Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Chronic Total Coronary Occlusion With Well-Developed Collaterals
- Authors
- Choi, Se Yeon; Choi, Byoung Geol; Rha, Seung-Woon; Baek, Man Jong; Ryu, Yang Gi; Park, Yoonjee; Byun, Jae Kyeong; Shim, Minsuk; Li, Hu; Mashaly, Ahmed; Jang, Won Young; Kim, Woohyeun; Choi, Jah Yeon; Park, Eun Jin; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo
- Issue Date
- 9월-2017
- Publisher
- WILEY
- Keywords
- chronic total occlusion; collateral circulation; medical therapy; percutaneous coronary intervention
- Citation
- JOURNAL OF THE AMERICAN HEART ASSOCIATION, v.6, no.9
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF THE AMERICAN HEART ASSOCIATION
- Volume
- 6
- Number
- 9
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/82489
- DOI
- 10.1161/JAHA.117.006357
- ISSN
- 2047-9980
- Abstract
- Background-The impact of percutaneous coronary intervention (PCI) on chronic total occlusion in patients with well-developed collaterals is not clear. Methods and Results-A total of 640 chronic total occlusion patients with collateral flow grade >= 2 were divided into 2 groups; chronic total occlusion patients either treated with PCI (the PCI group; n=305) or optimal medical therapy (the optimal medical therapy group; n=335). To adjust for potential confounders, a propensity score matching analysis was performed. Major clinical outcomes were compared between the 2 groups up to 5 years. In the entire population, the PCI group had a lower hazard of myocardial infarction (hazard ratio [HR], 0.177; P=0.039; 95% confidence interval [CI], 0.03-0.91) and the composite of total death or myocardial infarction (HR, 0.298; P=0.017; 95% CI, 0.11-0.80); however, it showed higher hazard of target lesion revascularization (HR, 3.942; P=0.003; 95% CI, 1.58-9.81) and target vessel revascularization (HR, 4.218; P=0.001; 95% CI, 1.85-9.60). After propensity score matching, a total of 158 matched pairs were generated. Although the PCI group showed a higher hazard of target lesion revascularization (HR, 2.868; P=0.027; 95% CI, 1.13-7.31) and target vessel revascularization (HR=2.62; P=0.022; 95% CI, 1.15-5.97), it still exhibited a lower incidence of the composite of total death or myocardial infarction (HR, 0.263; P=0.017; 95% CI, 0.087-0.790). The mean ejection fraction was improved from 47.8% to 51.6% (P<0.001) after PCI. Conclusions-In our study, successful revascularization by PCI for chronic total occlusion lesions with well-developed collaterals was associated with lower incidence of death and myocardial infarction, improved left ventricular function, but increased repeat revascularization rate.
- Files in This Item
- There are no files associated with this item.
- Appears in
Collections - Graduate School > Department of Biomedical Sciences > 1. Journal Articles
- College of Medicine > Department of Medical Science > 1. Journal Articles
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.