| Objective: These patients with chronic total occlusions(CTO) remain the most problem in interventional cardiology.Whether there is long-term benefit in performing angioplasty of these lesions is unknown. The purpose of the present report was to analyze the long-term outcome of successful revascularization of patients with CTO including long-term survival, left ventricular function,and the need of CABG,to compare the clinic outcome between different subgroups who underwent successful PCI.,and to evaluate the long-term outcome of implanting DES.Methods: Between June 1993 and December 2007, the clinical data of 1604 conse-cutive patients in the General Hospital of Shenyang Command underwent PCI for CTOs were analyzed retrospectively.The mean age was 59.4±11.5 years. Amomg them 1039 patients had unstable angina pectoris(64.8%), 434 stable angina pectoris (27.1% ) , 131 silent ischemia (8.2% ). These patients were divided into two groups according to the procedural success (n=1447) or failure(n=157). The patients in CTO success group was further stratified into single-vessel or multi-vessel diseases, single-CTO or multi- CTOs,and DES or BMS deployment subgroups.Result: The overall success rates of of patients and lesions in this chort were 90.2% (1447 /1604)and 87.1%(1669/1916), respectively. Except the CTO duration more then 6 monthes had a lower incidence in CTO success group,the other baseline clinical characteristics for CTO success group and CTO failure group are similar. The presences of calcification, bridge collaterals,and severe tortuosity of the target lesion were more frequent in those with unsuccessful PCI. The in-hospital major adverse cardiac event (MACE)rates of CTO successful and CTO failure groupswere [1.8% (26 /1447)vs 5.1% (8/157),P <0.01], respectively. The rates of freedom from angina of CTO success and CTO failure were (87.6 % vs 65.8%,P <0.01).The CTO success group experienced a superior 10-year survival compared to the CTO failure group(77.6% vs 66.2% P<0.05).Patients who had a successful revascularization of the occluded segment had a significantly higher freedom from survival at 10 years compared to the failure group(51.4% vs 33.4% , P < 0.05). Left ventricular function improved and at 6.6±2.7months. LVEF increased from44.5±3.2% to 50.2±5.7% in patients with congestive heart failure(LVEF less than 50%) by opening CTO.There was no significant chang of LVEF in those patients with normal left ventricular function. Median follow-up was available at 58.4±46.1 and 56.8±45.3 months, respectively. Patients with single- CTO who had a successful revascularization had a significantly higher survival at 10 years compared with those with mutil-CTO (83.1%vs 71.3%, P <0.05).During follow-up,the CABG rates were lower in CTO success group (4.6% vs 14.5%,P <0.01). Median follow-up for 29.4±18.7 and 28.6±18.1 months, respectively,there was no significant difference in mortality and MI between the DES group and BMS group. The TVR for DES group was 12.4% versus 27.5% for BMS group (P< 0.005). MACE for DES group was 14.7% versus 30.2% for BMS group(P<0.005).Conclusions: Successful procedures of CTO leads to a relief of angina,and the improvement of long-term survival, left ventricular function, and the reduced risk of MACE particular the need for CABG.Successfully opening a CTO is associated with reduced cardiac risk of re-myocardial infarction to those with muti-vessel diseases. Compared with implanting BMS, implanting DES leads to reduced MACE and superior long-term clinic outcome. |
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