Abstract

Background: Although recanalizing the chronically occluded right coronary artery (RCA) is common in clinical practice, the benefit of this procedure still needs to be fully demonstrated. Therefore, we compared 2-year clinical outcomes of percutaneous coronary intervention (PCI) with medical treatment in patients with chronically occluded RCA.

Methods: The present analysis enrolled a total of 290 patients with chronically occluded RCA who underwent successful PCI (n=103) or medical treatment (n=187) in Korea University Hospital from Jan 2004 to Dec 2010. All patients received optimal medical treatment as per existing guidelines. Propensity score matching was applied to adjust the baseline differences, producing 103 pairs of patients. Major clinical outcomes at 2 years were compared between the two propensity score matched groups.

Results: After propensity score matching, the baseline clinical and angiographic characteristics were similar between the 2 groups. Two-year clinical outcomes of the propensity score matched patients showed that the 2 groups had similar incidence of all cause death, myocardial infarction and revascularization although there was a trend toward higher incidence of revascularization in the PCI group (Table).

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Conclusions: Despite of restored antegrade blood flow, clinically significant advantage could hardly be seen in patients undergoing PCI, suggesting mechanical recanalization of chronically occluded RCA might be a thankless job as compared with medical therapy. Randomized study with larger study population will be needed to get the final conclusion.