Advertisement

Submit Manuscripts
Author Information
Subscribe/Renew
Order Reprints
Email Alerts
Feedback
RSS Feed
CME

About the Journal
Editorial Board & Staff

About JACC CME
Hardware/Software Requirements
Contact Us
Policy on Privacy and Confidentiality
Copyright Information

JACC Imaging Homepage JACC Interventions Homepage
Still not a subscriber to JACC Imaging or JACC Interventions?
Click here
to sign up now!

ACC.org
Cardiosmart
Cardiosource
CVN
Imaging Library
JACC Imaging
JACC Interventions

Click here for more guidelines.
2009 Focused Updates: ACC/AHA Guidelines for STEMI and ACC/AHA/SCAI Guidelines for PCI
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
ACC 2009 Advocacy Position Statement: Principles for Comparative Effectiveness Research
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2001; 38:409-414
© 2001 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Suero, J. A.
Right arrow Articles by Rutherford, B. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Suero, J. A.
Right arrow Articles by Rutherford, B. D.

CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience

James A. Suero, MDa, Steven P. Marso, MDa, Philip G. Jones, MSa, Steven B. Laster, MD, FACCa, Kenneth C. Huber, MD, FACCa, Lee V. Giorgi, MD, FACCa, Warren L. Johnson, MD, FACCa and Barry D. Rutherford, MD, FACCa

a Mid-America Heart Institute, St. Luke’s Hospital, Kansas City, Missouri, USA

Manuscript received June 12, 2000; revised manuscript received April 5, 2001, accepted April 11, 2001.

Reprint requests and correspondence: Dr. Barry D. Rutherford, Cardiovascular Consultants, P.C., 4330 Wornall Road, Kansas City, Missouri 64111
jsuero{at}earthlink.net

OBJECTIVES

The study compared procedural outcomes and long-term survival for patients undergoing percutaneous coronary intervention (PCI) of a chronic total coronary artery occlusion (CTO) with a matched non-CTO cohort to determine whether successful PCI of a CTO is associated with improved survival.

BACKGROUND

Percutaneous coronary intervention of a CTO is a common occurrence, and the long-term survival for patients with successful PCI of a CTO has not been clearly defined.

METHODS

Between June 1980 and December 1999, a total of 2,007 consecutive patients underwent PCI for a CTO. Utilizing propensity scoring methods, a matched non-CTO cohort of 2,007 patients was identified and compared to the CTO group. The cohorts were stratified into successful and failed procedures.

RESULTS

The in-hospital major adverse cardiac event (MACE) rate was 3.8% in the CTO cohort. Technical success has improved over the last 10 years (overall 74.4%, slope 1.0%/yr, p = 0.02, R2 = 49.9%) as did procedural success (overall 69.9%, slope 1.2%/yr, p = 0.02, R2 = 51.5%) without a concomitant increase in in-hospital MACE rates (slope 0.1%/yr, p = 0.7). There was a distinct 10-year survival advantage for successful CTO treatment compared with failed CTO treatment (73.5% vs. 65.1%, p = 0.001). The CTO versus non-CTO 10-year survival was the same (71.2% vs. 71.4%, p = 0.9). Diabetics in the CTO cohort had a lower 10-year survival compared with nondiabetics (58.3% vs. 74.3%, p < 0.0001).

CONCLUSIONS

These data represent follow-up of the largest reported series of patients undergoing PCI for a CTO. The 10-year survival rates for matched non-CTO and the CTO cohorts were similar. Success rates have continued to improve without an accompanying increase in MACE rates. A successfully revascularized CTO confers a significant 10-year survival advantage compared with failed revascularization.

Abbreviations and Acronyms
  CABG = coronary artery bypass graft surgery
  CPK = creatine phosphokinase
  CTO = chronic total coronary artery occlusion
  MACE = major adverse cardiac event
  MAHI = Mid-America Heart Institute
  MI = myocardial infarction
  MVP = multivessel procedure
  PCI = percutaneous coronary intervention
  PTCA = percutaneous transluminal coronary angioplasty
  SVP = single-vessel procedure




This article has been cited by other articles:


Home page
 J Am Coll Cardiol IntvHome page
M. Kimura, O. Katoh, E. Tsuchikane, K. Nasu, Y. Kinoshita, M. Ehara, M. Terashima, H. Matsuo, T. Matsubara, K. Asakura, et al.
The Efficacy of a Bilateral Approach for Treating Lesions With Chronic Total Occlusions: The CART (Controlled Antegrade and Retrograde subintimal Tracking) Registry
J. Am. Coll. Cardiol. Intv., November 1, 2009; 2(11): 1135 - 1141.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
C. A. Thompson, J. E. Jayne, J. F. Robb, B. J. Friedman, A. V. Kaplan, B. D. Hettleman, N. W. Niles, and W. L. Lombardi
Retrograde Techniques and the Impact of Operator Volume on Percutaneous Intervention for Coronary Chronic Total Occlusions: An Early U.S. Experience
J. Am. Coll. Cardiol. Intv., September 1, 2009; 2(9): 834 - 842.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
D. E. Kandzari
Import and Export of Interventional Technique: Something to Declare at the Border
J. Am. Coll. Cardiol. Intv., September 1, 2009; 2(9): 843 - 845.
[Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
K. Tsujita, A. Maehara, G. S. Mintz, T. Kubo, H. Doi, A. J. Lansky, G. W. Stone, J. W. Moses, M. B. Leon, and M. Ochiai
Intravascular Ultrasound Comparison of the Retrograde Versus Antegrade Approach to Percutaneous Intervention for Chronic Total Coronary Occlusions
J. Am. Coll. Cardiol. Intv., September 1, 2009; 2(9): 846 - 854.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
J. A. Grantham, S. P. Marso, J. Spertus, J. House, D. R. Holmes Jr, and B. D. Rutherford
Chronic Total Occlusion Angioplasty in the United States
J. Am. Coll. Cardiol. Intv., June 1, 2009; 2(6): 479 - 486.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
S. Rathore, H. Matsuo, M. Terashima, Y. Kinoshita, M. Kimura, E. Tsuchikane, K. Nasu, M. Ehara, Y. Asakura, O. Katoh, et al.
Procedural and In-Hospital Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions of Coronary Arteries 2002 to 2008: Impact of Novel Guidewire Techniques
J. Am. Coll. Cardiol. Intv., June 1, 2009; 2(6): 489 - 497.
[Abstract] [Full Text] [PDF]

Home page
 Circ Cardiovasc IntervHome page
S. Rathore, O. Katoh, H. Matsuo, M. Terashima, N. Tanaka, Y. Kinoshita, M. Kimura, E. Tsuchikane, K. Nasu, M. Ehara, et al.
Retrograde Percutaneous Recanalization of Chronic Total Occlusion of the Coronary Arteries: Procedural Outcomes and Predictors of Success in Contemporary Practice
Circ Cardiovasc Interv, April 1, 2009; 2(2): 124 - 132.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EchocardiogrHome page
A. A. Boshchenko, A. V. Vrublevsky, and R. S. Karpov
Transthoracic echocardiography in the detection of chronic total coronary artery occlusion
Eur J Echocardiogr, January 1, 2009; 10(1): 62 - 68.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
R. Valenti, A. Migliorini, U. Signorini, R. Vergara, G. Parodi, N. Carrabba, G. Cerisano, and D. Antoniucci
Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion
Eur. Heart J., October 1, 2008; 29(19): 2336 - 2342.
[Abstract] [Full Text] [PDF]

Home page
 Circ Cardiovasc IntervHome page
M.-S. Lin, L.-C. Lin, H.-Y. Li, C.-H. Lin, C.-C. Chao, C.-N. Hsu, Y.-H. Lin, S.-C. Chen, Y.-W. Wu, and H.-L. Kao
Procedural Safety and Potential Vascular Complication of Endovascular Recanalization for Chronic Cervical Internal Carotid Artery Occlusion
Circ Cardiovasc Interv, October 1, 2008; 1(2): 119 - 125.
[Abstract] [Full Text] [PDF]

Home page
 Circ Cardiovasc IntervHome page
D. R. Holmes Jr and D. O. Williams
Catheter-Based Treatment of Coronary Artery Disease: Past, Present, and Future
Circ Cardiovasc Interv, August 1, 2008; 1(1): 60 - 73.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
D. M. Safley, J. A. House, S. P. Marso, J. A. Grantham, and B. D. Rutherford
Improvement in Survival Following Successful Percutaneous Coronary Intervention of Coronary Chronic Total Occlusions: Variability by Target Vessel
J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 295 - 302.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
K. Kendziorra, H. Barthel, S. Erbs, F. Emmrich, R. Hambrecht, G. Schuler, O. Sabri, and R. Kluge
Effect of Progenitor Cells on Myocardial Perfusion and Metabolism in Patients After Recanalization of a Chronically Occluded Coronary Artery
J. Nucl. Med., April 1, 2008; 49(4): 557 - 563.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. Sabate
Revascularization of the Infarct-Related Artery: Never Too Late to Do Well
J. Am. Coll. Cardiol., March 4, 2008; 51(9): 965 - 967.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
B. K. Courtney, N. R. Munce, K. J. Anderson, A. S. Thind, G. Leung, P. E. Radau, F. S. Foster, I. A. Vitkin, R. S. Schwartz, A. J. Dick, et al.
Innovations in imaging for chronic total occlusions: a glimpse into the future of angiography's blind-spot
Eur. Heart J., March 1, 2008; 29(5): 583 - 593.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
A. S.H. Cheng, J. B. Selvanayagam, M. Jerosch-Herold, W. J. van Gaal, T. D. Karamitsos, S. Neubauer, and A. P. Banning
Percutaneous treatment of chronic total coronary occlusions improves regional hyperemic myocardial blood flow and contractility insights from quantitative cardiovascular magnetic resonance imaging.
J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 44 - 53.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
P. W.J.C. Serruys and R.-J. van Geuns
Arguments for recanalization of chronic total occlusions.
J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 54 - 55.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
E. Martuscelli, F. Clementi, M. M. Gallagher, A. D'Eliseo, G. Chiricolo, A. Nigri, B. Marino, F. Romeo, and on behalf of CABRI trialists
Revascularization strategy in patients with multivessel disease and a major vessel chronically occluded; data from the CABRI trial
Eur. J. Cardiothorac. Surg., January 1, 2008; 33(1): 4 - 8.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
G. S Werner
Collaterals: how important are they?
Heart, July 1, 2007; 93(7): 778 - 779.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. Prasad, C. S. Rihal, R. J. Lennon, H. J. Wiste, M. Singh, and D. R. Holmes Jr
Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions: A 25-Year Experience From the Mayo Clinic
J. Am. Coll. Cardiol., April 17, 2007; 49(15): 1611 - 1618.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
G. S. Werner, R. Surber, M. Ferrari, M. Fritzenwanger, and H. R. Figulla
The functional reserve of collaterals supplying long-term chronic total coronary occlusions in patients without prior myocardial infarction
Eur. Heart J., October 2, 2006; 27(20): 2406 - 2412.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. Di Giammarco, M. Pano, M. Giancane, A. Di Francesco, and M. Di Mauro
Off-Pump Revascularization of Chronically Occluded Left Anterior Descending Artery Through Left Anterior Small Thoracotomy: Early and Late Angiographic and Clinical Follow-Up.
Ann. Thorac. Surg., October 1, 2006; 82(4): 1446 - 1450.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
M. J. Suttorp, G. J. Laarman, B. M. Rahel, J. C. Kelder, M. A.R. Bosschaert, F. Kiemeneij, J. M. ten Berg, E. T. Bal, B. J. Rensing, F. D. Eefting, et al.
Primary Stenting of Totally Occluded Native Coronary Arteries II (PRISON II): A Randomized Comparison of Bare Metal Stent Implantation With Sirolimus-Eluting Stent Implantation for the Treatment of Total Coronary Occlusions
Circulation, August 29, 2006; 114(9): 921 - 928.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes and Vascular Disease ResearchHome page
D. M Safley, J. A House, B. D Rutherford, and S. P Marso
Success rates of percutaneous coronary intervention of chronic total occlusions and long-term survival in patients with diabetes mellitus
Diabetes and Vascular Disease Research, May 1, 2006; 3(1): 45 - 51.
[Abstract] [PDF]

Home page
 J Am Coll CardiolHome page
T. Baks, R.-J. van Geuns, D. J. Duncker, F. Cademartiri, N. R. Mollet, G. P. Krestin, P. W. Serruys, and P. J. de Feyter
Prediction of Left Ventricular Function After Drug-Eluting Stent Implantation for Chronic Total Coronary Occlusions
J. Am. Coll. Cardiol., February 21, 2006; 47(4): 721 - 725.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
A. Hoye, R. T. van Domburg, K. Sonnenschein, and P. W. Serruys
Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992-2002
Eur. Heart J., December 2, 2005; 26(24): 2630 - 2636.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
K D Dawkins, T Gershlick, M de Belder, A Chauhan, G Venn, P Schofield, D Smith, J Watkins, H H Gray, and Joint Working Group on Percutaneous Coronary Inter
Percutaneous coronary intervention: recommendations for good practice and training
Heart, December 1, 2005; 91(suppl_6): vi1 - vi27.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
G. W. Stone, N. J. Reifart, I. Moussa, A. Hoye, D. A. Cox, A. Colombo, D. S. Baim, P. S. Teirstein, B. H. Strauss, M. Selmon, et al.
Percutaneous Recanalization of Chronically Occluded Coronary Arteries: A Consensus Document: Part II
Circulation, October 18, 2005; 112(16): 2530 - 2537.
[Full Text] [PDF]

Home page
 CirculationHome page
G. W. Stone, D. E. Kandzari, R. Mehran, A. Colombo, R. S. Schwartz, S. Bailey, I. Moussa, P. S. Teirstein, G. Dangas, D. S. Baim, et al.
Percutaneous Recanalization of Chronically Occluded Coronary Arteries: A Consensus Document: Part I
Circulation, October 11, 2005; 112(15): 2364 - 2372.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
E. Jorgensen and H. Kelbaek
Drug-eluting stents for chronic total occlusions make sense, but it is too early to close the discussion
Eur. Heart J., June 1, 2005; 26(11): 1049 - 1051.
[Full Text] [PDF]

Home page
 HeartHome page
S Aziz and D R Ramsdale
Chronic total occlusions--a stiff challenge requiring a major breakthrough: is there light at the end of the tunnel?
Heart, June 1, 2005; 91(suppl_3): iii42 - iii48.
[Full Text] [PDF]

Home page
 HeartHome page
F Piscione, G Galasso, G De Luca, G Marrazzo, G Sarno, O Viola, D Accardo, and M Chiariello
Late reopening of an occluded infarct related artery improves left ventricular function and long term clinical outcome
Heart, May 1, 2005; 91(5): 646 - 651.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. S. Werner, A. Krack, G. Schwarz, D. Prochnau, S. Betge, and H. R. Figulla
Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents
J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2301 - 2306.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
G S Werner, U Emig, P Bahrmann, M Ferrari, and H R Figulla
Recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion
Heart, November 1, 2004; 90(11): 1303 - 1309.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. Hoye, K. Tanabe, P. A. Lemos, J. Aoki, F. Saia, C. Arampatzis, M. Degertekin, S. H. Hofma, G. Sianos, E. McFadden, et al.
Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions
J. Am. Coll. Cardiol., June 2, 2004; 43(11): 1954 - 1958.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
E. Mahmud and S. Keramati
highlights of the 2003 transcatheter cardiovascular therapeutics annual meeting: clinical implications
J. Am. Coll. Cardiol., February 18, 2004; 43(4): 684 - 690.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. S. Werner, P. Bahrmann, O. Mutschke, U. Emig, S. Betge, M. Ferrari, and H. R. Figulla
Determinants of target vessel failure in chronic total coronary occlusions after stent implantation: The influence of collateral function and coronary hemodynamics
J. Am. Coll. Cardiol., July 16, 2003; 42(2): 219 - 225.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
S. P Marso, B. D Bliven, J. A House, G. F Muehlebach, and A.M. Borkon
Myonecrosis following isolated coronary artery bypass grafting is common and associated with an increased risk of long-term mortality
Eur. Heart J., July 2, 2003; 24(14): 1323 - 1328.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
G. S. Werner, B. M. Richartz, S. Heinke, M. Ferrari, and H. R. Figulla
Impaired acute collateral recruitment as a possible mechanism for increased cardiac adverse events in patients with diabetes mellitus
Eur. Heart J., June 2, 2003; 24(12): 1134 - 1142.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
Z. Olivari, P. Rubartelli, F. Piscione, F. Ettori, A. Fontanelli, L. Salemme, C. Giachero, C. Di Mario, G. Gabrielli, L. Spedicato, et al.
Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE)
J. Am. Coll. Cardiol., May 21, 2003; 41(10): 1672 - 1678.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. A. Garcia and J. P. Carrozza Jr
Stenting chroniccoronary artery occlusions: One step closer?
J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1493 - 1495.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. C. Ferreira, A. A. Peter, T. A. Salerno, H. Bolooki, and E. de Marchena
Clinical impact of drug-eluting stents in changing referral practices for coronary surgical revascularization in a tertiary care center
Ann. Thorac. Surg., February 1, 2003; 75(2): 485 - 489.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. W. Stone, P. S. Teirstein, R. Rubenstein, D. Schmidt, P. L. Whitlow, E. J. Kosinski, G. Mishkel, and J. A. Power
A prospective, multicenter, randomized trial of percutaneous transmyocardial laser revascularization in patients with nonrecanalizable chronic total occlusions
J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1581 - 1587.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
S. K. Chugh
Revascularizing chronic total occlusions: what about the coronary collaterals and myocardial viability story?
J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1702 - 1703.
[Full Text] [PDF]


 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement