Long-Term Follow-Up Published on Elective CTO PCI From the UK Central Cardiac Audit Database

July 14, 2014—Long-term follow-up findings on elective treatment of coronary chronic total occlusions (CTOs) from the UK Central Cardiac Audit database (CCAD) were published by Sudhaker George, MD, et al in the Journal of the American College of Cardiology (2014;64:235–243). In the study, the investigators aimed to compare outcomes of patients with successful versus unsuccessful percutaneous coronary interventions (PCIs) to treat CTOs.

According to the investigators, a CTO is reported in 18% to 30% of patients undergoing coronary angiography. PCI is usually performed to relieve anginal symptoms, but data are emerging to suggest that it may also confer a mortality benefit.

The investigators analyzed the UK CCAD for all CTO PCI cases carried out in England and Wales between January 1, 2005, and December 31, 2009. Vital status in September 2010 was obtained from the Medical Research Information Service.

As summarized in the Journal of the American College of Cardiology, a total of 13,443 patients (78.8% men) had a mean age of 63.5 years and underwent 14,439 procedures for CTOs. CTO PCI was successful in 10,199 cases (70.6%). During a follow-up of 2.65 years (interquartile range, 1.59–3.83 years), successful PCI of at least one CTO was associated with improved survival (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.62–0.83; P < .001). Complete revascularization was also associated with improved survival compared with partial revascularization (HR, 0.7; 95% CI, 0.56–0.87; P = .002) or failed revascularization (HR, 0.61; 95% CI, 0.5–0.74; P < .001).

The investigators concluded that successful CTO PCI was associated with improved long-term survival rates, and the improvement was greatest when complete revascularization was achieved. The identity of the successfully treated occluded vessel was not associated with differences in outcome, reported the investigators in the Journal of the American College of Cardiology.