Título original: Long-Term Survival Benefit of Revascularization Compared UIT Medical Therapy in Practice UIT Coronary Chronic Total Occlusion and Well-Developed Collateral Circulation. Reference: Woo Jin Jan, el at. J Am Coll Cardiol Interv 2015;8:271-9
Multiple studies have shown the benefit of chronic total occlusion (CTO) revascularization, but for patients presenting Rentrop 3 grade collateral circulation (CC), such benefit remains unclear.
The study included 738 patients presenting at least one Rentrop 3 grade CTO, symptomatic and silent ischemia patients, and excluded patients with a history of revascularization, cardiogenic shock, cardiopulmonary resuscitation or acute ST elevation myocardial infarction 48hs prior to procedure.
Primary end point was death during follow up and secondary end points were all cause death, infarction, repeat revascularization and combined events (MACE). 236 patients (32%) received medical treatment and 502 were treated with revascularization procedures (170 CABG and 332 with PCI).
Those treated with revascularization were younger, dislipemic, with ACS, higher ejection fraction and shorter catheterization history. The extent of heart failure was similar in both groups.
Follow up was 42 months. Multivariable analysis revealed a lower incidence of cardiac death (HR 0.29; CI 95% 0.15 to 0.58; p<0.01) and MACE (HR 0.32; CI 95% 0.21 to 0.49 p<0.01) in favor of the revascularization group. After propensity score matching, the incidence of death and MACE still favored the revascularization group. There were no differences in CABG and PCI, except for the higher rate of repeat revascularization.
Conclusion
In CTO patients and good collateral circulation, revascularization reduce the risk of cardiac death and combined events.
Editorial Comment
Previous studies had shown that good collateral circulation was beneficial for the evolution and this analysis shows it is even better when patients are treated with revascularization procedures, being PCI a valid alternative with a higher rate of repeat revascularization but with no difference in mortality.
Gentileza del Dr Carlos Fava
Cardiólogo Intervencionista
Fundación Favaloro – Argentina
Carlos Fava