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Long-term clinical outcomes of optimal medical therapy vs. successful percutaneous coronary intervention for patients with coronary chronic total occlusions.

Long-term clinical outcomes of optimal medical therapy vs. successful percutaneous coronary intervention for patients with coronary chronic total occlusions.
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Guo L, Zhong L, Chen K, Wu J, Huang RC,


Guo L, Zhong L, Chen K, Wu J, Huang RC, (click to view)

Guo L, Zhong L, Chen K, Wu J, Huang RC,

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Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese 2018 03 29() pii S1109-9666(17)30611-5
Abstract
OBJECTIVES
There are little data on the long-term clinical outcomes of optimal medical therapy (OMT) compared with successful percutaneous coronary intervention (PCI) in patients with chronic total occlusions (CTOs).

METHODS
A total of 388 patients with ≥1 CTO were enrolled from January 2008 to December 2010. 62 patients were excluded, and 326 patients were divided into an OMT group (n = 125) and PCI group (n = 201) according to the initial treatment strategy. Propensity-score matching was also done to adjust for baseline characteristics. The primary outcome was major adverse cardiac event (MACE), included cardiac death, recurrent myocardial infarction, and repeated revascularization.

RESULTS
After a mean follow-up of 47.2 ± 20.0 months, there was no significant difference between the two groups with respect to the prevalence of MACE (successful PCI vs. OMT: 29.6% vs. 21.9%, unadjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 0.95-2.28, p=0.085). After multivariate analyses, there were significant differences in the prevalence of MACE (adjusted HR 1.76, 95% CI 1.09-2.28, p=0.02) and repeated revascularization (2.14; 1.18-3.90, 0.01). In the propensity score-matched population (80 pairs), there were no significant differences in the prevalence of MACE (adjusted HR 1.89, 95% CI 0.96-3.71, p=0.06) and cardiac death (1.30, 0.44-3.80, 0.63) between groups.

CONCLUSION
In the treatment of patients with CTOs, successful PCI did not reduce the long-term risk of MACE compared with OMT.

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