Three-year outcomes of A Randomized Multicentre Trial Comparing Revascularization and Optimal Medical Therapy for Chronic Total Coronary Occlusions (EuroCTO).
EuroIntervention
; 19(7): 571-579, 2023 Sep 18.
Article
de En
| MEDLINE
| ID: mdl-37482940
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 (21 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.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Occlusion coronarienne
/
Intervention coronarienne percutanée
/
Infarctus du myocarde
Type d'étude:
Clinical_trials
/
Etiology_studies
/
Guideline
/
Risk_factors_studies
Aspects:
Patient_preference
Limites:
Humans
Langue:
En
Journal:
EuroIntervention
Sujet du journal:
ANGIOLOGIA
/
CARDIOLOGIA
/
TERAPEUTICA
Année:
2023
Type de document:
Article
Pays d'affiliation:
Allemagne