Percutaneous coronary intervention versus optimal medical therapy for chronic total coronary occlusion with well-developed collaterals

Se Yeon Choi, Byoung Geol Choi, Seung-Woon Rha, Man Jong Baek, Yang Gi Ryu, Yoonjee Park, Jae Kyeong Byun, Minsuk Shim, Hu Li, Ahmed Mashaly, Won Young Jang, Woohyeun Kim, Jah Yeon Choi, Eun Jin Park, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog SeoDong Joo Oh

Research output: Contribution to journalArticle

11 Citations (Scopus)

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.

Original languageEnglish
Article numbere006357
JournalJournal of the American Heart Association
Volume6
Issue number9
DOIs
Publication statusPublished - 2017 Sep 1

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Coronary Occlusion
Percutaneous Coronary Intervention
Confidence Intervals
Myocardial Infarction
Propensity Score
Therapeutics
Incidence
Group Psychotherapy
Left Ventricular Function
Population

Keywords

  • Chronic total occlusion
  • Collateral circulation
  • Medical therapy
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous coronary intervention versus optimal medical therapy for chronic total coronary occlusion with well-developed collaterals. / 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.

In: Journal of the American Heart Association, Vol. 6, No. 9, e006357, 01.09.2017.

Research output: Contribution to journalArticle

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. / Percutaneous coronary intervention versus optimal medical therapy for chronic total coronary occlusion with well-developed collaterals. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 9.
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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.",
keywords = "Chronic total occlusion, Collateral circulation, Medical therapy, Percutaneous coronary intervention",
author = "Choi, {Se Yeon} and Choi, {Byoung Geol} and Seung-Woon Rha and Baek, {Man Jong} and Ryu, {Yang Gi} and Yoonjee Park and Byun, {Jae Kyeong} and Minsuk Shim and Hu Li and Ahmed Mashaly and Jang, {Won Young} and Woohyeun Kim and Choi, {Jah Yeon} and Park, {Eun Jin} and Na, {Jin Oh} and Choi, {Cheol Ung} and Lim, {Hong Euy} and Kim, {Eung Ju} and Park, {Chang Gyu} and Seo, {Hong Seog} and Oh, {Dong Joo}",
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T1 - Percutaneous coronary intervention versus optimal medical therapy for chronic total coronary occlusion with well-developed collaterals

AU - Choi, Se Yeon

AU - Choi, Byoung Geol

AU - Rha, Seung-Woon

AU - Baek, Man Jong

AU - Ryu, Yang Gi

AU - Park, Yoonjee

AU - Byun, Jae Kyeong

AU - Shim, Minsuk

AU - Li, Hu

AU - Mashaly, Ahmed

AU - Jang, Won Young

AU - Kim, Woohyeun

AU - Choi, Jah Yeon

AU - Park, Eun Jin

AU - Na, Jin Oh

AU - Choi, Cheol Ung

AU - Lim, Hong Euy

AU - Kim, Eung Ju

AU - Park, Chang Gyu

AU - Seo, Hong Seog

AU - Oh, Dong Joo

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

AB - 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.

KW - Chronic total occlusion

KW - Collateral circulation

KW - Medical therapy

KW - Percutaneous coronary intervention

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