AUTHOR=Maestre-Luque Luis Carlos , Gonzalez-Manzanares Rafael , Suárez de Lezo Javier , Hidalgo Francisco , Barreiro-Mesa Lucas , de Juan Jaime , Gallo Ignacio , Perea Jorge , Alvarado Marco , Romero Miguel , Ojeda Soledad , Pan Manuel 

TITLE=Complete vs. incomplete percutaneous revascularization in patients with chronic total coronary artery occlusion

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1443258

DOI=10.3389/fcvm.2024.1443258

ISSN=2297-055X

ABSTRACT=There is current controversy about the benefits of percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTO). We aimed to evaluate the impact of complete percutaneous revascularization on major adverse cardiovascular events (MACE) in patients with CTO.Methods: Retrospective observational study of consecutive patients referred for invasive coronary angiography at a single center between January 2018 and December 2019 and at least a CTO. They were divided in two groups according to the result of the procedure: complete revascularization of CTO (CR-CTO) versus incomplete revascularization (ICR-CTO) (patients with at least one non-recanalized CTO). Short and mid-term clinical outcomes were evaluated. The primary endpoint was a composite of MACE that included all cause death, non-fatal myocardial infarction, non-fatal stroke, or unplanned revascularization.: 359 patients with CTO were included. The median age was 68 [interquartile range 60-77] years, 66 (18%) were women and 169 (47.3%) had diabetes mellitus. In all, 167 patients (46.5%) received complete revascularization. After a median follow up of 42 [interquartile range 46-50] months the primary endpoint occurred in 39 (23.4 %) patients in the CR-CTO group and in 75 (39.1%) in the ICR-CTO group [HR 0.50, CI 95% (0.34-0.74) p<0.001]. This association remained significant in an inverse probability weighted model considering prognostic factors [HRadj 0.61 (0.41-0.92), p=0.018], and was driven by lower rates of all cause death [ORadj 0.50 (0.23-0.84) p=0.01]. Conclusions: Complete revascularization of CTO was associated with a lower risk of MACE in the mid-term follow up.