Improved cardiac survival, freedom from MACE and angina-related quality of life after successful percutaneous recanalization of coronary artery chronic total occlusions

Background: Most percutaneous recanalizations of coronary artery chronic total occlusion (CTO) are not attempted because of the skepticism on their long-term clinical benefit. We assessed the effect of percutaneous CTO recanalization procedures on long-term cardiac survival, freedom from MACE and angina-related quality of life (AQL).

Methods: All consecutive patients who underwent attempt of percutaneous native coronary artery CTO recanalization between 2003 and 2009 were included in the study. MACE was defined as combined cardiac death, myocardial infarction (MI) and target vessel revascularization (TVR). AQL was assessed by the Seattle Angina Questionnaire-UK-version (SAQ-UK).

Results: Among 302 patients who received an attempt of percutaneous CTO recanalization, 237 (78%) had a successful procedure while in 65 (22%) the procedure failed. Overall intra-hospital complication rate was 3.0%, with no difference between the two groups. Median follow-up was 4.0 years, during which 13 patients had a fatal cardiac event. Patients in whom the CTO recanalization procedure failed had a higher risk of cardiac death (HR 3.39; 95% CI 1.14-10.1;p=0.03; after propensity score adjustment, HR 2.83; 95% CI 0.89-8.96;p=0.07) and MACE (HR 5.40; 95% CI 2.71-10.5;p<0.001; adjusted HR 3.34; 95% CI 1.47-7.58;p=0.003) compared to patients with successful procedure. CTO recanalization significantly improved the AQL during follow-up: patients with successful procedure experienced less physical activity limitation (p=0.01), rarer angina episodes (p<0.001) and greater treatment satisfaction (p=0.03) compared to patients with failed procedure.

Conclusions: Patients with successful CTO recanalization had a trend towards better cardiac survival and significant lower risk of MACE and improvement of AQL compared to patients with failed procedures.