Impact of Complete Revascularization in Chronic Total Occlusion Patients With Multivessel Disease on Long-Term Clinical Outcomes

초록

Background This study compares the long-term clinical outcomes between two different treatment strategies: percutaneous coronary intervention (PCI) vs medical therapy (MT) for chronic total occlusion (CTO) in multivessel disease (MVD) patients. Methods The study data obtained from the CTO registry of Korea University Guro Hospital (KUGH), Seoul, South Korea. This trial is a single-center, prospective, all-comer registry designed to reflect “real world” practice since 2004. the study population has been divided into two groups: the CTO-PCI group having 233 patients and the CTO-MT group having 230 patients. A propensity score matching (PSM) analysis had performed to adjust for confounding factors. Results Following PSM, the two groups comprised the matched individuals from 336 pairs (total n = 272 patients). The baseline clinical and angiographic characteristics were well-balanced between the two groups. Up to a 5-year clinical follow-up by Kaplan-Meier survival analysis, the primary end point, as defined as the composite of all-cause death or myocardial infarction (MI), occurred more in the CTO-MT group (32.6%) than in the PCI group (2.3%), as did all-cause death (2.3% vs 8.4%, P = 0.042) and MI (4.3% vs 0.0%, P = 0.023). Target vessel revascularization (TVR) at CTO lesions still occurred more in the CTO-PCI group than in the CTO-MT group (38.3% vs 6.8%, P = 0.009). Conclusion PCI is shown as a reasonable treatment option compared to MT for CTO lesions in MVD patients; TVR risk is still higher, although.