CLINICAL RESEARCH
Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total OcclusionsA 25-Year Experience From the Mayo Clinic
Abhiram Prasad, MD, FRCP, FACC*,*,
Charanjit S. Rihal, MD, FACC*,
Ryan J. Lennon, MS ,
Heather J. Wiste, BS,
Mandeep Singh, MD, FACC* and
David R. Holmes, Jr, MD, FACC*
* Division of Cardiovascular Diseases
Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Manuscript received September 20, 2006;
revised manuscript received November 21, 2006,
accepted December 20, 2006.
* Reprint requests and correspondence: Dr. Abhiram Prasad, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. (Email: prasad.abhiram{at}mayo.edu).
Objectives: The aim of our study was to examine the trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over the last 25 years from a single PCI registry and to examine the impact of drug-eluting stents.
Background: The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and there are limited data available from contemporary practice.
Methods: We evaluated the outcomes of 1,262 patients from the Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to the time of their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era).
Results: Procedural success rates were 51%, 72%, 73%, and 70% (p < 0.001), respectively, in the 4 groups. In-hospital mortality (2%, 1%, 0.4%, and 0%, p = 0.009), emergency coronary artery bypass grafting (15%, 3%, 2%, and 0.7%, p < 0.001), and rates of major adverse cardiac events (8%, 5%, 3%, and 4%, p = 0.052) decreased over time. During follow-up, the combined end point of death, myocardial infarction, or target lesion revascularization, was significantly lower in the 2 most recent cohorts compared with those patients treated before (p = 0.001 for trend). Technical failure to treat the CTO was not an independent predictor of long-term mortality (hazard ratio 1.16 [95% confidence interval 0.90 to 1.5], p = 0.25).
Conclusions: Procedural success rates for CTO have not improved over time in the stent era, highlighting the need to develop new techniques and devices. Compared with the prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50%.
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Abbreviations and Acronyms
| | BMS = bare-metal stents | | CABG = coronary artery bypass grafting | | CTO = chronic total occlusion | | DES = drug-eluting stents | | MACE = major adverse cardiac events | | MI = myocardial infarction | | PCI = percutaneous coronary intervention | | TLR = target lesion revascularization |
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