Clinical Outcomes in Chronic Total Occlusion Revascularization Versus No Chronic Total Occlusion Revascularization: Variability by Target Vessel

Abstract

We aimed to investigate the impact of target vessel on clinical outcomes in chronic total occlusion (CTO) revascularization versus no CTO revascularization. This multicenter, retrospective, cohort study involves patients with ≥1 CTO. After classification based on different CTO target vessels or multiple CTOs, patients were further categorized as the CTO revascularization group and the no CTO revascularization group based on treatment received. The primary outcome was a composite of death, myocardial infarction, stroke, repeated revascularization, and hospital admission due to ischemic symptoms. From August 2016 to August 2017, 1712 eligible patients were consecutively enrolled. Chronic total occlusion revascularization was associated with lower risk of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs; adjusted hazard ratio [HR]: 0.36; 95% CI: 0.20-0.67; P = .001) compared with no CTO revascularization in left anterior descending (LAD) CTO patients. The benefit of CTO revascularization was not evident among those with left circumflex (LCX; adjusted HR: 0.51; 95% CI: 0.23-1.10; P = .087), right coronary artery (RCA; adjusted HR: 1.17; 95% CI: 0.59-2.33; P = .648), and multiple CTOs (adjusted HR: 1.00; 95% CI: 0.41-2.44; P = .994). Revascularization for LAD CTO, but not LCX, RCA, or multiple CTOs, was associated with lower risk of 1-year MACCEs compared with no CTO revascularization.