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JAHA: Late-stage survival rate of PCI treatment for CTO

Patients: 10-year follow-up study

JAHA: Late-stage survival rate of PCI treatment for CTO. As an initial treatment strategy, PCI may reduce the late cardiogenic death of CTO patients compared with OMT.

As an initial treatment strategy, in the treatment of patients with chronic total coronary occlusion (CTO), percutaneous coronary intervention (PCI) compared with optimal medical therapy (OMT), the medium-term survival rate did not significantly improve.

Two randomized trials involving CTO-PCI versus optimal medical therapy (OMT) have been conducted in the past: The DECISION-CTO trial and the EUROCTO trial did not confirm that percutaneous coronary intervention (PCI) is the best Compared with medical treatment (OMT), major cardiovascular and cerebrovascular events can be improved.

Both trials have some limitations, including insufficient sample size, mid-term follow-up, and selection of low-risk populations.

A retrospective study recently published in the journal JAHA aims to explore whether PCI can reduce the risk of late cardiogenic death in patients with CTO as an initial treatment strategy compared with OMT.

Research overview

Research method

The study included 2,024 CTO patients registered in a single-center registration center in South Korea from March 2003 to February 2012 and followed up for about 10 years. CTO patients (n=477) who underwent coronary artery bypass surgery were excluded. The treatment strategy divided patients into CTO-PCI group (n=883) and OMT group (n=664). Both groups of patients with multivascular disease received PCI for obstructive non-CTO disease. In the CTO-PCI group, 699 patients (79.2%) successfully underwent revascularization.

Primary endpoint: 10-year cardiogenic mortality.
Secondary endpoints: the incidence of all-cause deaths, acute myocardial infarction, and any revascularization in 10 years.

Research results

The 10-year cardiogenic mortality rate in the CTO-PCI group was lower (10.4% vs. 22.3%; hazard ratio [HR] 0.44, [95% CI: 0.32-0.59]; P <0.001) higher than that in the OMT group.

After propensity score matching analysis, the CTO-PCI group had a lower 10-year cardiac death rate (13.6% vs. 20.8%; HR 0.64, [95%CI 0.45-0.91]; P=0.01).

The relative decrease in 10-year cardiogenic death was mainly due to the relative decrease between 3-10 years (8.3% vs. 16.6%; HR 0.43, [95%CI 0.27-0.71]; P＜0.001), but none within 3 years (5.7% vs. 5.0%; HR 1.12, [95%CI: 0.63-2.50]; P=0.71).

Late differential patterns of cardiogenic death were also observed in the survival curves of all-cause death, acute myocardial infarction, and any revascularization. The beneficial effects of CTO-PCI are consistent among the subgroups. (See Figure 1-Figure 3)

JAHA: Late-stage survival rate of PCI treatment for CTO