International Circulation:  What improvements in clinical outcome result in patients with STO who undergo PCI?

ST Lim:  If properly selected and with indication， we hope to actually reduce the symptoms of chest pain in patients who experience and reduce the number of medications that they need to consume to control their symptoms.  And also to improvement the pumping action of the heart and the ejection fraction， and improve the quality of life and hopefully in certain patients we can prolong their survival， especially those with large area of ischemia of the heart muscle. 

International Circulation:  What is the mechanism for improved clinical outcome in patients with CTO who undergo PCI? Is there any evidence based medicine to support it?

ST Lim:  Yeah， it is indirect.  It is first from the relief of ischemia that we hope that electrically the marker is more stable and less prone to arrthymia.  By relieving the ischemia， the hibernating marker then may improve and then contribute to the overall improvement in the left ventricle function.  And also if the artery has opened up， may be able to serve as a source of a provider to other arteries which may block off in the future. 

International Circulation:  What can affect clinical outcome in patients with CTO?

ST Lim:  Clinical outcome， it depends.  It depends on the successful performance of the revascularization and whether they have complications and of course the ejection fraction of the patient as well as the other co morbidities of the patient.

International Circulation:  So normal complications?

ST Lim:  Yes

International Circulation: What can affect clinical outcome in patients with CTO

ST Lim:  Yes if we can actually successfully revascularize the CTO with an implantation of the XXX it has been shown in several studies that it reduces the risk of restenosis and as you can see in one of the slides the artery will reocclude， then it serves as deterioriation of left ventricle function.

International Circulation:  The procedure of PCI in patients with CTO is very difficult， and the success rate is not high. Is the low success rate of PCI a primary factor affecting clinical outcome?

ST Lim:  Yes， that is one of the reasons for a not so favourable clinical outcome.  And not just a low success rate， sometimes there is a higher complication rate that they experienced.  So therefore the CTO intervention is best done in more experienced center by more experienced operators with proper selection criteria and with all the tools available.

International Circulation:  When done correctly， the success rate is higher.

ST Lim:  Yes， higher success rate.  Many centres how achieve a success rate of 90% or more， that is possible.
 

S T Lim教授简介
 
Dr Lim Soo Teik
National Heart Centre Singapore
Head & Senior Consultant， Department of Cardiology
Director， Interventional Cardiology
MBBS， MMed (Internal Medicine)， MRCP (UK)， FRCP (Edin)， FAMS