TY - JOUR
T1 - Management strategies in patients affected by chronic total occlusions: Results from the Italian Registry of Chronic Total Occlusions
AU - Tomasello, Salvatore D.
AU - Boukhris, Marouane
AU - Giubilato, Simona
AU - Marza, Francesco
AU - Garbo, Roberto
AU - Contegiacomo, Gaetano
AU - Marzocchi, Antonio
AU - Niccoli, Giampaolo
AU - Gagnor, Andrea
AU - Varbella, Ferdinando
AU - Desideri, Alessandro
AU - Rubartelli, Paolo
AU - Cioppa, Angelo
AU - Baralis, Giorgio
AU - Galassi, Alfredo R.
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
KW - Aged
KW - Cardiovascular Agents
KW - Chronic Disease
KW - Chronic total occlusion † Registry † PCI † CABG † Optimal medical therapy
KW - Coronary Angiography
KW - Coronary Artery Bypass
KW - Coronary Occlusion
KW - Female
KW - Humans
KW - Italy
KW - Male
KW - Percutaneous Coronary Intervention
KW - Prevalence
KW - Prospective Studies
KW - Registries
KW - Treatment Outcome
KW - Ventricular Dysfunction, Left
KW - Aged
KW - Cardiovascular Agents
KW - Chronic Disease
KW - Chronic total occlusion † Registry † PCI † CABG † Optimal medical therapy
KW - Coronary Angiography
KW - Coronary Artery Bypass
KW - Coronary Occlusion
KW - Female
KW - Humans
KW - Italy
KW - Male
KW - Percutaneous Coronary Intervention
KW - Prevalence
KW - Prospective Studies
KW - Registries
KW - Treatment Outcome
KW - Ventricular Dysfunction, Left
UR - http://hdl.handle.net/10807/172343
U2 - 10.1093/eurheartj/ehv450
DO - 10.1093/eurheartj/ehv450
M3 - Article
SN - 0195-668X
VL - 36
SP - 3189
EP - 3198
JO - European Heart Journal
JF - European Heart Journal
ER -