Influence of recanalization success on long-term outcome after percutaneous coronary intervention for chronic total coronary occlusions

Purpose: Despite advancements in recanalization technique there is limited data on prognosis after percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTOs) in the era of drug-eluting stents (DES). Methods: We evaluated long-term mortality in 1642 consecutive patients who underwent elective PCI of a CTO in our center between 01/2005 and 12/2011. Median follow-up was 3.0 years (interquartile range 1.1–3.8 years). Procedural success was defined as <30% residual diameter stenosis of the CTO lesion after DES implantation. Survival was assessed with unadjusted and adjusted Cox proportional hazard models. Results: Mean age was 65.8±11 years, 18% were female, 28% diabetics, 17% had a serum creatinin >1.3mg/dl, 11% a prior coronary bypass operation, 24% a previous myocardial infarction and 17% a left ventricular ejection fraction <40%. Procedural success was obtained in 1216 (74.1%) patients with a stent rate of 96.2%. Of the stents implanted 92% were DES. Patients with procedural success compared to failure were younger and had less often a previous coronary bypass operation. After multivariable adjustment procedural success was independently predictive for reduced long-term mortality (adjusted HR 0.56; 95% CI 0.38–0.81; p=0.003). Figure shows adjusted 3-years mortality from any cause. ![Figure][1] Conclusion: Successful recanalization of a CTO is an independent predictor for reduced long-term mortality. [1]: pending:yes