques
, Carlo Di Mario
, Young-Hak Kim
, Seung-Jung Park
, Gregg W. Stone
, Martin B. Leon
, Jeffrey W. Moses
, Antonio Colombo

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objectives The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Background Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. Methods We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years). Results Procedural success was obtained in 1,226 (68%) patients. Stents were implanted in 1,160 patients (95%); 396 patients (34%) received bare-metal stents (BMS), and 764 patients (66%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.21 to 0.75, p <0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95% CI: 0.13 to 0.40, p <0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2% vs. 31.1%, p <0.01); definite/probable stent thrombosis rates were similar (DES 1.7%, BMS 2.3%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes. Conclusions Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes. (J Am Coll Cardiol Intv 2011;4: 952-61) (C) 2011 by the American College of Cardiology Foundation

Original language	English
Pages (from-to)	952-961
Journal	JACC. Cardiovascular interventions
Volume	4
Issue number	9
DOIs	https://doi.org/10.1016/j.jcin.2011.03.021
Publication status	Published - 2011

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SDG 3 Good Health and Well-being

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10.1016/j.jcin.2011.03.021

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Mehran, R., Claessen, B. E., Godino, C., Dangas, G. D., Obunai, K., Kanwal, S., Carlino, M., Henriques, J. P. S., Di Mario, C., Kim, Y.-H., Park, S.-J., Stone, G. W., Leon, M. B., Moses, J. W., & Colombo, A. (2011). Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions. JACC. Cardiovascular interventions, 4(9), 952-961. https://doi.org/10.1016/j.jcin.2011.03.021

@article{d66e2420bc00483889d50433428f3efa,

title = "Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions",

abstract = "Objectives The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Background Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. Methods We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years). Results Procedural success was obtained in 1,226 (68\%) patients. Stents were implanted in 1,160 patients (95\%); 396 patients (34\%) received bare-metal stents (BMS), and 764 patients (66\%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95\% confidence interval [CI]: 0.21 to 0.75, p <0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95\% CI: 0.13 to 0.40, p <0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95\% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2\% vs. 31.1\%, p <0.01); definite/probable stent thrombosis rates were similar (DES 1.7\%, BMS 2.3\%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes. Conclusions Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes. (J Am Coll Cardiol Intv 2011;4: 952-61) (C) 2011 by the American College of Cardiology Foundation",

author = "Roxana Mehran and Claessen, \{Bimmer E.\} and Cosmo Godino and Dangas, \{George D.\} and Kotaro Obunai and Sunil Kanwal and Mauro Carlino and Henriques, \{Jos{\'e} P. S.\} and \{Di Mario\}, Carlo and Young-Hak Kim and Seung-Jung Park and Stone, \{Gregg W.\} and Leon, \{Martin B.\} and Moses, \{Jeffrey W.\} and Antonio Colombo",

year = "2011",

doi = "10.1016/j.jcin.2011.03.021",

language = "English",

volume = "4",

pages = "952--961",

journal = "JACC. Cardiovascular interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "9",

}

Mehran, R, Claessen, BE, Godino, C, Dangas, GD, Obunai, K, Kanwal, S, Carlino, M, Henriques, JPS, Di Mario, C, Kim, Y-H, Park, S-J, Stone, GW, Leon, MB, Moses, JW & Colombo, A 2011, 'Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions', JACC. Cardiovascular interventions, vol. 4, no. 9, pp. 952-961. https://doi.org/10.1016/j.jcin.2011.03.021

TY - JOUR

T1 - Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions

AU - Mehran, Roxana

AU - Claessen, Bimmer E.

AU - Godino, Cosmo

AU - Dangas, George D.

AU - Obunai, Kotaro

AU - Kanwal, Sunil

AU - Carlino, Mauro

AU - Henriques, José P. S.

AU - Di Mario, Carlo

AU - Kim, Young-Hak

AU - Park, Seung-Jung

AU - Stone, Gregg W.

AU - Leon, Martin B.

AU - Moses, Jeffrey W.

AU - Colombo, Antonio

PY - 2011

Y1 - 2011

N2 - Objectives The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Background Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. Methods We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years). Results Procedural success was obtained in 1,226 (68%) patients. Stents were implanted in 1,160 patients (95%); 396 patients (34%) received bare-metal stents (BMS), and 764 patients (66%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.21 to 0.75, p <0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95% CI: 0.13 to 0.40, p <0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2% vs. 31.1%, p <0.01); definite/probable stent thrombosis rates were similar (DES 1.7%, BMS 2.3%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes. Conclusions Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes. (J Am Coll Cardiol Intv 2011;4: 952-61) (C) 2011 by the American College of Cardiology Foundation

AB - Objectives The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Background Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. Methods We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years). Results Procedural success was obtained in 1,226 (68%) patients. Stents were implanted in 1,160 patients (95%); 396 patients (34%) received bare-metal stents (BMS), and 764 patients (66%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.21 to 0.75, p <0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95% CI: 0.13 to 0.40, p <0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2% vs. 31.1%, p <0.01); definite/probable stent thrombosis rates were similar (DES 1.7%, BMS 2.3%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes. Conclusions Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes. (J Am Coll Cardiol Intv 2011;4: 952-61) (C) 2011 by the American College of Cardiology Foundation

U2 - 10.1016/j.jcin.2011.03.021

DO - 10.1016/j.jcin.2011.03.021

M3 - Article

C2 - 21939934

SN - 1936-8798

VL - 4

SP - 952

EP - 961

JO - JACC. Cardiovascular interventions

JF - JACC. Cardiovascular interventions

IS - 9

ER -

Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions

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