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Improvement in Survival Following Successful Percutaneous Coronary Intervention of Coronary Chronic Total Occlusions: Variability by Target Vessel

David M. Safley, MD, FACC^_*,,_*, John A. House, MS^_*, Steven P. Marso, MD, FACC^_*,, J. Aaron Grantham, MD, FACC^_*,, Barry D. Rutherford, MD, FACC^_*,

^_* Division of Cardiology and Biostatistics, Saint Luke's Health System, Mid America Heart Institute, Kansas City, Missouri
University of Missouri—Kansas City, Kansas City, Missouri.

^_* Reprint requests and correspondence: Dr. David M. Safley, Assistant Professor, University of Missouri—Kansas City, Saint Luke's Health System, Mid America Heart Institute, 4401 Wornall Road, Kansas City, Missouri 64111. (Email: dsafley{at}cc-pc.com).

Objectives: This study compared the survival benefit of opening a chronic total occlusion (CTO) of the left anterior descending (LAD), left circumflex (LCX), or right coronary artery (RCA).

Background: Previous analyses demonstrate improved survival following successful percutaneous coronary intervention (PCI) for CTO.

Methods: Eligible patients underwent attempted CTO PCI in a single vessel. Procedural success rates were calculated for each vessel. The primary end point was survival at 5 years, compared across target vessel groups stratified by procedural success.

Results: There were 2,608 patients included. The LAD was the target vessel in 936 (36%), the LCX in 682 (26%), and the RCA in 990 (38%) patients. Angiographic success rates for LAD were 77%, LCX 76%, and RCA 72%. Baseline demographics and comorbidities were well matched, though there were significantly more males in the LCX compared with LAD or RCA groups (80% vs. 75% and 73%, respectively, p = 0.005). Procedural success compared with failure was associated with improved 5-year survival in the LAD (88.9% vs. 80.2%, p < 0.001) group, but not in the LCX (86.1% vs. 82.1%, p = 0.21) and RCA groups (87.7% vs. 84.9%, p = 0.23). In multivariable analysis, CTO PCI success in the LAD group remained associated with decreased mortality risk (HR: 0.61, 95% CI: 0.42 to 0.89).

Conclusions: The data suggest that PCI for CTO of the LAD, but not LCX or RCA, is associated with improved long-term survival. This information may assist in selecting patients for attempted CTO PCI.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CAD = coronary artery disease   CCS = Canadian Cardiovascular Society   CTO = chronic total occlusion   GP = glycoprotein   LAD = left anterior descending   LCX = left circumflex   MI = myocardial infarction   PCI = percutaneous coronary intervention   RCA = right coronary artery

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