Résumé
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) is a challenging procedure in interventional cardiology. Despite studies suggesting clinical benefits, the long-term outcomes of successful versus failed CTO-PCI remain unclear. Objectives: this study aimed to evaluate the impact of successful CTO-PCI on long-term major adverse cardiovascular events (MACE), survival, left ventricular ejection fraction (LVEF), symptoms, and myocardial ischemia over up to eight years of follow-up. Methods: we conducted an observational study involving 448 patients who underwent PCI for CTOs by experienced operators at Montpellier University Hospital from January 2015 to December 2022. Patients were categorized based on the success or failure of the PCI. The primary endpoint was the occurrence of MACE, defined as the composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization. Secondary endpoints included all-cause mortality, rehospitalizations for cardiac reasons, restenosis, and improvements in LVEF, symptoms, and myocardial ischemia. Results: out of 448 patients, 401 (89.5%) had successful CTO-PCI, while 47 (10.5%) experienced a failed procedure. During a mean follow-up of 3.7 years, MACE occurred in 12 patients (25.5%) in the failed group and 59 patients (14.7%) in the successful group (HR 2.52; p<0.01). Overall survival was higher in the successful group (88.8% vs. 74.5%; HR 2.23; p=0.02). Significant improvements in LVEF, dyspnea, and myocardial ischemia were observed only in the successful group (p<0.01).