Article ; Online: Three-year outcomes of A Randomized Multicentre Trial Comparing Revascularization and Optimal Medical Therapy for Chronic Total Coronary Occlusions (EuroCTO).
2024 Volume 19, Issue 7, Page(s) 571–579
Abstract: Background: Percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO) improves clinical symptoms and quality of life. The longer-term safety of PCI compared to optimal medical therapy (OMT) remains uncertain.: Aims: We ... ...
| Abstract | Background: Percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO) improves clinical symptoms and quality of life. The longer-term safety of PCI compared to optimal medical therapy (OMT) remains uncertain. Aims: We sought to evaluate the long-term safety of PCI for CTO in a randomised trial as compared to OMT. Methods: A total of 396 patients with a symptomatic CTO were enrolled into a randomised, multicentre clinical trial comparing PCI and OMT. Half of the patients had a single CTO; the others had multivessel disease. Non-CTO lesions were treated prior to randomisation (2:1 ratio). During follow-up, crossover from OMT to PCI occurred in 7.3% (1 year) and 17.5% (3 years) of patients. Results: At 3 years, the incidence of cardiovascular death or nonfatal myocardial infarction was not significantly different between the groups (OMT 3.7% vs PCI 6.2%; p=0.29). By per-protocol analysis, the difference remained non-significant (OMT 5.7% vs PCI 4.7%; p=0.67). Overall, major adverse cardiovascular events (MACE) were more frequent with OMT (OMT 21.2% vs PCI 11.2%), largely because of ischaemia-driven revascularisation. The rates of stroke or hospitalisation for bleeding were not different between the groups. Conclusions: At 3 years there was no difference in the rate of cardiovascular death or myocardial infarction between PCI or OMT among patients with a remaining single coronary CTO. The MACE rate was higher in the OMT group due largely to ischaemia-driven revascularisation. CTO PCI appears to be a safe option for patients with a single remaining significant coronary CTO. CinicalTrials.gov: NCT01760083. |
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| MeSH term(s) | Humans ; Coronary Occlusion/diagnostic imaging ; Coronary Occlusion/therapy ; Treatment Outcome ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/methods ; Quality of Life ; Myocardial Infarction/therapy ; Chronic Disease ; Risk Factors |
| Language | English |
| Publishing date | 2024-01-12 |
| Publishing country | France |
| Document type | Randomized Controlled Trial ; Multicenter Study ; Journal Article |
| ZDB-ID | 2457174-X |
| ISSN | 1969-6213 ; 1774-024X |
| ISSN (online) | 1969-6213 |
| ISSN | 1774-024X |
| DOI | 10.4244/EIJ-D-23-00312 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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