Recanalization of isolated chronic total occlusions in patients with stable angina

Abstract Background Despite procedural advances, recanalization of chronic total occlusions (CTOs) with percutaneous coronary intervention (PCI) remains controversial, particularly given that its long-term benefits are unclear. We assessed the association between successful PCI and symptom improvement as well as outcomes in patients with CTO and stable angina. Methods We performed a retrospective study of 386 consecutive patients undergoing attempted PCI of an isolated CTO (i.e., no other angiographically-significant disease was present). We analyzed prospectively the change in Canadian Cardiovascular Society (CCS) classification system and occurrence of major adverse cardiovascular events (death, myocardial infarction or target vessel revascularization), after stratifying patients by procedural success. To understand which patients might benefit most from attempted PCI, multivariable models were constructed to predict: likelihood of successful PCI and symptom improvement, defined as resolution of angina or improvement of ≥2 CCS classes. Results A total of 247 (64%) patients had successful PCI. Greater symptom improvement was noted after successful PCI at both 6months (79.8% versus 34.5% with resolution of angina or improvement of ≥2 CCS classes, p Conclusions Several factors are associated with successful PCI, but identifying those most likely to have symptom improvement remains challenging.