Coronary interventions

Three-year outcomes of A Randomized Multicentre Trial Comparing Revascularization and Optimal Medical Therapy for Chronic Total Coronary Occlusions (EuroCTO)

EuroIntervention 2023;19:571-579. DOI: 10.4244/EIJ-D-23-00312

Gerald Werner
Gerald S. Werner1, MD, PhD; David Hildick-Smith2, MD, PhD; Victoria Martin Yuste3, MD, PhD; Nicolas Boudou4, MD; Georgios Sianos5, MD, PhD; Valery Gelev6, MD, PhD; Jose Ramon Rumoroso7, MD; Andrejs Erglis8, MD, PhD; Evald Hoj Christiansen9, MD, PhD; Javier Escaned10, MD, PhD; Carlo Di Mario11, MD, PhD; Luis Teruel12, MD; Alexander Bufe13, MD, PhD; Bernward Lauer14, MD, PhD; Alfredo Ruggero Galassi15, MD, PhD; Yves Louvard16, MD
1. Klinikum Darmstadt GmbH, Darmstadt, Germany; 2. Brighton and Sussex University Hospitals, Brighton, UK; 3. Interventional Cardiology, CH Angoulême, Angoulême, France; 4. Interventional Cardiology, Clinique Saint Augustin, Bordeaux, France; 5. AHEPA University Hospital, Thessaloniki, Greece; 6. MHAT Tokuda Hospital Sofia, Sofia, Bulgaria; 7. Hospital Galdakao-Usansolo, Galdakao, Spain; 8. Pauls Stradins Clinical University Hospital, Riga, Latvia; 9. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; 10. Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain; 11. Department of Cardiology, University of Florence, Florence, Italy; 12. Bellvitge University Hospital, Barcelona, Spain; 13. Helios Klinikum Krefeld, Krefeld, Germany; 14. Medizinische Klinik 1, Klinikum der Friedrich-Schiller Universität, Jena, Germany; 15. Department of Cardiology, University of Palermo, Palermo, Italy; 16. Hôpital privé Jacques Cartier, Massy, France

Background: Percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTO) improves clinical symptoms and quality of life. The longer-term safety of PCI compared to optimal medical therapy (OMT) remains uncertain.

Aims: We sought to evaluate the long-term safety of PCI for CTO in a randomised trial as compared to OMT.

Methods: A total of 396 patients with a symptomatic CTO were enrolled into a randomised, multicentre clinical trial comparing PCI and OMT. Half of the patients had a single CTO; the others had multivessel disease. Non-CTO lesions were treated prior to randomisation (2:1 ratio). During follow-up, crossover from OMT to PCI occurred in 7.3% (1 year) and 17.5% (3 years) of patients.

Results: At 3 years, the incidence of cardiovascular death or nonfatal myocardial infarction was not significantly different between the groups (OMT 3.7% vs PCI 6.2%; p=0.29). By per-protocol analysis, the difference remained non-significant (OMT 5.7% vs PCI 4.7%; p=0.67). Overall, major adverse cardiovascular events (MACE) were more frequent with OMT (OMT 21.2% vs PCI 11.2%), largely because of ischaemia-driven revascularisation. The rates of stroke or hospitalisation for bleeding were not different between the groups.

Conclusions: At 3 years there was no difference in the rate of cardiovascular death or myocardial infarction between PCI or OMT among patients with a remaining single coronary CTO. The MACE rate was higher in the OMT group due largely to ischaemia-driven revascularisation. CTO PCI appears to be a safe option for patients with a single remaining significant coronary CTO. NCT01760083.

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stable anginamultiple vessel diseasesingle-vessel diseasechronic coronary total occlusionpercutaneous transluminal interventionoptimal medical therapyprognosis
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