Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions. A 25-Year Experience From the Mayo Clinic

Abhiram Prasad, Charanjit Rihal, Ryan J. Lennon, Heather J. Wiste, Mandeep Singh, David Holmes

Research output: Contribution to journalArticle

263 Citations (Scopus)

Abstract

Objectives: The aim of our study was to examine the trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over the last 25 years from a single PCI registry and to examine the impact of drug-eluting stents. Background: The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and there are limited data available from contemporary practice. Methods: We evaluated the outcomes of 1,262 patients from the Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to the time of their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era). Results: Procedural success rates were 51%, 72%, 73%, and 70% (p < 0.001), respectively, in the 4 groups. In-hospital mortality (2%, 1%, 0.4%, and 0%, p = 0.009), emergency coronary artery bypass grafting (15%, 3%, 2%, and 0.7%, p < 0.001), and rates of major adverse cardiac events (8%, 5%, 3%, and 4%, p = 0.052) decreased over time. During follow-up, the combined end point of death, myocardial infarction, or target lesion revascularization, was significantly lower in the 2 most recent cohorts compared with those patients treated before (p = 0.001 for trend). Technical failure to treat the CTO was not an independent predictor of long-term mortality (hazard ratio 1.16 [95% confidence interval 0.90 to 1.5], p = 0.25). Conclusions: Procedural success rates for CTO have not improved over time in the stent era, highlighting the need to develop new techniques and devices. Compared with the prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50%.

Original languageEnglish (US)
Pages (from-to)1611-1618
Number of pages8
JournalJournal of the American College of Cardiology
Volume49
Issue number15
DOIs
StatePublished - Apr 17 2007

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Percutaneous Coronary Intervention
Stents
Drug-Eluting Stents
Registries
Coronary Balloon Angioplasty
Hospital Mortality
Coronary Artery Bypass
Emergencies
Metals
Myocardial Infarction
Confidence Intervals
Equipment and Supplies
Mortality
Therapeutics

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions. A 25-Year Experience From the Mayo Clinic. / Prasad, Abhiram; Rihal, Charanjit; Lennon, Ryan J.; Wiste, Heather J.; Singh, Mandeep; Holmes, David.

In: Journal of the American College of Cardiology, Vol. 49, No. 15, 17.04.2007, p. 1611-1618.

Research output: Contribution to journalArticle

Prasad, Abhiram ; Rihal, Charanjit ; Lennon, Ryan J. ; Wiste, Heather J. ; Singh, Mandeep ; Holmes, David. / Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions. A 25-Year Experience From the Mayo Clinic. In: Journal of the American College of Cardiology. 2007 ; Vol. 49, No. 15. pp. 1611-1618.
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abstract = "Objectives: The aim of our study was to examine the trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over the last 25 years from a single PCI registry and to examine the impact of drug-eluting stents. Background: The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and there are limited data available from contemporary practice. Methods: We evaluated the outcomes of 1,262 patients from the Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to the time of their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era). Results: Procedural success rates were 51{\%}, 72{\%}, 73{\%}, and 70{\%} (p < 0.001), respectively, in the 4 groups. In-hospital mortality (2{\%}, 1{\%}, 0.4{\%}, and 0{\%}, p = 0.009), emergency coronary artery bypass grafting (15{\%}, 3{\%}, 2{\%}, and 0.7{\%}, p < 0.001), and rates of major adverse cardiac events (8{\%}, 5{\%}, 3{\%}, and 4{\%}, p = 0.052) decreased over time. During follow-up, the combined end point of death, myocardial infarction, or target lesion revascularization, was significantly lower in the 2 most recent cohorts compared with those patients treated before (p = 0.001 for trend). Technical failure to treat the CTO was not an independent predictor of long-term mortality (hazard ratio 1.16 [95{\%} confidence interval 0.90 to 1.5], p = 0.25). Conclusions: Procedural success rates for CTO have not improved over time in the stent era, highlighting the need to develop new techniques and devices. Compared with the prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50{\%}.",
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AU - Wiste, Heather J.

AU - Singh, Mandeep

AU - Holmes, David

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N2 - Objectives: The aim of our study was to examine the trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over the last 25 years from a single PCI registry and to examine the impact of drug-eluting stents. Background: The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and there are limited data available from contemporary practice. Methods: We evaluated the outcomes of 1,262 patients from the Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to the time of their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era). Results: Procedural success rates were 51%, 72%, 73%, and 70% (p < 0.001), respectively, in the 4 groups. In-hospital mortality (2%, 1%, 0.4%, and 0%, p = 0.009), emergency coronary artery bypass grafting (15%, 3%, 2%, and 0.7%, p < 0.001), and rates of major adverse cardiac events (8%, 5%, 3%, and 4%, p = 0.052) decreased over time. During follow-up, the combined end point of death, myocardial infarction, or target lesion revascularization, was significantly lower in the 2 most recent cohorts compared with those patients treated before (p = 0.001 for trend). Technical failure to treat the CTO was not an independent predictor of long-term mortality (hazard ratio 1.16 [95% confidence interval 0.90 to 1.5], p = 0.25). Conclusions: Procedural success rates for CTO have not improved over time in the stent era, highlighting the need to develop new techniques and devices. Compared with the prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50%.

AB - Objectives: The aim of our study was to examine the trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over the last 25 years from a single PCI registry and to examine the impact of drug-eluting stents. Background: The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and there are limited data available from contemporary practice. Methods: We evaluated the outcomes of 1,262 patients from the Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to the time of their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era). Results: Procedural success rates were 51%, 72%, 73%, and 70% (p < 0.001), respectively, in the 4 groups. In-hospital mortality (2%, 1%, 0.4%, and 0%, p = 0.009), emergency coronary artery bypass grafting (15%, 3%, 2%, and 0.7%, p < 0.001), and rates of major adverse cardiac events (8%, 5%, 3%, and 4%, p = 0.052) decreased over time. During follow-up, the combined end point of death, myocardial infarction, or target lesion revascularization, was significantly lower in the 2 most recent cohorts compared with those patients treated before (p = 0.001 for trend). Technical failure to treat the CTO was not an independent predictor of long-term mortality (hazard ratio 1.16 [95% confidence interval 0.90 to 1.5], p = 0.25). Conclusions: Procedural success rates for CTO have not improved over time in the stent era, highlighting the need to develop new techniques and devices. Compared with the prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50%.

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