Percutaneous coronary interventions and cardiovascular outcomes for patients with chronic total occlusions

E. Marc Jolicæur, Micheal J. Sketch, Daniel M. Wojdyla, Sean Payman Javaheri, Shravan Nosib, Yuliya Lokhnygina, Manesh R. Patel, Linda K. Shaw, James E. Tcheng

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objectives: This study sought to assess the benefits of a coronary chronic total occlusion CTO recanalization after adjusting for the case-mix and the propensity to undergo the CTO intervention in a population of patients with stable coronary artery disease. Background: The benefits of percutaneous recanalization of CTO are disputed. Methods: In 1,602 patients with a least one CTO and treated by percutaneous coronary intervention (PCI), we derived a propensity score to undergo a CTO recanalization by comparing the characteristics of patients who did (n = 346) and did not (n = 1,256) undergo a CTO PCI attempt. Among the patients who underwent a CTO PCI attempt, we identified the angiographic predictors of failure. The primary analysis was ultimately performed by looking at the association between the outcome of the CTO recanalization and the survival free of death and cardiovascular rehospitalizations. Sensitivity analyses were performed by adjusting for the propensity to undergo a CTO recanalization, for the anatomical predictors of failure, and for the extent of coronary artery revascularization achieved. Results: A successful CTO recanalization was not significantly associated with survival free of death and cardiovascular rehospitalization (HR = 0.90, 95% CI 0.64-1.25). Even more conservative hazards ratio point estimates were obtained with the sensitivity analyses. Conclusions: Successful percutaneous CTO recanalization is not associated with survival free of death and cardiovascular hospitalizations in a contemporary population of patients with symptomatic coronary artery disease.

Original languageEnglish (US)
Pages (from-to)603-612
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume79
Issue number4
DOIs
StatePublished - Mar 1 2012
Externally publishedYes

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Percutaneous Coronary Intervention
Survival
Coronary Artery Disease
Propensity Score
Diagnosis-Related Groups
Population
Coronary Vessels
Hospitalization

Keywords

  • angina
  • chronic total occlusion
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous coronary interventions and cardiovascular outcomes for patients with chronic total occlusions. / Jolicæur, E. Marc; Sketch, Micheal J.; Wojdyla, Daniel M.; Javaheri, Sean Payman; Nosib, Shravan; Lokhnygina, Yuliya; Patel, Manesh R.; Shaw, Linda K.; Tcheng, James E.

In: Catheterization and Cardiovascular Interventions, Vol. 79, No. 4, 01.03.2012, p. 603-612.

Research output: Contribution to journalArticle

Jolicæur, EM, Sketch, MJ, Wojdyla, DM, Javaheri, SP, Nosib, S, Lokhnygina, Y, Patel, MR, Shaw, LK & Tcheng, JE 2012, 'Percutaneous coronary interventions and cardiovascular outcomes for patients with chronic total occlusions', Catheterization and Cardiovascular Interventions, vol. 79, no. 4, pp. 603-612. https://doi.org/10.1002/ccd.23269
Jolicæur, E. Marc ; Sketch, Micheal J. ; Wojdyla, Daniel M. ; Javaheri, Sean Payman ; Nosib, Shravan ; Lokhnygina, Yuliya ; Patel, Manesh R. ; Shaw, Linda K. ; Tcheng, James E. / Percutaneous coronary interventions and cardiovascular outcomes for patients with chronic total occlusions. In: Catheterization and Cardiovascular Interventions. 2012 ; Vol. 79, No. 4. pp. 603-612.
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AU - Nosib, Shravan

AU - Lokhnygina, Yuliya

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AB - Objectives: This study sought to assess the benefits of a coronary chronic total occlusion CTO recanalization after adjusting for the case-mix and the propensity to undergo the CTO intervention in a population of patients with stable coronary artery disease. Background: The benefits of percutaneous recanalization of CTO are disputed. Methods: In 1,602 patients with a least one CTO and treated by percutaneous coronary intervention (PCI), we derived a propensity score to undergo a CTO recanalization by comparing the characteristics of patients who did (n = 346) and did not (n = 1,256) undergo a CTO PCI attempt. Among the patients who underwent a CTO PCI attempt, we identified the angiographic predictors of failure. The primary analysis was ultimately performed by looking at the association between the outcome of the CTO recanalization and the survival free of death and cardiovascular rehospitalizations. Sensitivity analyses were performed by adjusting for the propensity to undergo a CTO recanalization, for the anatomical predictors of failure, and for the extent of coronary artery revascularization achieved. Results: A successful CTO recanalization was not significantly associated with survival free of death and cardiovascular rehospitalization (HR = 0.90, 95% CI 0.64-1.25). Even more conservative hazards ratio point estimates were obtained with the sensitivity analyses. Conclusions: Successful percutaneous CTO recanalization is not associated with survival free of death and cardiovascular hospitalizations in a contemporary population of patients with symptomatic coronary artery disease.

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