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Vol. 72. Issue 9.
Pages 717-723 (September 2019)
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Vol. 72. Issue 9.
Pages 717-723 (September 2019)
Original article
DOI: 10.1016/j.rec.2018.07.011
Impact of Chronic Total Coronary Occlusion Location on Long-term Survival After Percutaneous Coronary Intervention
Impacto de la localización de la oclusión coronaria crónica total en la supervivencia a largo plazo tras intervención coronaria percutánea
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Jong-Hwa Ahna,, Jeong Hoon Yangb,c,, Young Bin Songb, Joo-Yong Hahnb, Jin-Ho Choib, Sang Hoon Leeb, Hyeon-Cheol Gwonb, Seung-Hyuk Choib,
Corresponding author
sh1214.choi@samsung.com

Corresponding author: Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Republic of Korea.
a Division of Cardiology, Department of Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
b Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
c Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Tables (2)
Table 1. Baseline Characteristics of Patients With pmLAD and Non-pmLAD CTO
Table 2. Clinical Outcomes With OMT Versus PCI in the Propensity-matched Population
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Abstract
Introduction and objectives

Limited data are available on the clinical outcomes of optimal medical therapy (OMT) compared with revascularization by percutaneous coronary intervention (PCI) in patients with chronic total coronary occlusion (CTO) of the proximal or middle left anterior descending artery (pmLAD). Therefore, the objective of this study was to compare the long-term outcomes of patients with pmLAD CTO who were treated with a PCI strategy with those of patients treated with an OMT strategy.

Methods

Between March 2003 and February 2012, 2024 patients with CTO were enrolled in a single-center registry. Among this patient group, we excluded CTO patients who underwent coronary artery bypass grafting. After the exclusion, a total of 1547 patients remained. They were stratified according to classification of coronary segments (pmLAD or non-pmLAD CTO) and the initial treatment strategy (OMT or PCI). Propensity score matching was performed. The primary outcome was cardiac death.

Results

The median follow-up was 45.9 (interquartile range, 22.9-71.1) months. After propensity score matching, the incidence of cardiac death (HR, 0.54; 95%C, 0.31-0.94, P=.029) was significantly lower in the PCI with pmLAD CTO group than in the OMT group. In contrast, no significant difference was found in the rate of cardiac death between the PCI and OMT groups with non-pmLAD CTO (HR, 0.62; 95%CI, 0.27–1.42, P=.26).

Conclusions

As an initial treatment strategy, PCI of pmLAD CTO, but not PCI of non-pmLAD, is associated with improved long-term survival.

Keywords:
Chronic total coronary occlusion
Optimal medical therapy
Percutaneous coronary intervention
Proximal or middle left anterior descending artery
Abbreviations:
CABG
CTO
MI
OMT
PCI
pmLAD
Resumen
Introducción y objetivos

Se dispone de poca información sobre los resultados clínicos del tratamiento médico óptimo (TMO) comparado con la revascularización mediante intervención coronaria percutánea (ICP) en pacientes con oclusión coronaria total (OCT) crónica de la arteria descendente anterior proximal o media (ADApm). Por lo tanto, el objetivo del presente estudio es comparar los resultados a largo plazo de los pacientes con OTC de la ADApm tratados con ICP o con TMO.

Métodos

Entre marzo de 2003 y febrero de 2012, se reclutó a 2.024 pacientes con OCT en un registro unicéntrico. De este grupo se excluyó a los pacientes con OCT revascularizados quirúrgicamente, y finalmente resultaron 1.547 pacientes. Se los estratificó según la localización anatómica de la OCT (ADApm o no-ADApm) y la estrategia inicial de tratamiento (TMO o ICP). Se aplicó emparejamiento por puntuación de propensión. El objetivo primario fue la mortalidad cardiaca.

Resultados

El seguimiento medio fue de 45,9 [intervalo intercuartílico, 22,9-71,1] meses. Tras el emparejamiento por puntuación de propensión, se observó una incidencia en la mortalidad cardiaca significativamente menor en el grupo de pacientes con OTC tratados con ICP sobre ADApm que en el de ADApm con TMO (HR=0,54; IC95%, 0,31-0,94; p=0,029). Sin embargo, no hubo diferencias significativas en la mortalidad cardiaca entre los grupos de ICP y de TMO de pacientes con OCT de no-ADApm (HR=0,62; IC95%, 0,27-1,42; p=0,26).

Conclusiones

La estrategia incial de ICP sobre ADApm, pero no sobre no-ADApm, se asoció con una mejor supervivencia a largo plazo.

Palabras clave:
Oclusión coronaria total crónica
Tratamiento médico óptimo
Intervención coronaria percutánea
Arteria descendente anterior proximal o media

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