06 Mar Recanalization of Chronically Occluded Coronary Vessels Did Not Improve Survival

Posted at 14:33h in Author Interviews, Heart Disease, JACC, Surgical Research by

MedicalResearch.com Interview with:
Seung-Whan Lee, MD, PHD
Associate professor, Asan Medical Center
University of Ulsan College of Medicine
on behalf of our investigators. 

Medical Research: What is the background for this study?

Response: Survival benefit of successful coronary Chronic Total Occlusion  (CTO) recanalization has been a rationale behind PCI for CTOs. However, this knowledge is based on many observational studies that predate the widespread use of dedicated devices or techniques, drug-eluting stents (DESs), and current standards of medical management, making them low-quality evidence from the current perspective.

Medical Research: What are the main findings?

Response: Our study showed that successful PCI using DES was not associated with a lower risk for mortality compared with failed CTO-PCI.

The revascularization strategy for non-CTO vessels, high frequency of subsequent CABG in patients with failed PCI, and high procedural success with low life-threatening complication rate may all have contributed to our study finding.

Medical Research: What should clinicians and patients take away from your report?

Response: Considering that the true  beneficial effect of successful CTO-PCI cannot be made by comparing outcomes after successful PCI with outcomes after failed PCI, a randomized comparison between CTO-PCI and optimal medical therapy is required to define the prognostic impact of CTO-PCI.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: The true prognostic impact of CTO-PCI should be defined by a randomized comparison between successful CTO-PCI and optimal medical therapy such as DECISION-CTO or EURO-CTO trial which are being conducted.  

Medical Research: Is there anything else you would like to add?

Response: The complete revascularization rates for non-CTO arteries were similar between the two groups after the index procedure and for those patients, the long-term outcomes did not show statistical difference whether or not CTO-PCI succeeded in our subgroup analysis Thus, if feasible, strategies to achieve patency of non-CTO vessels may be necessary, even in patients with failed CTO-PCI.

Citation: JACC

Lee P, Lee S, Park H, et al. Successful Recanalization of Native Coronary Chronic Total Occlusion Is Not Associated With Improved Long-Term Survival. J Am Coll Cardiol Intv.2016;():. doi:10.1016/j.jcin.2015.11.016.

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Dr. Seung-Whan Lee (2016). Recanalization of Chronically Occluded Coronary Vessels Did Not Improve Survival 

Last Updated on March 6, 2016 by Marie Benz MD FAAD

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