The Impact of Successful Percutaneous Coronary Intervention on the Reduction of Major Adverse Cardiovascular Events in Patients with Chronic Total Coronary Occlusion

Background: Chronic total coronary occlusion (CTOs) is associated with an increased risk of adverse clinical outcomes. The benefits of percutaneous coronary intervention (PCI) in CTO are still being debated due to the limited data available. This study aimed to determine the relationship between the revascularization of CTO and the reduction of major adverse cardiovascular events (MACE). Methods: We conducted a retrospective cohort analytic observational study. Around 578 individuals with at least one CTO were detected among a total of 2165 patients who had angiography at Dr. Saiful Anwar Hospital in Malang from August 2017 to September 2020. This study included 510 participants after excluding 68 individu-als. They were separated into two groups: the revascularized CTO (n = 141) and the non-revascularized CTO (n = 369) groups. The outcome of this study was MACE, which included cardiac mortality, all-cause mortality, and rehospitalization. Result: Patients with revascularized CTO compared to those with non-revascularized CTO had a higher history of heart failure, involvement of LM disease, multivessel disease, and three vessel disease (41.2% vs 18.4%, p = 0.041; 16.5% vs 1.8%, p < 0.001; 69.4% vs 22.7%, p < 0.001; 56.5% vs 14.1%, p < 0.001) with a lower mean LVEF (0.49 ± 0.06 vs 0.51 ± 0.07, p=0.045) and older age (60±9 vs 57±8 years; p=0.007). At a 12-month follow-up, in the revascularized CTO group had a better prognosis than the non-revascularized CTO group in terms of MACE (19.9% vs 33.1% Log-rank p= 0.002). These results were consistent for all-cause mortality (5.5% vs 20.6%, Log-rank p=0.027), cardiac mortality (3.7% vs 20.6%, Log-rank p< 0.001) and rehospitalization. (7.5% vs 32.2%, Log-rank p= 0.001). Conclusion: Successful revascularization of CTO by PCI may provide clinical benefits in patients with CTO including MACE reduction.