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Stent failure in CTOs did not influence long-term mortality
Successful stent outcomes for chronic total occlusion compared with failed procedures did not reduce the risk for 3-year mortality, results from a registry cohort have found.
In all, 1,524 patients in the CREDO-Kyoto registry cohort-2 underwent PCI for CTO. Clinical outcomes were compared between 1,192 patients with successful CTO PCI and 332 patients with failed CTO PCI. In-hospital death tended to occur less frequently in the success group than after failed procedures (1.4% vs. 3%; P=.053).
Rates of all-cause death did not significantly differ between the successful and failed groups (9% vs. 13.1%; P=.18), whereas cumulative incidence of cardiac death was significantly less in the successful group than in the failed group (4.5% vs. 8.4%; P=.03). After adjusting for potential confounders, successful procedures were not associated with lesser risk for all-cause death (HR=0.93; 95% CI, 0.64-1.37) or cardiac death (HR=0.71; 95% CI, 0.44-1.16). However, the cumulative incidence of CABG was less in patients with successful procedures compared with those with failed ones (1.8% vs. 19.6%; P<.0001). Successful stent procedures also were associated with significantly fewer subsequent CABG procedures.
Researchers wrote that, inconsistent with prior reports, successful CTO PCI was not associated with lesser risk for all-cause death or cardiac death. Possible reasons may include that complications of PCI for CTO might have some influence on mortality, or that there was a difference in the rate of subsequent revascularization after PCI.
“Given the discrepancy between the present and previous studies in terms of long-term mortality benefit of successful CTO PCI, it is currently unclear whether successful CTO PCI could improve long-term mortality,” they wrote.
Disclosure: The researchers report no relevant financial disclosures.