Objectives: To compare clinical outcomes of percutaneous coronary intervention (PCI) with those of optimal medical therapy (OMT) alone in patients with chronic total occlusion (CTO) of a single coronary artery.
Background: Limited data are available on the efficacy of OMT for the treatment of single-vessel CTO.
Methods: Between March 2003 and February 2012, we enrolled 2024 CTO patients in a retrospective, observational registry and analyzed 435 patients with CTO of a single coronary artery. We divided patients into an OMT group (n=147) and PCI group (n=288) according to the initial treatment strategy. One-to-many (1:N) propensity score matching with a non-fixed matching ratio was also performed. The primary outcome measured in this study was major adverse cardiac events (MACEs) including cardiac death, myocardial infarction, and repeated coronary revascularization.
Results: The median follow-up duration was 47.6 (interquartile range: 22.9 to 68.9) months. Major adverse cardiac events were noted for 16 patients (10.9%) in the OMT group compared to 41 patients (14.2%) in the PCI group (p=0.38). After propensity-score matching, there were no significant differences between the OMT group and PCI group with respect to MACE frequency (10.1% vs. 16.9%, adjusted hazard ratio [HR], 2.03; 95% confidence interval [CI], 0.88-4.68, p=0.10) or cardiac death (OMT vs. PCI: 5.1% vs. 4.8%, HR, 1.14; 95% CI, 0.30-4.42, p=0.85). Subgroup analysis showed that the rate of MACEs was significantly lower in the OMT group compared to the PCI group among patients with an APPROACH score ≤ 18 and SYNTAX score ≤ 12.
Conclusions: As a treatment strategy in patients with single-vessel CTO, PCI did not reduce the risk of MACE or cardiac death. These results suggest that OMT may be a better initial strategy for patients as assessed by low APPROACH and SYNTAX scores.
Keywords: Chronic total occlusion; Optimal medical treatment; Revascularization.
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