Debate: Chronic total coronary occlusions. The interventional cardiologist perspective

QUESTION: Do we have enough evidence to be able to say that the coronary recanalization of a chronic total coronary occlusion (CTO) improves the prognosis of patients? ANSWER: I would say so. I believe it is hard to have well-designed, randomized clinical trials with large populations of patients and long follow-up periods on this issue comparing the 3 possible strategies of treatment (drugs, surgery, and percutaneous coronary interventions) which, by the way, are the prerequisites to show some mortality net benefit in this group of patients. Also, the results from the procedures performed in the different groups are not comparable whatsoever. On the other hand, if we look at the registries already published and presented in congresses over the last few years (3-4 years), we will see that only those with long follow-up periods are positive. Usually, the revascularization of a CTO has no implications in the rate of infarction at follow-up, yet the overall and cardiac mortality rate of non-revascularized patients compared to revascularized patients (both percutaneously and using surgery) trebles compared to the population of patients with CTO who are on medical treatment. The only 2 randomized clinical trials ever published that compare the clinical evolution of patients with a CTO...