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May 1, 2017

VA CART Program Data Used to Evaluate CTOs and Treatment With PCI

May 1, 2017—An evaluation of the contemporary incidence of chronic total occlusions (CTOs) and the success rates of CTO percutaneous coronary intervention (PCI), as well as the complications and long-term outcomes patients with CTOs experience, was published by Thomas T. Tsai, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2017;10:866–875). The investigators evaluated detailed baseline clinical, angiographic, and follow-up outcomes using national data from the Veterans Affairs Clinical Assessment Reporting and Tracking (VA CART) program. 

As summarized in JACC: Cardiovascular Interventions, the study was composed of 111,273 patients with obstructive coronary artery disease who underwent coronary angiography at 79 VA sites between 2007 and 2013. The investigators concluded that approximately one in four patients with obstructive coronary artery disease on coronary angiography had ≥ 1 CTO (n = 29,399 [26.4%]), most commonly in the right coronary artery distribution (n = 18,986 [64.6%]). Among patients who underwent elective CTO PCI (n = 2,394 patients [8.1%]), the procedural success rate was 79.7%. Compared with failed CTO PCI, successful CTO PCI was associated with a decreased risk for mortality, as well as a decreased need for subsequent coronary artery bypass graft surgery.

The investigators found that the odds of CTO PCI success increased during the study period (odds ratio, 1.08; 95% confidence interval [CI], 1.01–1.16; P = .03). Compared with failed CTO PCI, successful CTO PCI was associated with a decreased adjusted risk for mortality (hazard ratio [HR], 0.67; 95% CI, 0.47–0.95; P = .02) and coronary artery bypass graft surgery (HR, 0.14; 95% CI, 0.08–0.24; P < .01) at 2 years, but there was no significant change in the risk for hospitalization for myocardial infarction (HR, 0.89; 95% CI, 0.58–1.36; P = .58), reported the investigators in JACC: Cardiovascular Interventions.

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