738–3 Long-term Survival with a Chronic Total Coronary Occlusion: A Comparison of Medical Therapy versus Angloplasty in Patients with Single Vessel Disease

While medical management of pts with single vessel chronic total occlusions has been associated with high rates of death, MI and need for revascularization at long-term follow-up, the role of PTCA in these pts is poorly defined. To develop a paradigm for the comparison of medical therapy versus PTCA in the management of chronic total occlusions, we retrospectively analyzed prospectively-collected data on 23,005 pts undergoing cardiac catherization between April 1986 and February 1994. Of the 6,430 pts with single-vessel disease, 748 had a total occlusion without an acute myocardial infarction within 30 days and no history of PTCA or CABG. A total of 611 pts were managed medically and 137 pts underwent PTCA. The 2 groups were similar with regard to most baseline characteristics, but the medically-treated group had higher rates of CHF (16 vs 9%) and prior MI (50 vs 31%), and the PTCA cohort had more unstable angina (36 vs 20%) and left anterior decending disease (63 vs 34%). While early mortality was similar, the 4-year mortality was statistically insignificantly higher in the medical cohort (12 vs 7%). Kaplan-Meier 4-year estimates: Events Medicine (%) PTCA(%) P-value  – CABG 10 30 0.0001  – PTCA 8 33 0.0001  – MI 6 10 0.009 Conclusion The trend towards lower mortality in the presence of higher non-fatal events provides a rationale for opening chronic total occlusions that can be tested in larger prospective studies.