Cardiac and sudden death after chronic total occlusion percutaneous coronary intervention: Prognostic role of the target vessel
Andrea Scotti MD
Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorCorresponding Author
Cosmo Godino MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Correspondence
Cosmo Godino, MD, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
Email: [email protected]
Search for more papers by this authorAndrea Munafò MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorCarlo A. Pivato MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Cardio Center, Humanitas Research Hospital, Milan, Italy
Search for more papers by this authorMauro Chiarito MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Cardio Center, Humanitas Research Hospital, Milan, Italy
Search for more papers by this authorGiorgio Fiore MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorSilvana Di Maio MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorPasquale Vergara MD
Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
Search for more papers by this authorPaolo Della Bella MD
Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
Search for more papers by this authorMauro Carlino MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorAlberto Margonato MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorAntonio Colombo MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
Search for more papers by this authorAndrea Scotti MD
Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorCorresponding Author
Cosmo Godino MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Correspondence
Cosmo Godino, MD, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
Email: [email protected]
Search for more papers by this authorAndrea Munafò MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorCarlo A. Pivato MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Cardio Center, Humanitas Research Hospital, Milan, Italy
Search for more papers by this authorMauro Chiarito MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Cardio Center, Humanitas Research Hospital, Milan, Italy
Search for more papers by this authorGiorgio Fiore MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorSilvana Di Maio MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorPasquale Vergara MD
Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
Search for more papers by this authorPaolo Della Bella MD
Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
Search for more papers by this authorMauro Carlino MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorAlberto Margonato MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorAntonio Colombo MD
Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
Search for more papers by this authorAbstract
Background
The role of the target vessel in percutaneous revascularization of chronic total occlusion (CTO) is unclear.
Objective
We sought to assess the long-term results of percutaneous coronary intervention (PCI) for CTO lesions in each coronary artery and to investigate the impact of successful revascularization and previous myocardial infarction (MI) in the territory of the target vessel.
Methods and Results
Cohort observational study on 1,124 patients who have undergone CTO PCI attempt: 371 on left anterior descending artery (LAD), 485 right coronary artery, and 268 left circumflex. Patients were further stratified by successfully revascularized and not-revascularized CTO (CTO-NR). Vessels affected by a previous MI were defined as infarct-related artery (IRA). The primary endpoint was cardiac death; the secondary endpoint was the combined rate of sudden cardiac-death and sustained ventricular-arrhythmias (SCD/SVAs). Propensity score-matching was performed to evaluate LAD versus NON-LAD CTO. Up to 12-year follow-up, the clinical benefit associated with successful PCI was consistent across the three groups. CTO-NR had the greatest association with cardiac death and SCD/SVAs in each coronary artery and in IRA-CTO patients.
Conclusions
Unsuccessful percutaneous CTO revascularization was associated with lower cardiac survival and freedom from SCD/SVAs, irrespective of the vessel treated. This result was mainly driven by patients with an IRA CTO.
CONFLICT OF INTEREST
The authors declare no potential conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
Data available upon reasonable request.
Supporting Information
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| ccd29425-sup-0001-supinfo.docxWord 2007 document , 234.4 KB | Appendix S1: Supporting information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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