Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Interventions: Characteristics, Success, and Outcomes. (May 2016) - Hannan, Edward L.
Abstract : Background—: Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) has been identified as a beneficial treatment, but there is limited information about its use in everyday practice. Methods and Results—: Data from New York's PCI registry between July 1, 2009, and June 30, 2012, were used to examine the utilization and variation in use of CTO PCI, the success rates across providers, the multivariable correlates of success, and the mortality of successful CTO PCI. A total of 4030 (3.1%) patients undergoing PCI underwent CTO PCI with a success rate of 61.3%. Patients with successful CTO PCIs were younger; had higher ejection fractions; were less likely to have had previous revascularization or carotid/cerebrovascular disease; and were more likely to have the CTO in the left anterior descending artery. Operators with annual CTO PCI volumes of at least 48 per year (the top volume quartile) had odds of achieving success that were more than twice as high as the half of all operators who performed <9 CTO PCIs per year. Patients with unsuccessful CTO PCIs had significantly higher 2.5-year mortality (adjusted hazard ratio, 1.63; 95% confidence interval, 1.28–2.08) than patients who had complete revascularization (CR) for all CTOs and other diseased lesions. Conclusions—: The success rate for CTO is low compared with the rate for other lesions. Successful revascularization of CTO is associated with improved survival compared with procedures with unsuccessful CTO, and higher-volume CTO operators are more successful.