Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE)

doi:10.1016/S0735-1097(03)00312-7

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J Am Coll Cardiol, 2003; 41:1672-1678, doi:10.1016/S0735-1097(03)00312-7
© 2003 by the American College of Cardiology Foundation

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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 and12-month clinical outcome of percutaneous coronary intervention(PCI) for chronic total occlusion (CTO) in the contemporaryera.

BACKGROUND: The technique of PCI involving CTO has improved over time. However,limited data on acute and follow-up results in patients treatedwith PCI on CTO in recent years are available.

METHODS: Four hundred nineteen consecutive patients scheduled for PCIof CTO of $≥$ 30 days of duration were enrolled in 29 centers; 390CTOs were confirmed in 376 patients in an independent core laboratory.The end points were technical and procedural success, in-hospitaland 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 cardiacevents occurred in 5.1% of patients. Multivariate analysis identifiedCTO length >15 mm or not measurable, moderate to severe calcifications,duration $≥$ 180 days, and multivessel disease as significant predictorsof PCI failure. At 12 months, patients with a successful procedureexperienced a lower incidence of cardiac deaths or myocardialinfarction (1.05% vs. 7.23%, p = 0.005), a reduced need forcoronary 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 witha low incidence of complications. At one-year follow-up, patientswith successful PCI of a CTO had a significantly better clinicaloutcome than those whose PCI was unsuccessful.

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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