Yonsei Med J.  2018 Jul;59(5):602-610. 10.3349/ymj.2018.59.5.602.

Five-Year Outcomes of Successful Percutaneous Coronary Intervention with Drug-Eluting Stents versus Medical Therapy for Chronic Total Occlusions

• Rha SW
• Choi BG
• Baek MJ
• Ryu YG
• Li H
• Choi SY
• Byun JK
• Mashaly A
• Park Y
• Jang WY
• Kim W
• Choi JY
• Park EJ
• Na JO
• Choi CU
• Lim HE
• Kim EJ
• Park CG
• Seo HS
• Oh DJ

• KMID: 2412651
• DOI: http://doi.org/10.3349/ymj.2018.59.5.602

Abstract

PURPOSE
Many recent studies have reported that successful percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) for chronic total occlusion (CTO) has more beneficial effects than failed CTO-PCI; however, there are only limited data available from comparisons of successful CTO-PCI with medical therapy (MT) in the Korean population.
MATERIALS AND METHODS
A total of 840 consecutive CTO patients who underwent diagnostic coronary angiography, receiving either PCI with DESs or MT, were enrolled. Patients were divided into two groups according to the treatment assigned. To adjust for potential confounders, propensity score matching (PSM) analysis was performed using logistic regression. Individual major clinical outcomes and major adverse cardiac events, a composite of total death, myocardial infarction (MI), stroke, and revascularization, were compared between the two groups up to 5 years.
RESULTS
After PSM, two propensity-matched groups (265 pairs, n=530) were generated, and the baseline characteristics were balanced. Although the PCI group showed a higher incidence of target lesion and vessel revascularization on CTO, the incidence of MI tended to be lower [hazard ratio (HR): 0.339, 95% confidence interval (CI): 0.110 to 1.043, p=0.059] and the composite of total death or MI was lower (HR: 0.454, 95% CI: 0.224 to 0.919, p=0.028), compared with the MT group up to 5 years.
CONCLUSION
In this study, successful CTO PCI with DESs was associated with a higher risk of repeat PCI for the target vessel, but showed a reduced incidence of death or MI.

Keyword

Chronic total occlusion; percutaneous coronary intervention; drug-eluting stent; medical therapy

MeSH Terms

Coronary Angiography
Drug-Eluting Stents*
Humans
Incidence
Logistic Models
Myocardial Infarction
Percutaneous Coronary Intervention*
Propensity Score
Stroke

Figure

• 

  Fig. 1 Flow chart of group distribution. CTO, chronic total occlusion; PCI, percutaneous coronary intervention; MT, medical therapy; KUGH, Korea University Guro Hospital.

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  Fig. 2 Paired t-test analysis to evaluate changes in LVEF in the first 1.7 years. CTO; chronic total occlusion, PCI; percutaneous coronary intervention; LVEF, left ventricular ejection fraction.

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  Fig. 3 Predictions of composite events regarding total death and MI by Cox-proportional hazard ratio model analysis. MI, myocardial infarction; HR, hazard ratio; CI, confidence interval; CTO, chronic total occlusion; LAD, left arterial descending artery; PCI, percutaneous coronary intervention; CCS, Canadian Cardiovascular Society.

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