The Impact of Right Coronary Artery Chronic Total Occlusion on Clinical Outcome of Patients Undergoing Percutaneous Coronary Intervention for Unprotected Left Main Disease

Objectives The aim of the present study was to investigate whether right coronary artery chronic total occlusion (CTO) carries prognostic implications in patients undergoing drug-eluting stent-supported percutaneous coronary intervention (PCI) for unprotected left main disease (ULMD). Background No data exist on the prognostic implication of CTO in patients undergoing PCI for ULMD. Methods Prospective registry of consecutive patients undergoing PCI for ULMD. Patients with ST-segment elevation myocardial infarction were excluded. Primary endpoints were 6-month and long-term cardiac mortality. Results From January 2004 to December 2009, 330 patients underwent PCI for ULMD. Of the 330 patients, 78 (24%) had CTO of the right coronary artery, 22 (7%) had CTO of the left anterior descending artery, and 16 (5%) had CTO of the left circumflex artery. Patients with right coronary artery CTO had a higher risk profile compared with patients without right coronary artery CTO. The 6-month mortality rate was 12.8% in patients with right coronary artery CTO, and 3.6% in patients without right coronary artery CTO (p < 0.002), and the 3-year cardiac survival rate was 76.4 +/- 6.8% and 89.7 +/- 2.7% (p < 0.003), respectively. By multivariable analysis, the only 2 independent predictors of 3-year cardiac mortality were right coronary artery CTO (hazard ratio: 2.15, 95% confidence interval: 1.02 to 4.50; p = 0.043) and EuroSCORE (hazard ratio: 1.03, 95% confidence interval: 1.02 to 1.05; p < 0.001). Conclusions Right coronary artery CTO occurs frequently and is a significant predictor of mortality in patients with ULMD undergoing PCI. (J Am Coll Cardiol 2011;58:125-30) (C) 2011 by the American College of Cardiology Foundation