Outcome of Patients with Chronic Total Occlusion of the Right Coronary Artery

Background: Revascularization of chronic total occlusion (CTO) of the right coronary artery (RCA) may facilitate myocardial perfusion in the event of subsequent occlusion within the left coronary artery. It is unknown whether revascularizing RCA CTO improves survival. Due to variable progression of coronary disease, extended follow-up may be required to evaluate the natural history of patients with RCA CTO.

Methods: A single-center registry of diagnostic coronary angiograms which were performed over a 10-year period was retrospectively analyzed. We identified all patients with isolated RCA CTO who did not have lesions within the left coronary artery for which revascularization was indicated. Outcome of patients who underwent successful percutaneous coronary intervention (PCI) of the CTO was compared to those who did not receive revascularization. Predictors of mortality were analyzed.

Results: Within a cohort of 16,832 diagnostic coronary angiograms, isolated RCA CTO were detected in 278 patients (1.7%). Fifty-two of these patients underwent successful PCI. Patients who underwent PCI were younger (60.2 vs. 66.3 years, p=0.001), had higher creatinine clearance (106 vs. 83 ml/min, p<0.0001) and had fewer co-morbidities than those who did not receive revascularization. Follow-up was performed over 4.3±2.5 years. Cox model identified lack of PCI revascularization as a univariable predictor of mortality (HR=2.65, 95% CI:1.06- 6.4). On multivariable analysis, the only predictors of mortality were increased age (HR 1.04, 95%CI: 1.01-1.07), reduced creatinine clearance (HR 1.02,95%CI: 1.01-1.03) and ejection fraction below 55% (HR 2.24, 95%CI: 1.22-4.11).

Conclusions: In this real-world cohort of subjects with isolated RCA CTO with extended follow-up, those who received revascularization were younger and had fewer co-morbidities than those who did not undergo PCI. Revascularization of the occluded RCA was not an independent predictor of increased survival.