CLINICAL RESEARCH
Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions
data from a multicenter, prospective, observational study (TOAST-GISE)
Zoran Olivari, MD*,*,
Paolo Rubartelli, MD ,
Federico Piscione, MD ,
Federica Ettori, MD ,
Alessandro Fontanelli, MD||,
Luigi Salemme, MD¶,
Corinna Giachero, MD,
Carlo Di Mario, MD#,
Gabriele Gabrielli, MD**,
Leonardo Spedicato, MD,
Francesco Bedogni, MD TOAST-GISE Investigators
* Ospedale Cà Foncello, Treviso, Italy
Ospedale San Martino, Genoa, Italy
Università Federico II, Naples, Italy
Spedali Civili, Brescia, Italy
|| Ospedale San Bortolo, Vicenza, Italy
¶ Clinica Montevergine, Mercogliano, Italy
# Ospedale S. Raffaele, Milan, Italy
** Ospedale Lancisi, Ancona, Italy
Ospedale Santa Maria della Misericordia, Udine, , Italy
Istituto Clinico S. Ambrogio, Milan, Italy
Manuscript received December 7, 2002;
revised manuscript received January 31, 2003,
accepted February 6, 2003.
* Reprint requests and correspondence: Dr. Zoran Olivari, UO Cardiologia, Ospedale Cà Foncello, Piazzale Ospedale 1, 31100 Treviso, Italy.
nutell{at}tin.it
OBJECTIVES: We sought to investigate the success rate and the acute and 12-month clinical outcome of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in the contemporary era.
BACKGROUND: The technique of PCI involving CTO has improved over time. However, limited data on acute and follow-up results in patients treated with PCI on CTO in recent years are available.
METHODS: Four hundred nineteen consecutive patients scheduled for PCI of CTO of  30 days of duration were enrolled in 29 centers; 390 CTOs were confirmed in 376 patients in an independent core laboratory. The end points were technical and procedural success, in-hospital and 12-month major adverse cardiac events (MACE) occurrence, and 12-month symptomatic status.
RESULTS: Technical and procedural success was obtained in 77.2% and 73.3% of lesions, respectively. In-hospital major adverse cardiac events occurred in 5.1% of patients. Multivariate analysis identified CTO length >15 mm or not measurable, moderate to severe calcifications, duration 180 days, and multivessel disease as significant predictors of PCI failure. At 12 months, patients with a successful procedure experienced a lower incidence of cardiac deaths or myocardial infarction (1.05% vs. 7.23%, p = 0.005), a reduced need for coronary artery bypass surgery (2.45% vs. 15.7%, p < 0.0001), and were more frequently free of angina (88.7% vs. 75.0%, p = 0.008) compared with patients who had an unsuccessful procedure.
CONCLUSIONS: Successful PCI was achieved in a high percentage of CTOs with a low incidence of complications. At one-year follow-up, patients with successful PCI of a CTO had a significantly better clinical outcome than those whose PCI was unsuccessful.
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Abbreviations and Acronyms
| | CABG | | coronary artery bypass graft surgery | | CTO | | chronic total occlusion | | MACE | | major adverse cardiac events | | MI | | myocardial infarction | | PCI | | percutaneous coronary intervention | | TIMI | | Thrombolysis In Myocardial Infarction | | TLR | | target lesion revascularization | | TOAST-GISE | | Total Occlusion Angioplasty Study-Società Italiana di Cardiologia Invasiva |
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