Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well-Developed Collaterals.

Abstract

BACKGROUND:

The impact of percutaneous coronary intervention (PCI) on chronic total occlusion in patients with well-developed collaterals is not clear.

METHODS AND RESULTS:

A total of 640 chronic total occlusion patients with collateral flow grade ≥2 were divided into 2 groups; chronic total occlusion patients either treated with PCI (the PCI group; n=305) or optimal medical therapy (the optimal medical therapy group; n=335). To adjust for potential confounders, a propensity score matching analysis was performed. Major clinical outcomes were compared between the 2 groups up to 5 years. In the entire population, the PCI group had a lower hazard of myocardial infarction (hazard ratio [HR], 0.177; P=0.039; 95% confidence interval [CI], 0.03-0.91) and the composite of total death or myocardial infarction (HR, 0.298; P=0.017; 95% CI, 0.11-0.80); however, it showed higher hazard of target lesion revascularization (HR, 3.942; P=0.003; 95% CI, 1.58-9.81) and target vessel revascularization (HR, 4.218; P=0.001; 95% CI, 1.85-9.60). After propensity score matching, a total of 158 matched pairs were generated. Although the PCI group showed a higher hazard of target lesion revascularization (HR, 2.868; P=0.027; 95% CI, 1.13-7.31) and target vessel revascularization (HR=2.62; P=0.022; 95% CI, 1.15-5.97), it still exhibited a lower incidence of the composite of total death or myocardial infarction (HR, 0.263; P=0.017; 95% CI, 0.087-0.790). The mean ejection fraction was improved from 47.8% to 51.6% (P<0.001) after PCI.

CONCLUSIONS:

In our study, successful revascularization by PCI for chronic total occlusion lesions with well-developed collaterals was associated with lower incidence of death and myocardial infarction, improved left ventricular function, but increased repeat revascularization rate.

• Authors: Se Yeon Choi, Byoung Geol Choi, Seung-Woon Rha, Man Jong Baek, Yang Gi Ryu, Yoonjee Park, Jae Kyeong Byun, Minsuk Shim, Hu Li, Ahmed Mashaly, Won Young Jang, Woohyeun Kim, Jah Yeon Choi, Eun Jin Park, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 6 Issue 9 (Sep 13 2017) ISSN: 2047-9980 [Electronic] England
• PMID: 28903939 (Publication Type: Comparative Study, Journal Article, Observational Study)
• Copyright: © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Chemical References

• Cardiovascular Agents

Topics

• Aged
• Angioplasty, Balloon, Coronary (adverse effects, instrumentation, mortality)
• Cardiovascular Agents (adverse effects, therapeutic use)
• Chi-Square Distribution
• Chronic Disease
• Collateral Circulation
• Coronary Circulation
• Coronary Occlusion (diagnosis, mortality, physiopathology, therapy)
• Coronary Vessels (physiopathology)
• Databases, Factual
• Drug-Eluting Stents
• Female
• Humans
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Middle Aged
• Myocardial Infarction (etiology)
• Propensity Score
• Proportional Hazards Models
• Recovery of Function
• Registries
• Risk Factors
• Stroke Volume
• Time Factors
• Treatment Outcome
• Ventricular Function, Left