Percutaneous coronary intervention versus optimal medical therapy for chronic total coronary occlusion with well-developed collaterals

Background-the impact of percutaneous coronary intervention (pci) on chronic total occlusion in patients with well-developed collaterals is not clear. methods and results-a total of 640 chronic total occlusion patients with collateral flow grade ≥2 were divided into 2 groups; chronic total occlusion patients either treated with pci (the pci group; n=305) or optimal medical therapy (the optimal medical therapy group; n=335). to adjust for potential confounders,a propensity score matching analysis was performed. major clinical outcomes were compared between the 2 groups up to 5 years. in the entire population,the pci group had a lower hazard of myocardial infarction (hazard ratio [hr],0.177; p=0.039; 95% confidence interval [ci],0.03-0.91) and the composite of total death or myocardial infarction (hr,0.298; p=0.017; 95% ci,0.11-0.80); however,it showed higher hazard of target lesion revascularization (hr,3.942; p=0.003; 95% ci,1.58-9.81) and target vessel revascularization (hr,4.218; p=0.001; 95% ci,1.85- 9.60). after propensity score matching,a total of 158 matched pairs were generated. although the pci group showed a higher hazard of target lesion revascularization (hr,2.868; p=0.027; 95% ci,1.13-7.31) and target vessel revascularization (hr=2.62; p=0.022; 95% ci,1.15-5.97),it still exhibited a lower incidence of the composite of total death or myocardial infarction (hr,0.263; p=0.017; 95% ci,0.087-0.790). the mean ejection fraction was improved from 47.8% to 51.6% (p < 0.001) after pci. conclusions-in our study,successful revascularization by pci for chronic total occlusion lesions with well-developed collaterals was associated with lower incidence of death and myocardial infarction,improved left ventricular function,but increased repeat revascularization rate. © 2017 the authors.