Long-term effect of coronary revasculization with pci and/or cabg subjected to chronic total occlusion in the main coronary arteries

Purpose: To evaluate the long-term survival and cardiac performance in the patients who underwent percutaneous coronary intervention(PCI) or coronary artery bypass graft surgery(CABG) to the chronic total occluded(CTO) lesions in their main coronary arteries. Subjects: Consecutive 317 patients who had CTO lesions (TIMI 0) in their main coronary arteries were treated with PCI (PTCA,DCA,STENT,PTCRA) or CABG between June 1991 and 2000. CTO lesion was excluded when CABG was formerly performed. Methods: These patients were compared by survival rate,LVEF,EDVI,ESVI at pre PCI/CABG and LVEF,EDVI,ESVI in the chronic phase i.e., mean followed-up interval of four years, between successfully revasculized group(Y) and unsuccessful group(N). Results: In the cardiac death group(n=16), chronic LVEF,EDVI,ESVI were significantly worse (35vs56,124vs87,84vs41), compared with survived group(n=280). In the Y group, LVEF and ESVI were significantly improved after revasculazation of CTO, although there was no improvement in N group. Furtheremore, when patients were limited to have less than 100ml/m2 of LVESV before PCI/CABG, improvement of LVEF and ESVI was found much more clear. Summary: Better LVEF and LVESV before PCI/CABG predicts much more improvement of cardiac function after revasculization of CTO. In addition, Lower LVEF (35%) and Larger LV volume (LVEDV;124ml/m2,LVESV;84ml/m2) in chronic phase indicates higher mortality in spite of the recanalization of CTO.