Extent of coronary artery disease and prognostic effect of recanalisation success after percutaneous intervention for chronic total coronary occlusions

Purpose: There is limited data on prognosis after percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTOs) in multi-vessel disease. Methods: Between 01/2005 and 12/2011 we performed elective PCI of a CTO in 1642 consecutive patients. Median follow-up was 3.0 (1.1,3.8) years. CTO patients were assigned to coronary one/two vessel disease (1+2VD) or three vessel disease (3VD). Procedural success was defined as <30% residual diameter stenosis of the CTO lesion after drug eluting stent implantation. All-cause mortality was assessed with adjusted Cox proportional hazard models. Results: Of the CTO patients 757 (46%) had 1+2VD and 885 (54%) had 3VD. Patients with 3VD compared to 1+2VD were older (67.3±11 vs. 64.0±11; p<0.001), had higher serum creatinine (1.10±0.6 vs. 1.03±0.6; p=0.033), more often diabetes (33.5% vs. 25.8%; p<0.001), left ventricular ejection fraction (LVEF) <40% (25.2% vs. 16.7%; p<0.001), previous myocardial infarction (25.9% vs. 17.8%; p<0.001) or coronary bypass operation (19.1% vs. 2.6%; p<0.001). Procedural success was lower in 3VD compared to 1+2VD (70.9% vs. 78.5%; p<0.001). Total long-term mortality for 3VD and 1+2VD was (21.4% and 15.6%; p=0.003). After multivariable adjustment for relevant covariates (age, serum creatinine, LVEF <40%) procedural success remained an independent predictor for reduced long-term mortality in patients in 3VD (adjusted HR 0.50; 95% CI 0.31-0.81; p=0.004) but not in patients in 1+2VD (adjusted HR 0.71; 95% CI 0.37-1.35; p=0.3) [Figure]. Figure 1 Conclusion: Successful recanalisation of a CTO is a strong independent predictor for reduced long-term mortality in patients with 3VD but not with 1+2VD. So there is an enhanced prognostic effect of recanalisation success for CTO patients with more extensive coronary artery disease.