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Both surgical and percutaneous revascularization improve prognosis in patients with a coronary chronic total occlusion (CTO) irrespective of collateral robustness

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Abstract

The impact of surgical or percutaneous coronary revascularization on prognosis in patients with a chronic total occlusion (CTO) remains uncertain. Particularly, whether revascularization of those with robust coronary collaterals improves prognosis is unknown. The objective of this study was to determine the predictors and prognostic impact of revascularization of a CTO, and to determine the clinical impact of robust coronary collaterals. Patients with a CTO diagnosed on coronary angiography between Jul 2010 and Dec 2019 were included in this study. Management strategy of the CTO was defined as percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or medical management. The degree of collateral robustness was determined by the Rentrop grading classification. Demographic, angiographic and clinical outcomes were recorded. A total of 954 patients were included in the study, of which 186 (19.5%) patients underwent CTO PCI, 296 (31.0%) patients underwent CABG and 472 (49.5%) patients underwent medical management of the CTO. 166 patients (17.4%) had Rentrop grade zero or one collaterals, 577 (60.5%) patients had Rentrop grade two and 211 (22.1%) had Rentrop grade three collaterals. The independent predictors of medical management of the CTO were older age, greater stenosis in the donor vessel, an emergent indication for angiography, a non-LAD CTO and female sex. The degree of collateral robustness was not associated with long-term mortality, while patients who were revascularized either through CABG or PCI had a significantly lower mortality compared to medical management alone (p < 0.0001). In patients with a CTO, the presence of robust collaterals is not associated with prognosis, while both surgical and percutaneous revascularization is associated with improved prognosis. Further research into the optimal revascularization strategy for a CTO is required.

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Funding

UKA has received an unconditional research grant from Heart Research Australia. RB has received an unconditional future leaders fellowship from the Heart Foundation.

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Authors and Affiliations

  1. Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia

    Usaid K. Allahwala, Avedis Ekmejian, Nadeem Mughal, Michael Ward & Ravinay Bhindi

  2. The University of Sydney, Sydney, Australia

    Usaid K. Allahwala, Michael Ward, James C. Weaver & Ravinay Bhindi

  3. Faculty of Medicine and Health Sciences, Macquarie University, Marsfield, Australia

    Hosen Kiat

  4. Faculty of Medicine, University of New South Wales, Kensington, Australia

    Hosen Kiat

  5. Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia

    Levi Bassin

  6. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia

    James C. Weaver

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  1. Usaid K. Allahwala
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Correspondence to Usaid K. Allahwala.

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UKA has received an unconditional research grant from Heart Research Australia. RB has received an unconditional future leaders fellowship from the Heart Foundation.

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Allahwala, U.K., Kiat, H., Ekmejian, A. et al. Both surgical and percutaneous revascularization improve prognosis in patients with a coronary chronic total occlusion (CTO) irrespective of collateral robustness. Heart Vessels 36, 1653–1660 (2021). https://doi.org/10.1007/s00380-021-01859-2

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