Author + information
- Luis R. Alvarez-Contreras,
- Victoria Martin-Yuste,
- Salvatore Brugaletta,
- Yajaziel Azpeitia-Hernandez,
- Alejandro Santos and
- Manel Sabate
The presence of a chronic total occlusion (CTO) in up to 30% of routine angiograms emphasizes the importance to select an optimal treatment strategy effectiveness of its treatment and its implication in future clinical events.
We assessed the rationale for decision-making in treatment of CTO at our institution.
From June 2010 to December 2012 we evaluated all consecutive patients in our catheterization laboratory in which at least one CTO was diagnosed. Data were prospectively collected on treatment decisions (medical vs. surgery vs. percutaneous coronary intervention <PCI>), PCI indications and subsequent cardiac events through time.
711 patients with at least one CTO in the basal coronary angiogram were included. Two groups were made according to programmed to PCI (PPCI)=189 patients and non-programed to PCI (NPPCI)=522 patients. There was a statistical difference among basal characteristics in patients PPCI vs. NPPCI with less acute myocardial infarction (AMI) 16(13,6%) vs. 81(15,5%) p=0.016; less involvement of 3-vessel disease 56(29,6%) vs. 224 (42,9%) p=0.002; and less presence of coronary left-main disease 12 (6,4%) vs. 72 (13,8%) p=0.007. There was also a difference between age (62,6±10.4 years vs. 68,3±10.7 years; p=<0.0001); ejection fraction (EF) (47,1±13,8% vs. 44,9±13,9;p=0.017%) and creatinine clearance (70,8 ±28,6 ml/min vs. 62 ±23,1, ml/min; p=<0.001). The multivariate analysis demonstrated that the following variables in predicting no PCI as first step approach in CTO lesions: AMI, number of diseased vessels, left main lesion and age. There was a trend to be treated by PCI as first step approach in patients with positive ischemia by a stress test.
In a large all comer CTO lesion population, in a University hospital; the first step approach of revascularization is dictated by clinical factors as age, comorbidity (EF and creatinine clearance), AMI; anatomical factors such as left-main disease and 3-vessel disease. On the other hand, at our institution the choice of PCI as first step approach is in the global context of less patient fragility and the positivity of an ischemia test.