Abstract
Background. Chronic total occlusion (CTO) of a coronary artery represents one of the most complex forms of coronary artery disease, and the optimal treatment strategy remains controversial.
Objective. To compare very long-term (≥5 years) clinical outcomes of percutaneous coronary intervention plus optimal medical therapy (PCI+OMT) versus OMT alone in patients with chronic coronary syndrome and angiographically confirmed CTO.
Materials and methods. This multicenter retrospective study included 100 patients with coronary artery disease and angiographically confirmed CTO hospitalized between 2005 and 2018. Preprocedural assessment comprised laboratory testing, noninvasive ischemia evaluation, electrocardiography, and echocardiography. Invasive assessment was performed using bilateral coronary angiography with evaluation according to the SYNTAX and J-CTO scores, as well as the Werner and Rentrop classifications. Patients were allocated into two equal groups: PCI+OMT and OMT alone. The primary endpoint was major adverse cardiovascular events (MACE), defined as all-cause mortality, myocardial infarction, and stroke. Secondary endpoints included individual MACE components, cardiovascular-related hospitalizations, clinical status (Canadian Cardiovascular Society – CCS angina class and NYHA functional class), and echocardiographic parameters (left ventricular ejection fraction, end-diastolic and end-systolic volumes).
Results. The median follow-up was 68 months (Q1–Q3: 33.6–109; range 12–240 months). No significant differences were observed between groups in MACE (p=1,000), all-cause mortality (p=0,842), myocardial infarction (p=0,855), or stroke (p=0,978). Recurrent hospitalization rates were similar (p=0,069). No between-group differences in CCS class were detected (p=0,152); however, angina progression occurred in the OMT group p=0,014). Echocardiographic parameters did not differ significantly, although a reduction in left ventricular ejection fraction was observed in the restenosis subgroup (p=0,038).
Conclusions. In very long-term follow-up, PCI for CTO was not associated with improved cardiovascular outcomes compared with OMT alone. Conservative therapy was associated with progression of angina symptoms.
Keywords: chronic total occlusion, percutaneous coronary intervention, optimal medical therapy, major adverse cardiovascular events, long-term outcomes.
For citation:Skovran P.Ya., Babunashvili A.M., Zhuravlev A.S., Semitko S.P., Tsereteli N.V., Ioseliani D.G. Comparison of very long-term clinical outcomes of percutaneous coronary intervention versus optimal medical therapy in patients with coronary chronic total occlusion. Clinical review for general practice. 2026; 7 (5): 30–36 (In Russ.). DOI: 10.47407/kr2026.7.5.00836
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