Predictors of Adverse Events Among Chronic Total Occlusion Patients Undergoing Successful Percutaneous Coronary Intervention and Medical Therapy

Figures & data

Figure 1 Study flow chart.

Abbreviations: CABG, coronary artery bypass grafting; CTO, chronic total occlusion; MACE, major adverse cardiovascular events; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction.

Table 1 Baseline Clinical, Angiographic and Procedural Characteristics and in-Hospital Outcome of All Patients According to the Occurrence of MACE in the Successful Recanalization and Medical Therapy Groups

Variables	Successful Recanalization (n=718)			Medical Therapy (n=1297)
	MACE (+) (n = 123)	MACE (-) (n = 595)	P value	MACE (+) (n = 326)	MACE (-) (n = 971)	P value
Age, years	65.2 ± 9.6	62.9 ± 9.7	0.099	60.7 ± 10.0	60.2 ± 8.9	0.434
Male	91 (74.0)	450 (75.6)	0.700	555 (83.5)	340 (79.8)	0.126
Smoking	52 (42.3)	254 (42.7)	0.933	315 (47.4)	198 (46.5)	0.774
Hypertension	86 (69.9)	392 (65.9)	0.388	419 (63.0)	269 (63.1)	0.963
Diabetes mellitus	46 (37.4)	203 (34.1)	0.486	256 (38.5)	157 (36.9)	0.585
Hyperlipidemia	88 (71.5)	433 (72.8)	0.781	500 (75.2)	317 (74.4)	0.664
Familial history of CAD	9 (7.3)	74 (12.4)	0.106	77 (11.6)	47 (11.0)	0.782
Previous MI	45 (36.6)	161 (27.1)	0.033	238 (35.8)	116 (27.2)	0.003
CKD	13 (10.7)	38 (6.5)	0.103
Heart failure	24 (19.5)	66 (11.1)	0.010	77 (11.6)	47 (11.0)	0.782
LVEF, %	52.1 ± 8.9	55.1 ± 7.2	0.001	60.7 ± 10.0	60.2 ± 8.9	0.434
Baseline medication
Aspirin	121 (98.4)	579 (97.3)	0.492	650 (97.7)	420 (98.6)	0.320
Clopidogrel	116 (94.3)	579 (97.3)	0.085	609 (91.6)	410 (96.2)	0.002
Statin	114 (92.7)	574 (96.5)	0.056	645 (97.0)	409 (96.0)	0.381
β blocker	94 (76.4)	452 (76.0)	0.914	511 (76.8)	316 (74.2)	0.316
ACEI or ARB	78 (63.4)	357 (60.0)	0.481	426 (64.1)	254 (59.6)	0.140
One CTO lesion	99 (80.5)	517 (86.9)	0.064	586 (88.1)	375 (88.0)	0.963
Two CTO lesions	22 (17.9)	73 (12.3)	0.094	75 (11.3)	47 (11.0)	0.900
LAD	52 (42.3)	238 (40.0)	0.640	214 (32.2)	163 (38.3)	0.039
LCX	28 (22.8)	138 (23.2)	0.918	219 (32.9)	87 (20.4)	<0.001
RCA	63 (51.2)	280 (47.1)	0.400	311 (46.8)	216 (50.7)	0.204
Multivessel disease	92 (74.8)	399 (67.1)	0.093	566 (85.1)	287 (67.4)	<0.001
Proximal or mid CTO	95 (77.2)	438 (73.6)	0.403	442 (66.5)	317 (74.4)	0.005
Calcification	25 (20.3)	69 (11.6)	0.009	104 (15.6)	39 (9.2)	0.002
Long lesions (≥20 mm)	83 (67.5)	379 (63.7)	0.780	401 (60.3)	277 (65.0)	0.117
J-CTO score	1.42 ± 1.05	1.45 ± 1.01	0.995	1.71 ± 1.22	1.44 ± 1.01	<0.001
SYNTAX score	20.6 ± 8.0	19.3 ± 6.7	0.367	22.1 ± 9.1	18.1 ± 7.9	0.062
Dual injection	34 (27.6)	154 (25.9)	0.686
Microcatheter use	43 (34.9)	184 (30.9)	0.381
Radial access	83 (67.4)	386 (64.8)	0.580
Femoral access	40 (32.6)	209 (35.2)	0.580
IVUS use	17 (13.8)	66 (11.1)	0.389
Number of stents	1.48 ± 0.72	1.45 ± 0.76	0.998
Total stent length, mm	42.8 ± 22.2	43.7 ± 21.8	0.554
Contrast volume, mL	228 ± 73	226 ± 81	0.999
Coronary dissection	6 (4.8)	20 (3.4)	0.425
Coronary perforation	2 (1.6)	6 (1.0)	0.631
In-hospital death	1 (0.8)	2 (0.3)	0.646	2 (0.6)	5 (0.5)	0.834

Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; CAD, coronary artery disease; CKD, chronic kidney disease; CTO, chronic total occlusion; IVUS, intravascular ultrasound; J-CTO, Japanese-chronic total occlusion; LAD, left ascending coronary artery; LCX, left circumflex coronary artery; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular events; MI, myocardial infarction; RCA, right coronary artery.

Table 2 Clinical Outcomes of All Patients with CTOs in the Successful Recanalization and Medical Therapy Groups

Variables	Successful Recanalization	Medical Therapy
	n = 718	n = 1297
MACE	123 (17.1)	326 (25.1)
Cardiac death	23 (3.2)	74 (5.7)
MI	49 (6.8)	106 (8.2)
TVR	80 (11.1)	188 (14.5)

Abbreviations: MACE, major adverse cardiovascular events; MI, myocardial infarction; PCI, percutaneous coronary intervention; PSM, propensity score matching; TVR, target-vessel revascularization.

Table 3 Univariate and Multivariate Analyses of the MACE in Patients Who Underwent Successful Recanalization for CTOs

Variables	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	P value	HR (95% CI)	P value
Age≥65 yrs	1.36 (0.96–1.94)	0.084	1.25 (0.86–1.82)	0.244
Male	0.97 (0.65–1.45)	0.894
Smoking	1.06 (0.74–1.51)	0.757
Hypertension	1.19 (0.81–1.75)	0.369
Diabetes mellitus	1.22 (0.84–1.76)	0.290
Hyperlipidemia	1.04 (0.81–1.33)	0.793
Previous MI	1.13 (0.78–1.63)	0.514
CKD	1.70 (0.95–3.02)	0.071	1.16 (0.61–2.19)	0.645
Heart failure	1.98 (1.26–3.09)	0.003	1.77 (1.04–3.04)	0.036
LVEF <40%	1.64 (0.92–2.94)	0.090	1.19 (0.62–2.28)	0.593
LAD CTO	1.06 (0.74–1.52)	0.743
J-CTO score (per point increment)	0.99 (0.83–1.91)	0.977
Multivessel disease	1.44 (0.96–2.16)	0.079	1.36 (0.89–2.10)	0.155
Total stent length ≥ 20 mm	0.87 (0.71–1.14)	0.732

Abbreviations: CKD, chronic kidney disease; CTO, chronic total occlusion; J-CTO, Japanese-chronic total occlusion; LAD, left ascending coronary artery; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular events; MI, myocardial infarction.

Table 4 Univariate and Multivariate Analyses of the MACE in Patients Who Underwent Medical Therapy for CTOs

Variables	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	P value	HR (95% CI)	P value
Age≥65 yrs	1.08 (0.87–1.35)	0.451
Male	1.42 (1.06–1.90)	0.017	1.53 (1.13–2.05)	0.005
Smoking	1.14 (0.92–1.42)	0.221
Hypertension	0.99 (0.79–1.26)	0.974
Diabetes mellitus	1.37 (1.10–1.70)	0.005	1.39 (1.11–1.74)	0.003
Hyperlipidemia	1.01 (0.79–1.30)	0.898
Previous MI	1.25 (1.00–1.55)	0.048	1.05 (0.83–1.33)	0.648
CKD	1.43 (1.04–1.96)	0.026	1.22 (0.88–1.70)	0.222
Heart failure	1.66 (1.30–2.12)	<0.001	1.44 (1.10–1.87)	0.007
LVEF <40%	1.29 (0.95–1.77)	0.101
LAD CTO	1.05 (0.83–1.32)	0.669
J-CTO score (per point increment)	1.19 (1.08–1.30)	<0.001	1.17 (1.07–1.28)	0.001
Multivessel disease	2.35 (1.52–3.61)	<0.001	2.20 (1.42–3.39)	<0.001

Abbreviations: CKD, chronic kidney disease; CTO, chronic total occlusion; J-CTO, Japanese-chronic total occlusion; LAD, left ascending coronary artery; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular events; MI, myocardial infarction.

Figure 2 Kaplan–Meier curves for MACE (A) and cardiac death (B) during follow-up for successful recanalization versus medical therapy in total patients.

Abbreviation: MACE, major adverse cardiovascular events.