| Title | Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic. | | Author(s) | Prasad A, Rihal CS, Lennon RJ, Wiste HJ, Singh M, Holmes DR | | Institution | Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. prasad.abhiram@mayo.edu | | Source | J Am Coll Cardiol 2007 Apr 17; 49(15):1611-8. | | MeSH | Academic Medical Centers
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Cause of Death
Chest Pain
Cohort Studies
Confidence Intervals
Coronary Angiography
Coronary Artery Bypass
Coronary Restenosis
Coronary Stenosis
Female
Follow-Up Studies
Hospital Mortality
Humans
Incidence
Male
Middle Aged
Minnesota
Probability
Retrospective Studies
Risk Assessment
Severity of Illness Index
Stents
Survival Analysis
Time Factors
Treatment Outcome
| | Abstract | OBJECTIVES: The aim of our study was to examine the trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over the last 25 years from a single PCI registry and to examine the impact of drug-eluting stents.
BACKGROUND: The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and there are limited data available from contemporary practice.
METHODS: We evaluated the outcomes of 1,262 patients from the Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to the time of their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era).
RESULTS: Procedural success rates were 51%, 72%, 73%, and 70% (p < 0.001), respectively, in the 4 groups. In-hospital mortality (2%, 1%, 0.4%, and 0%, p = 0.009), emergency coronary artery bypass grafting (15%, 3%, 2%, and 0.7%, p < 0.001), and rates of major adverse cardiac events (8%, 5%, 3%, and 4%, p = 0.052) decreased over time. During follow-up, the combined end point of death, myocardial infarction, or target lesion revascularization, was significantly lower in the 2 most recent cohorts compared with those patients treated before (p = 0.001 for trend). Technical failure to treat the CTO was not an independent predictor of long-term mortality (hazard ratio 1.16 [95% confidence interval 0.90 to 1.5], p = 0.25).
CONCLUSIONS: Procedural success rates for CTO have not improved over time in the stent era, highlighting the need to develop new techniques and devices. Compared with the prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50%. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
| | PubMed ID | 17433951 |
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