Impact of complete percutaneous revascularization in elderly patients with chronic total occlusion

Objective: The aim of the study was to assess the prognostic impact of successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and completeness of revascularization in the elderly. Background: Successful CTO-PCI is associated with clinical benefit. Notwithstanding elderly patients are currently underrepresented in CTO-PCI randomized controlled trials and registries. Methods: From the Florence CTO-PCI registry 1,405 patients underwent CTO-PCI between 2004 and 2015; out of these, 460 consecutive patients were ≥75 years. End point of the study was long-term cardiac survival. The prognostic impact of successful CTO-PCI and complete revascularization on survival was assessed by Kaplan–Meier estimation and by Cox multivariable regression analysis. Results: Patients were stratified according to success (72%) or failure of CTO-PCI. Completeness of revascularization was achieved in 57% of patients. Five-year cardiac survival was significantly higher in the successful CTO-PCI group (84 ± 3% vs. 72 ± 6%; p =.006) and it was further improved if complete coronary revascularization was achieved (90 ± 3% vs. 68 ± 5%; p <.001). At multivariable analysis, increasing age (hazard ratio [HR] 1.08; p =.001), diabetes (HR 1.55; p =.033), chronic kidney disease (HR 1.96, p =.002), left ventricular ejection fraction <0.40 (HR 2.10; p <.001), and completeness of revascularization (HR 0.58; p <.005) resulted independently associated with long-term cardiac survival. Conclusions: In the elderly successful CTO-PCI is associated with a long-term survival benefit. The results of this study suggest that, even in the elderly, a CTO-PCI attempt should be considered to achieve complete coronary revascularization. © 2019 Wiley Periodicals, Inc.