Optimal medical therapy may be a better initial strategy in patients with chronic total occlusion of a single coronary artery

초록

Objectives To compare clinical outcomes of percutaneous coronary intervention (PCI) with those of optimal medical therapy (OMT) alone in patients with chronic total occlusion (CTO) of a single coronary artery. Background Limited data are available on the efficacy of OMT for the treatment of single-vessel CTO. Methods Between March 2003 and February 2012, we enrolled 2024 CTO patients in a retrospective, observational registry and analyzed 435 patients with CTO of a single coronary artery. We divided patients into an OMT group (n = 147) and PCI group (n = 288) according to the initial treatment strategy. One-to-many (1:N) propensity score matching with a non-fixed matching ratio was also performed. The primary outcome measured in this study was major adverse cardiac events (MACEs) including cardiac death, myocardial infarction, and repeated coronary revascularization. Results The median follow-up duration was 47.6 (interquartile range: 22.9 to 68.9) months. Major adverse cardiac events were noted for 16 patients (10.9%) in the OMT group compared to 41 patients (14.2%) in the PCI group (p = 0.38). After propensity-score matching, there were no significant differences between the OMT group and PCI group with respect to MACE frequency (10.1% vs. 16.9%, adjusted hazard ratio [HR], 2.03; 95% confidence interval [CI], 0.88–4.68, p = 0.10) or cardiac death (OMT vs. PCI: 5.1% vs. 4.8%, HR, 1.14; 95% CI, 0.30–4.42, p = 0.85). Subgroup analysis showed that the rate of MACEs was significantly lower in the OMT group compared to the PCI group among patients with an APPROACH score ≤ 18 and SYNTAX score ≤ 12. Conclusions As a treatment strategy in patients with single-vessel CTO, PCI did not reduce the risk of MACE or cardiac death. These results suggest that OMT may be a better initial strategy for patients as assessed by low APPROACH and SYNTAX scores.

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