Author + information
- Cheol Woong Yu1,
- Duck Hyun Jang2,
- Je Sang Kim3,
- Seung Hun Lee4,
- Jae Hyoung Park2,
- Rak Kyeong Choi5,
- Young Jin Choi6,
- Jin Sik Park7,
- Hyung Joon Joo2,
- Jeong Hoon Yang8,
- Joo Yong Hahn9,
- Seung Hyuk Choiu8,
- Hyeon Cheol Gwon8 and
- Do Sun Lim2
- 1Korean University Anam Hospital, Seoul, Korea, Republic of
- 2Korea University Anam Hospital, Seoul, Korea, Republic of
- 3Sejong Hospital, Bucheon, Gyeonggi, Korea, Republic of
- 4Anam Hospital, Korea University Medical Center, Seoul, Korea, Republic of
- 5Sejong general hospital, Kyunggi-do, Korea, Republic of
- 6Sejong General Hospital, Bucheon, Korea, Republic of
- 7Mediplex Sejong General Hospital, Incheon, Korea, Republic of
- 8Samsung Medical Center, Seoul, Korea, Republic of
- 9Interventional Cardiologist, Seoul, Korea, Republic of
Revascularization of chronic total occlusion in coronary artery is known to be associated with symptomatic improvement and long-term survival benefit. However, there has been a paucity of data about survival benefit of revascularization of chronic total occlusion in coronary artery according to existence of Left ventricular systolic dysfunction.
The patient pooled analysis was performed with 2173 patients with chronic total occlusion in coronary artery undergoing only medical therapy or revascularization from 3 Korean centers registry. The 8-year clinical outcomes were compared between non-revascularization (n=832) and revascularization (n=1341), stratified by existence of Left ventricular systolic dysfunction. The primary endpoint was a composite of all death or any myocardial infarction.
In chronic total occlusion with Left ventricular systolic dysfunction or without, the primary endpoint at 8 years were significantly higher in non-revascularization than revascularization (with LVSD 36.1% vs. 20.6%, p < 0.0001; without LVSD 13.3% vs. 5.7%, p < 0.0001), which was mainly driven by reduction of death. This effects of revascularization on the prognosis according to the existence of LVSD were also corroborated with similar results by the inverse probability weighted model. In this model, the fitting cox proportional hazard analysis showed revascularization of CTO was the stronger independent predictor for survival benefit in CTO with LVSD (hazard ratio: 2.160; 95% confidence interval: 1.667 to 2.801; p < 0.001) than without LVSD (hazard ratio: 1.468; 95% confidence interval: 1.155 to 1.866; p =0.0017).
Regardless of existence of LVSD, revascularization showed better survival benefit than non-revascularization in CTO. However, the benefit was the greater in the CTO with LVSD than without.
CORONARY: PCI Outcomes