Percutaneous angioplasty of chronically occluded coronary arteries: long-term clinical follow-up

BACKGROUND: Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) is one of the most demanding procedures in interventional cardiology. In spite of growing experience and technological progress, efficacy of PCI of CTO remains lower than that of standard PCI. AIM: To evaluate long-term clinical results of PCI in patients with stable angina and CTO. METHODS: The study involved 459 consecutive patients who underwent the procedure of CTO recanalisation between 1996 and 2003. All procedures were performed using the standard technique. Follow-up examination was carried out based on a written questionnaire, and the mean follow-up period was 30+/-18 months. RESULTS: The average success rate of intervention was 64.9% and 63.8% of patients underwent successful and uneventful procedures. Clinically significant in-hospital complications were noted in 8 (1.6%) patients including 1 (0.2%) death, 2 (0.4%) cases of myocardial infarction and 4 (1.0%) repeated revascularisations. Long-term survival following either successful or failed recanalisation was similar (97.5% vs 97.3%, NS) as was incidence of acute coronary syndromes (12.5% vs 12.1%, respectively; NS). Patients after successful recanalisation less frequently underwent surgical revascularisation (3.6% vs 8.1%, respectively; p <0.05) and also suffered less frequently from angina (CCS 0/CCS I: 20.4% vs 12.1%, p <0.00005). Otherwise, they were at higher risk of repeated PCI due to restenosis (13.2% vs 6.7%, respectively; p <0.05). CONCLUSIONS: Success rate of PCI in patients with chronically occluded coronary arteries and stable angina is moderately high with relatively low incidence of complications. Late benefits from successful recanalisation of coronary artery depend predominantly on improved coronary reserve and decreased need for surgical myocardial revascularisation. Successful recanalisation does not reduce the risk of death or myocardial infarction but is associated with higher frequency of repeated PCI due to restenosis.