Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions

被引：266

作者：

Mehran, Roxana ^{[1
,2
]}

Claessen, Bimmer E. ^{[2
,3
,5
]}

Godino, Cosmo ^{[4
]}

Dangas, George D. ^{[2
]}

Obunai, Kotaro ^{[2
,3
]}

Kanwal, Sunil ^{[2
,3
]}

Carlino, Mauro ^{[4
]}

Henriques, Jose P. S. ^{[5
]}

Di Mario, Carlo ^{[6
,7
]}

Kim, Young-Hak ^{[8
]}

Park, Seung-Jung ^{[8
]}

Stone, Gregg W. ^{[2
,3
]}

Leon, Martin B. ^{[2
,3
]}

Moses, Jeffrey W. ^{[2
,3
]}

Colombo, Antonio ^{[4
]}

机构：

[1] Mt Sinai Med Ctr, Cardiovasc Inst, New York, NY 10029 USA

[2] Cardiovasc Res Fdn, New York, NY USA

[3] Columbia Univ, Med Ctr, New York, NY USA

[4] Ist Sci San Raffaele, I-20132 Milan, Italy

[5] Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands

[6] Royal Brompton Hosp, London SW3 6LY, England

[7] Univ London Imperial Coll Sci Technol & Med, London, England

[8] Asan Med Ctr, Seoul, South Korea

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2011年 / 4卷 / 09期

关键词：

chronic total occlusions; drug-eluting stents; long-term outcomes; percutaneous coronary intervention; LEFT-VENTRICULAR FUNCTION; IN-HOSPITAL OUTCOMES; BARE-METAL STENT; RECANALIZATION; ARTERIES; MULTICENTER; IMPLANTATION; IMPROVEMENT; EXPERIENCE; SURVIVAL;

D O I：

10.1016/j.jcin.2011.03.021

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Background Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. Methods We evaluated long-term clinical outcomes in 1,791 patients who underwent PCI of 1,852 CTO at 3 tertiary care centers in the United States, South Korea, and Italy between 1998 and 2007. Median follow-up was 2.9 years (interquartile range: 1.5 to 4.6 years). Results Procedural success was obtained in 1,226 (68%) patients. Stents were implanted in 1,160 patients (95%); 396 patients (34%) received bare-metal stents (BMS), and 764 patients (66%) received drug-eluting stents (DES). After multivariable analysis, successful CTO PCI was an independent predictor of a lower cardiac mortality (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.21 to 0.75, p < 0.01) and reduced need for coronary artery bypass graft surgery (HR: 0.21, 95% CI: 0.13 to 0.40, p < 0.01); it also correlated with a strong trend toward lower all-cause mortality (HR: 0.63, 95% CI: 0.40 to 1.00, p = 0.05) at 5-year follow-up. Among patients who underwent stent implantation, treatment with DES rather than BMS resulted in less target vessel revascularization at long-term follow-up (17.2% vs. 31.1%, p < 0.01); definite/probable stent thrombosis rates were similar (DES 1.7%, BMS 2.3%, p = 0.58). Within the DES subgroup, patients treated with paclitaxel-eluting stents and sirolimus-eluting stents had similar clinical outcomes. Conclusions Successful CTO PCI is associated with reduced long-term cardiac mortality and need for coronary artery bypass graft surgery. Treatment of CTO with DES rather than BMS is associated with a significant reduction in target vessel revascularization with similar rates of stent thrombosis. Paclitaxel-eluting stents and sirolimus-eluting stents had similar long-term safety and efficacy outcomes. (J Am Coll Cardiol Intv 2011;4: 952-61) (C) 2011 by the American College of Cardiology Foundation

引用

页码：952 / 961

页数：10

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