Management strategies in patients affected by chronic total occlusions: Results from the Italian Registry of Chronic Total Occlusions

Giampaolo Niccoli, Salvatore D. Tomasello, Marouane Boukhris, Simona Giubilato, Francesco Marza, Roberto Garbo, Gaetano Contegiacomo, Antonio Marzocchi, Andrea Gagnor, Ferdinando Varbella, Alessandro Desideri, Paolo Rubartelli, Angelo Cioppa, Giorgio Baralis, Alfredo R. Galassi

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Background Through contemporary literature, the optimal strategy to manage coronary chronic total occlusions (CTOs) remains under debate. Objectives The aim of the Italian Registry of Chronic Total Occlusions (IRCTO) was to provide data on prevalence, characteristics, and outcome of CTO patients according to the management strategy. Methods The IRCTO is a prospective real world multicentre registry enrolling patients showing at least one CTO. Clinical and angiographic data were collected independently from the therapeutic strategy [optimal medical therapy (MT), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG)]; a comparative 1-year clinical followup was performed. Results A total of 1777 patients were enrolled for an overall CTO prevalence of 13.3%. The adopted therapeutic strategies were as follows: MT in 826 patients (46.5%), PCI in 776 patients (43.7%), and CABG in the remaining 175 patients (9.8%). At 1-year follow-up, patients undergoing PCI showed lower rate of major adverse cardiac and cerebrovascular events (MACCE) (2.6% vs. 8.2% and vs. 6.9%; P < 0.001 and P < 0.01) and cardiac death (1.4% vs. 4.7% and vs. 6.3%; P < 0.001 and P < 0.001) in comparison with those treated with MT and CABG, respectively. After propensity scorematching analysis, patients treated with PCI showed lower incidence of cardiac death (1.5 vs. 4.4%; P < 0.001), acute myocardial infarction (1.1 vs. 2.9%; P = 0.03), and re-hospitalization (2.3 vs. 4.4% P = 0.04) in comparison with those managed by MT. Conclusions Our data showed how CTO PCI might significantly improve the survival and decrease MACCE occurrence at 1 year follow-up in comparison with MT and/or CABG.
Original languageEnglish
Pages (from-to)3189-3198
Number of pages10
JournalEuropean Heart Journal
Volume36
DOIs
Publication statusPublished - 2015

Keywords

  • Aged
  • Cardiovascular Agents
  • Chronic Disease
  • Chronic total occlusion † Registry † PCI † CABG † Optimal medical therapy
  • Coronary Angiography
  • Coronary Artery Bypass
  • Coronary Occlusion
  • Female
  • Humans
  • Italy
  • Male
  • Percutaneous Coronary Intervention
  • Prevalence
  • Prospective Studies
  • Registries
  • Treatment Outcome
  • Ventricular Dysfunction, Left

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