Home > Interventional Cardiology, Journal Club > Journal Club 25 February 2015

Journal Club 25 February 2015

Paper

Long-Term Survival Benefit of Revascularization Compared With
Medical Therapy in Patients With Coronary Chronic Total Occlusion and Well-Developed Collateral Circulation

Presenter

SB

Summary

OBJECTIVES

The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total
occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy.

BACKGROUND

Little is known about the clinical outcomes and optimal treatment strategies of CTO with well developedcollateral circulation.

ETHODS

We screened 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram. Of these, we
analyzed data from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone
(n ¼ 236), coronary artery bypass grafting (n ¼ 170) or percutaneous coronary intervention (n ¼ 332; 80.1% successful).
Patients who underwent revascularization and medical therapy (revascularization group, n ¼ 502) were compared with
those who underwent medical therapy alone (medication group, n ¼ 236) in terms of cardiac death and major adverse
cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization.

RESULTS

During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence
of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p < 0.01) and MACE (HR:
0.32; 95% CI: 0.21 to 0.49; p < 0.01) in the revascularization group compared with the medication group. After propensity
score matching, the incidence of cardiac death (HR: 0.27; 95% CI: 0.09 to 0.80; p ¼ 0.02) and MACE (HR: 0.44;
95% CI: 0.23 to 0.82; p ¼ 0.01) were still significantly lower in the revascularization group than in the medication group.

CONCLUSIONS

In patients with coronary CTO and well-developed collateral circulation, aggressive revascularization
may reduce the risk of cardiac mortality and MACE.

Supplementary Material

Editorial is here.

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