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In a consecutive series of 2007 patients undergoing intended PCI of a nonacute coronary occlusion at the Mid America Heart Institute between 1980 and 1999, technical success was achieved in 74.4% and procedural success in 69.9% of cases. Compared with those patients in whom the procedure was successful, the in-hospital occurrence of major adverse сardiac events was significantly higher among patients with procedural failure (3.2% versus 5.4%; P0.02). Long-term survival was similar in patients with successful CTO recanalization compared with a matched cohort of patients undergoing successful angioplasty of nonoccluded lesions and significantly greater than in patients in whom attempted CTO revascularization failed (10-year survival 73.5% with CTO success versus 65.0% with CTO failure; P0.001). By multivariate analysis, failure to successfully recanalize the CTO was an independent predictor of reduced survival (hazard ratio 1.4; P0.0003).
Similarly, a time-independent benefit of total occlusion recanalization has been observed in the British Columbia Cardiac Registry, in which attempted revascularization of CTO lesions accounted for 15% of all PCI procedures.59 Among 1458 patients with CTOs, successful percutaneous revascularization was associated with increased survival and a reduced need for surgical revascularization over a 7-year follow-up period (both P0.001). CTO success was associated with a 56% relative reduction in late mortality (hazard ratio 0.44; 95% CI, 0.30 to 0.64)
prospective Total Occlusion Angioplasty Study–Società Italiana di Cardiologia Invasiva (TOASTGISE), successful PCI of a CTO (attempted in 390 lesions in 369 patients) was associated with a reduced 12-month incidence of cardiac death or MI (1.1% versus 7.2%; P0.005), a reduced need for coronary artery bypass surgery (2.5% versus 15.7%; P0.0001), and greater freedom from angina (88.7% versus 75.0%; P0.008). In the overall study population, the only factor associated with enhanced 1-year event-free survival was successful CTO recanalization (odds ratio 0.24; P0.018).
In a study by Kim et al, of 44 patients with 58 CTO segments and fixed SPECT perfusion defects had only subendocardial infarction involving 50% of the thickness of the left ventricle by MRI, including 12 patients (21%) in whom no evidence of infarction was present. Territories without extensive infarction at baseline demonstrated significant regional wall motion improvement after PCI, with subsequent resolution of ischemia demonstrated by adenosine stress MRI.
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