As Dr. Patrick W. Serruys told Reuters Health by email, "All-cause mortality is unrelated to coronary artery patency 10 years following revascularization, irrespective of initial revascularization strategy (percutaneous or surgical) or anatomical location of total coronary-artery occlusions. Further studies are needed to identify the factors that determine long-term clinical outcomes in patients undergoing revascularization of completely occluded coronary arteries."
For their study, Dr. Serruys of the National University of Ireland, in Galway, and colleagues examined data from the SYNTAXES trial, in which 1,800 patients deemed eligible for either approach were randomized to PCI or CABG. Of these, 460 had at least one TO.
All TOs were successfully recanalized in 43.5% of patients after PCI and 60.5% after CABG, the researchers report in the Journal of the American College of Cardiology. There was no significant difference in 10-year all-cause mortality between patients with successfully recanalized TO and those without in the PCI arm (29.9% vs. 29.4%) or the CABG arm (28.0% vs. 21.4%).
Comparison of patients with three-vessel disease and/or left-main disease also showed no difference between the PCI and CABG arm in terms of 10-year mortality.
These findings "might support contemporary practice among high-volume CTO-PCI centers where recanalization is primarily offered to patients for the management of angina refractory to medical therapy when myocardial viability is confirmed," the researchers write.
However, in an accompanying editorial Drs. Jeffrey W. Moses and Megha Prasad of Columbia University Irving Medical Center, in New York City, highlight a number of limitations of the study, including the "mixed bag" of occlusions involved. Moreover, they stress that, "Regardless of the presence of a TO, incomplete revascularization is associated with adverse outcomes."
Dr. Moses told Reuters Health by email, "The analysis as performed failed to adequately account for the differences in the amount of myocardium subserved by the occluded vessels. Large areas a residual ischemia, whether due to a stenosis or occlusion, are associated with higher mortality."
SOURCE: https://bit.ly/2MIFsOC and https://bit.ly/3oHExeo The Journal of the American College of Cardiology, online February 1, 2021.
By David Douglas
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