Long-term clinical outcomes after successful and failed recanalization to native chronic Total occlusion: Insights from the Busan chronic Total occlusion (B-CTO) Registry

Objective: To assess hard major adverse clinical events (HMACE) after successful versus failed percutaneous coronary intervention for chronic total occlusion (PCI-CTO). Background: There are limited data regarding long-term HMACE risks based on PCI-CTO success. Methods: First-time PCI was performed in 438 consecutive patients with 473 target CTO lesions. Patients after procedural success (n = 355; 378 CTO lesions) and failure (n = 83; 95 CTO lesions) were followed for an average 40 months (7-77 months range). We compared HMACE (composite of cardiac death, non-fatal myocardial infarction (MI), and stroke) dependent on the success of PCI. Results: The incidence of HMACE was low, with a total of 16 events, and did not differ {6% vs. 3.1%, HR = 0.47; CI [0.16-1.35; p = 0.162} dependent on the success of PCI-CTO. Therewere less cardiac deaths {0.3% vs. 1.2%, RR = 0.22; CI [0.01-3.50]; p = 0.283}, non fatal MI {1.1% vs. 3.6%, RR = 0.27; CI [0.06-1.22], p = 0.089}, but more strokes {1.7% vs. 1.2%, RR = 1.32; CI [0.16-10.99], p = 0.795} after successful PCI-CTO. Conclusions: The risks of HMACE after PCI-CTO over long-term follow-up were minimal, and do not depend on the procedure success. This unexpected finding somewhat challenge the aggressive interventional approach, and should be confirmed in the adequately powered randomized trial. (C) 2016 Elsevier Inc. All rights reserved.