Management of chronic total coronary occlusion in stable ischemic heart disease by percutaneous coronary intervention versus coronary artery bypass grafting versus medical therapy
Shuvy M, Qiu F, Chee-A-Tow A, Graham JJ, Abuzeid W, Buller C, Strauss BH, Wijeysundera HC. Am J Cardiol. 2017; 120(5):759-64. Epub 2017 Jun 15.
Coronary chronic total occlusions (CTOs) are found in approximately 20% of angiograms. We sought to assess the variation in the management of CTO patients and to contrast clinical outcomes of CTO versus non-CTO lesions. We conducted a population-based cohort study and included all patients with stable angina who underwent cardiac catheterization from October 1, 2012, to June 30, 2013 in Ontario, Canada. The primary outcome was a composite of mortality and hospitalization for myocardial infarction. A total of 7,864 patients were included, of whom 2,279 (29%) had a CTO. There were substantial differences in revascularization rates for CTO patients across hospitals in Ontario (44.9%-94.1%). Revascularization was associated with improved outcomes in the overall cohort. Although the advantage of CABG over medical therapy was consistent in both CTO and non-CTO patients, the benefit of PCI was limited to non-CTO patients (HR 0.56, 95% CI 0.40-0.78), with no difference in CTO patients. The CTO lesion however was revascularized in few of the PCI cases (41.1%), with PCI limited to the non-CTO lesion in most patients.
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