Original Title: Successful Recanalization of Native Coronary Chronic Total Occlusion Is Not Associated With Improved Long-Term Survival.
Reference: Pil Hyung Lee et al. J Am Coll Cardiol Intv. 2016. Online before print.
The aim of this study was to assess long term clinical outcomes after successful recanalization of chronic total occlusion (CTO) with DES implantation.
Between March 2003 and May 2014, 1173 native coronary CTO consecutive patients undergoing PCI were analyzed. DES were implanted in all successful procedures (1,004 patients, 85.6%).
At a median follow up of 4.6 years, all-cause mortality risk (HR: 1.04; IC 95% 0.53 to 2.04; p=0.92) and the combined risk of death and infarction (HR: 1.05 IC 95% 0.56 a 1.94; p=0.89) were comparable between successful and unsuccessful recanalization patients.
Neither were there differences between those patients with other compromised vessels, in addition to the one totally occluded (n=879), receiving complete revascularization, vs. those with incomplete revascularization for unsuccessful recanalization.
These finding were consistent between patients with multivessel disease and those with only the one occluded vessel.
Conclusion
Successful recanalization of CTO compared to unsuccessful recanalization was not associated with a reduction of hard events, such as death. However, successful recanalization was associated to a significate lower chance of CABG following CTO.
Editorial Comment
The different strategies to treat severely compromised, yet not occluded, vessels, the high rate of surgery following unsuccessful recanalization, and the high successful rate with very few serious complications, all contributed to the neutral outcome of this study.
The real prognostic impact of recanalizations should be decided between successful PCI vs. optimal medical treatment.
