Circulation, Vol 85, 106-115, Copyright © 1992 by American Heart Association
RJ Ivanhoe, WS Weintraub, JS Douglas Jr, NJ Lembo, M Furman, G Gershony, CL Cohen and SB King 3d
BACKGROUND. Angioplasty of chronically totally occluded vessels has been
associated with a success rate well below and restenosis rate well above
that for angioplasty of stenosed segments. However, long-term clinical
outcome after successful revascularization of a chronically totally
occluded vessel has not been reported in detail. METHODS AND RESULTS.
Accordingly, data for 480 patients undergoing angioplasty for chronic total
occlusion at Emory University Hospital, Atlanta, Ga., from 1980 to 1988
were analyzed for predictors of in-hospital procedural and clinical
(procedural success and absence of in-hospital complications) success,
restenosis, and 4-year clinical follow-up. The study population was grouped
by procedural and clinical success and failure. The groups were then
compared for outcome, both in hospital and long term. The initial clinical
success rate was 66% (317 of 480 patients). Independent correlates of
failure were the number of vessels diseased (p less than 0.001), vessel
location of the lesion (p = 0.016), and absence of any distal antegrade
filling (p = 0.002). Follow- up data revealed 98% cardiac survival and 96%
overall survival at 4 years for the group as a whole. Freedom from
myocardial infarction or cardiac death was significantly greater in
patients with clinical success (93%) than with clinical failure (89%, p =
0.0044). In the successful group, 87% were free from coronary surgery after
4 years compared with 64% in the failure group (p less than 0.0001). Two
thirds of the patients were free of angina at last follow-up. The presence
of angina at follow-up was the same for patients successfully treated and
for those with failed angioplasty, which may be related to the frequent use
of coronary surgery in the failure group. CONCLUSIONS. In well- selected
cases, the success rate for angioplasty of chronic total occlusion is
acceptable. Furthermore, long-term clinical benefit is suggested by the
high freedom from coronary surgery, myocardial infarction, and death in the
patients who underwent successful revascularization.
ARTICLES
Percutaneous transluminal coronary angioplasty of chronic total occlusions. Primary success, restenosis, and long-term clinical follow- up
Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Emory University Hospital, Atlanta, GA 30032.
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