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Using a Delphi panel to survey criteria for successful periodontal therapy in posterior teeth.

BACKGROUND: Health care providers have focused on outcome measures to determine the success or failure of treatment. In periodontics, there is no consistent view regarding what outcome measure(s) is(are) important for successful treatment. This study used a Delphi surveying technique to determine which outcome measures were clinically relevant to an expert panel of periodontists. METHODS: The Delphi surveyed 35 periodontists from the United States to determine the level of importance of attachment level, probing depth, furcation involvement, mobility, plaque, inflammation, esthetics, pain, and patient satisfaction following periodontal treatment of posterior teeth in a patient with severe chronic periodontitis. The Delphi panelists were questioned concerning the relative importance of each outcome measure, a minimally acceptable level considered necessary for success for each outcome measure, and the length of time required for these outcome measures to remain stable. RESULTS: Following two rounds of Delphi surveys, the panelists considered the control of pain to be an "extremely important" outcome measure for successful periodontal treatment. Attachment levels, probing depths, plaque levels, degree of inflammation, function, furcation involvement, and patient satisfaction were considered to be "very important" outcomes for successful periodontal treatment. The minimally acceptable reduction in probing depths following 1 year of treatment was 2 mm; whereas up to 1 mm of attachment loss was considered acceptable. The panel found that Glickman grade 2 furcation involvement or Miller degree II mobility would be considered an acceptable outcome for clinical success. Finally, the panel agreed that the 1-year results of treatment should remain stable for a minimum of 5 years. CONCLUSIONS: The Delphi surveying technique proved useful in developing a hierarchy for the relevance of periodontal outcome measures. Absence of pain was the only outcome measure considered to be "extremely important" for successful therapy. Although panelists considered attachment loss, furcation invasions, and mobility as "very important" outcomes, they were willing to accept loss of attachment of up to 1 mm, grade 2 furcation involvement, and degree II mobility following treatment as long as outcomes remained stable for 5 years. These data suggest that minimal standards for success of posterior teeth can be established among periodontal practitioners.

Delphi Technique↗

Using a Delphi panel to survey criteria for successful periodontal therapy in anterior teeth.

BACKGROUND: Valuable decision making for periodontal treatment success in situations where there is ambiguous or conflicting information was previously reported using a consensus building method, the Delphi survey, for posterior teeth with chronic periodontitis. This study focuses on outcome measures relevant in assessing therapy of anterior teeth with chronic periodontitis. METHODS: The Delphi panelists were the same American periodontists who participated in the previous Delphi survey evaluating successful therapy in posterior teeth. In this study, panelists determined the level of importance of attachment level, probing depth, mobility, plaque, inflammation, esthetics, pain, and patient satisfaction following periodontal treatment of a single tooth or multiple anterior teeth in a patient with severe chronic periodontitis. The panelists were questioned concerning the relative importance of each outcome measure, a minimally acceptable level considered necessary for success for each outcome measure, and the length of time required for these outcome measures to remain stable. RESULTS: The 35 panelists considered the control of pain, esthetics, and patient satisfaction to be "extremely important" outcome measures for successful periodontal treatment of single or multiple teeth. Attachment levels, probing depths, plaque levels, degree of inflammation, and mobility (for multiple teeth) were considered to be "very important" outcomes. The minimally acceptable reduction in probing depths following 1 year of treatment was 2 mm; whereas 2 mm of attachment gain was considered necessary for successful treatment. The panel also found a Miller degree I mobility as an acceptable outcome for clinical success. Finally, the panel agreed that the 1-year results of treatment should remain stable for a minimum of 5 years. CONCLUSIONS: The Delphi technique proved a practical instrument to transform expert opinion into a group consensus for relevant periodontal outcome measures. Absence of pain, esthetics, and patient satisfaction were outcome measures considered "extremely important" for successful therapy. Although panelists considered attachment loss, probing depths, and mobility somewhat less important outcomes, they wanted an attachment gain of 2 mm and would accept a degree I mobility as long as outcomes remained stable for 5 years. These data suggest that minimal standards for successful therapy of anterior teeth can be established among periodontal practitioners.

Delphi Technique↗

Imaging correlates of successful endoscopic third ventriculostomy.

OBJECT: The goal of this study was to determine and compare imaging correlates in pediatric patients who underwent successful or failed endoscopic third ventriculostomies (ETVs). To this end, the authors measured ventricular size changes and the presence of cerebrospinal fluid (CSF) flow void in both groups of children following ETV. METHODS: Images obtained in children with hydrocephalus immediately before and at least 30 days after having undergone ETV were reviewed by four independent observers (two blinded and two nonblinded). Each observer independently measured the frontal and occipital horn ratio ([FOR], a reliable and valid measure of ventricular size) and provided a subjective assessment of the presence of a flow void at the ETV site, the degree of periventricular edema, and the amount of CSF over the cerebral hemispheres. There were 29 children whose mean age was 6.6 years at the time of ETV and who had a mean postoperative follow-up period lasting 1.6 years. Postoperatively, the mean reduction in ventricular size (as measured using the FOR) was 7% (95% confidence interval [CI] 3-11%) in cases that were deemed failures (eight patients) and 16% (95% CI 12-20%) in clinically successful cases (21 patients). This reduction was significantly greater in cases of clinical success compared with those that were deemed failures (p = 0.03, t-test). There were no substantial differences between blinded and nonblinded assessments. Flow void was present in 94% of successes and absent in 75% of failures (p = 0.01, Fisher's exact test). The other subjective assessments were not significantly different between the groups of successes and failures. CONCLUSIONS: Ventricular size appears to be somewhat reduced in both groups of patients who underwent clinically successful and failed ETV; however, the reduction is significantly greater among clinically successful cases. The presence of a flow void also appears to correlate with clinical success and its absence with clinical failure.

Adolescent↗

Hospital-physician joint ventures: a strategic approach for both dimensions of success.

Joint ventures between hospitals and the physicians on their medical staffs have produced successes and failures. Each joint venture has two very different dimensions of success--financial and collaborative. The most successful ventures are able to accomplish both of these often conflicting goals. To enhance hospital executives' success in joint ventures with physicians, a strategic approach with a series of six steps and their corresponding models or maps is proposed. The steps in this strategic approach are: (1) identify key stakeholders and linkages among them; (2) surface stakeholder conflict using problem-oriented maps; (3) diagnose the venture on both dimensions of success; (4) classify the venture using both dimensions of success; (5) select a strategy to optimize the venture's current potential for success; and (6) select an approach to transform the venture with limited potential for success.

Conflict, Psychological↗

Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization.

BACKGROUND AND PURPOSE: Coil embolization of berry aneurysms is a relatively new treatment whose long-term efficacy has yet to be established. The purpose of this study was, first, to attempt to identify factors that might be important in predicting success both at the time of treatment and at the time of follow-up angiography, and, second, to study changes in the aneurysm between treatment and follow-up to determine the frequency of these changes. METHODS: The pretreatment, posttreatment, and follow-up angiograms of the first 63 aneurysms (in 58 patients) treated at our institution between June 1992 and April 1995 were analyzed, and the percentage of occlusion of each aneurysm was calculated. The size of any rest was noted for the posttreatment and follow-up angiograms. Treatment success was defined as a residue of less than 2 mm. Aneurysms were said to have changed if the percentage of occlusion had altered by more than 2.5% or if the difference in rest size was greater than 0.25 mm. Possible factors influencing primary and follow-up success rates were correlated against these calculations. RESULTS: Success rates at treatment and follow-up were 71% and 65%, respectively. No change occurred in 41% of aneurysms, and 20% had a decrease in size of the residue. Twenty-eight percent had coil compaction, and 11% had aneurysmal growth. Neck size was the only significant variable in primary treatment success. Success at follow-up correlated significantly with neck size, initial treatment success, vasospasm at the time of treatment, and clinical presentation. CONCLUSION: Best long-term angiographic results are obtained when the primary treatment is successful, when the aneurysm is small and narrow-necked, when the acutely ruptured aneurysm is treated within 15 days of ictus, and with anterior communicating and basilar-tip aneurysms.

Adolescent↗

Peripheral corneal contour measured by topography influences soft toric contact lens fitting success.

PURPOSE: Empirical fitting success is important to expanding the soft toric contact lens market. Previous study has lead to the hypothesis that lens flexure may alter expected fitting relationships and back vertex power (BVP) in situ. In this study, baseline topographic features as potential variables in predicting soft toric fitting success were analyzed. METHODS: One-hundred forty-nine eyes were empirically fit with back surface toric soft lenses after placido-based videokeratography was performed. Measurements recorded from baseline instantaneous maps included: flat simulated keratometry (Sim-K) value (in diopters) and axis, steep Sim-K value (in diopters) and axis, eccentricity of the flat meridian, and the form of corneal astigmatism. Astigmatism was classified as types I-V based upon differences between central and peripheral corneal toricity. RESULTS: Ninety-three of 149 (62.4%) eyes were successfully fit empirically with the first trial lens. One-hundred thirty-five of 149 (90.6%) eyes were ultimately successful after unsuccessful trial lenses were adjusted and reordered. There were no differences between the empirically fit success and failure groups in instrument reported eccentricity, Sim-K values, or Sim-K axes (P>0.05). Of 115 eyes classified for form of corneal astigmatism, 76 (66%) were classified with high or irregular peripheral astigmatism (types IV and V). There was a significant association between fitting success and the form of corneal toricity (P=0.0327). Thirty-nine of 115 (34%) eyes were classified as corneal types I-III (spherical or minimally toric corneal periphery) and were associated with empirical fitting success (P=0.0092). CONCLUSION: Empirical soft toric fitting success can be anticipated in spherical corneas, central astigmatism, or corneas with peripheral toricity which matches the central toricity. However, high and irregular peripheral corneal toricity occurs in the majority of astigmatic patients. Corneal topography is a valuable tool to assess peripheral astigmatism which may be one factor influencing unexpected lens performance.

Astigmatism↗

Outcome of formocresol/ZOE sub-base pulpotomies utilizing alternative radiographic success criteria.

PURPOSE: The purposes of this investigation were to 1) measure success of a primary tooth pulpotomy technique that applies formocresol in the sub-base without the common five-minute application of a formocresol impregnated cotton pellet; and 2) compare success rates of the pulpotomy procedure using traditional criteria found throughout the literature with new criteria recently established, excluding internal resorption as a radiographic failure. METHODS: Clinical and radiographic data were collected from a retrospective chart review of patients receiving formocresol pulpotomies with the application of formocresol in the zinc oxide-eugenol sub-base. RESULTS: Clinical and radiographic data were available for 196 primary molars in 122 children (followup=six to 103 months; mean=49 months). Traditional assessment of radiographic success and failure yielded a success rate of 79%. Alternative assessment excluding internal resorption as a failure yielded a 99% success rate. Most frequently observed pulpal responses were calcific metamorphosis and internal resorption. Overall clinical success was 99%. Two of the 196 teeth were extracted due to failure. A survival analysis demonstrated that the overall probability of survival remained high over time with a cumulative survival of over 95% after six years. CONCLUSIONS: The overall success rates in this study indicate that the formocresol pulpotomy technique incorporating formocresol in the zinc oxide-eugenol sub-base is a very successful treatment modality for primary molars requiring pulp therapy.

Chi-Square Distribution↗

[Success of treatment, experience of treatment, and satisfaction with treatment from the perspective of patients, parents, and therapists--results of an evaluative study on inpatient treatment in child and adolescent psychiatry].

In spite of the high importance of subjective opinions as essential evaluation criteria there are hardly any studies available, dealing with the research of subjective judgements made by children and adolescent patients in relation to their inpatient treatment, and comparison with the evaluation of their parents. The evaluative study on an age-group random sample survey (n=95) of patients and parents at the Department of Child and Adolescent Psychiatry at the University of Heidelberg includes success of treatment, experience of treatment and satisfaction with treatment by means of specially constructed and parallelized questionnaires for patients, parents and therapists. Apart from the extent of subjectively experienced changes in precisely defined success variables, not only agreements and differences were studied, but also connections between success of treatment, experience of treatment and satisfaction with treatment as well as influences of success variables and experience variables on treatment satisfaction. Parents', patients' and therapists' evaluations of the treatment in regard of most success variables were all positive. At the end of treatment a perspective convergence was noticeable in some variables. The pressure on the parents requires special therapeutic attention. In the sense of therapy evaluation the change in the way the problem was viewed proved to be a worthwile success criterium. From the patients' and parents' point of view the change in the problem "as a whole" is mainly characterized by a positive change in emotional disposition. The therapeutic atmosphere and organisation of therapeutic relationships were highly appreciated by patients and parents. All in all patients, parents and therapists were highly satisfied with inpatient treatment. The correlations found between the grade of success, experience of treatment and satisfaction with treatment were clearly positive. On the patients' side treatment satisfaction was dictated more by their experiences during the treatment, whereas on the parents' side the success of treatment proved to be the stronger factor.

Adolescent↗

Heterogeneity, the masked part of reproductive technology success rates.

BACKGROUND: Heterogeneity in women and men's fecundity is a well-established fact. The selection process of men and women treated for infertility might bias the success rates of reproductive technology. Bias may also arise from frequency and timing of intercourse with respect to the day of ovulation. METHODS: Several datasets were collected and analysed. They concern normally fertile couples who used natural family planning methods and infertile couples treated by artificial insemination with husband or donor's spermatozoa. The effects of heterogeneity on the success rates of treatment cycles are described and solutions are proposed as to data collection and statistical analysis in this specific field. RESULTS: The decrease in the success rates along successive cycles of assisted reproduction is a consequence of heterogeneity. The probability of conception varies among women and among men. After a first success, the probability of another success is higher. After a failure, the probability of success is lower. The most specialised centres treat the less fecund couples. There is a negative correlation between men and women's fertility in case of oligo/azoospermia. The fecund window cannot be correctly located by calendar calculations, but more appropriately by assessment of cervical mucus at the vulva. The variability of this location is wide. The decrease in the success rate with men and women's age results from a complex mixture of an increase in the proportion of sterile patients and a decrease in fecund patients' fecundity. CONCLUSION: Care should be taken to limit the bias due to patient selection and specific statistical methods should be used to allow for the progressive selection of patients during fertility studies and for the variability of the frequency and the timing of intercourse or insemination relative to ovulation.

Data Interpretation, Statistical↗

Does use of hydrophilic guidewires significantly improve technical success rates of peripheral PTA?

BACKGROUND: To determine whether the use of hydrophilic guidewires has increased the technical success rate of peripheral percutaneous transluminal angioplasty (PTA). MATERIAL/METHODS: We performed 125 procedures and analyzed the technical success rates of PTA using the conventional guidewire first and then if needed, the hydrophilic guidewire for iliac and SFA stenoses or occlusions. Angioplasty was performed on 25 stenosed, 25 occluded iliac arteries and 25 stenosed, 50 occluded femoral arteries. The result was defined as technical success when the lesion was crossed by a guidewire and balloon, then it was dilated with restoration of vessel lumen and less than 30% residual stenosis and the rise in ABI values was at least 0.15 after 24 hours. RESULTS: The technical success rate after PTA of stenosed iliac arteries was achieved in 96% (24/25) using conventional wires and 100% using hydrophilic guidewire; in iliac occlusions, the rates were 60% (15/25) and 96%, respectively; in femoral stenosis - 84% (21/25) and 100%; in occlusions in the first group: lesions <10 cm -64% (16/25) and 96%, in the second group: lesions >10 cm -48% (12/25) and 88%. In the iliac group, there was no significant difference in the success of iliac stenosis PTA. However, there were significant changes in the success rates of PTA performed for SFA stenosis and iliac and SFA occlusions. CONCLUSIONS: In summary, we report an overall improvement and high technical success rate for peripherial PTA. The use of hydrophilic guidewires made significant difference to the technical success rate of PTA, especially in occlusion and more complicated lesions.

Angioplasty, Balloon↗

Quantitative trait locus analysis of male mating success and sperm competition in Drosophila melanogaster.

Much of sexual selection theory depends on assumptions about the genetic basis of variation in male mating success and sperm competitive ability. Despite intense interest in this topic, few genes have been identified that contribute to variation in these traits. Here we report the results of quantitative trait locus (QTL) analyses of mating success of male Drosophila melanogaster when exposed to virgin females, remating success of males with previously mated females, and both defense and offense components of sperm competition. We found two to four significant QTLs for remating success, but no QTLs for mating success, even though mating success was more genetically variable than remating success in the recombinant inbred lines used in this study. By combining these results with data from previous gene-expression experiments, we were able to identify three X-linked candidate genes for variation in remating ability. For two of these genes, QTL and expression data were completely concordant with respect to directionality of effects: high mating success was associated with high levels of gene expression and with beneficial QTL effects on the trait. We found equivocal evidence for genetic variation in sperm offense and defense in the recombinant inbred lines, and we did not find any significant QTLs for either sperm competition trait.

Animals↗

Success rate in endodontic therapy--a retrospective study. Part I.

A survey was undertaken to review the success rate of endodontic treatment carried out by the undergraduates of the Dental Faculty, University of Singapore over a seven year period. A recall system resulted in a total of 385 cases which were successfully recalled and reviewed. The survey comprised of two parts:--A) history-taking from the endodontic record charts and B) clinical and radiographic evaluation of the cases. The cases in the survey had a minimum 2-year recall period. The success rate obtained was 90.6% which compared favourably with other studies. Root canals that were underfilled and root-fillings showing satisfactory apical compression were found to be more successful, the results being statistically significant (P less than 0.05). Endodontic therapy in non-vital teeth and a recall period of at least 2 years were also associated with a higher success rate. This paper discusses the overall success rate of endodontic therapy and the success and failure rate in relation to age and sex. The success rate in relation to other factors such as level of root-filling, apical compression and period of recall will be reported in a separate part of this paper.

Adult↗

The success of endodontic treatment in general dental practice: a retrospective clinical and radiographic study.

PURPOSE: To assess the success of orthograde endodontic treatment carried out by a group of general dental practitioners over a 15-year period. POPULATION STUDIED: Patients presenting for their annual dental inspection at a large Air Force station in the UK over a six-month period. All teeth root-filled by Royal Air Force dental practitioners were assessed. METHOD: Clinical and, where appropriate, radiographic review was undertaken of all root-filled teeth present at inspection. Root-filled teeth removed prior to inspection were included in the study only if extraction was related to failure of the root filling. Root fillings were classified as 'definitely successful', 'probably successful' or 'failed'. The effect on success of several variables was investigated. FINDINGS: There was a total of 136 root-filled teeth, of which 59% (n=80) were classified as 'definitely successful', 26% (n=35) as 'probably successful', and 15% (n=21) as failures. Of the variables studied, only time elapsed since root-filling placement had a statistically significant effect on treatment results with a downward trend in rate of failure with time (P=0.0268). CONCLUSIONS: An overall success rate of 85% was found for this sample of root fillings comparing well with the success rates for root fillings placed by specialists. However, there may be significant differences in the relative importance of clinical variables depending on the experience of the operator. There are few reliable indicators of the likely prognosis for the root filling, questioning the automatic replacement of poor technical quality, but asymptomatic root fillings.

General Practice, Dental↗

Successful long-term treatment outcomes in the field of osseointegrated implants: prosthodontic determinants.

PURPOSE: Because existing implant success criteria have not met with widespread use, consensus is needed among professionals working in the field as to what constitutes implant success. This article discusses implant success within the context of prosthesis success, and argues that successful use of implants cannot be judged without prosthesis consideration. RESULTS AND DISCUSSION: A framework for evaluating clinical success of prosthodontic treatment is presented. A context for judging success by presenting related topics that include contrasting process and outcome measures, and consideration of long-term outcomes that have a tangible meaning to the patient (i.e., are patient-based), is argued for. A hierarchy of outcomes is proposed for a better understanding of the relative strengths associated with various outcomes. Emphasis is given to the concept of prosthodontic treatment being prescribed to reduce the patient-specific burden associated with the missing tooth condition. CONCLUSION: The challenge is to define the best applications of dental implants within the broad context of prosthodontic options through demonstrated advantages over more conventional options. A broad understanding of "success" from multiple outcome domains is most likely to give the truest measure for implant application within the context of possible prosthodontic options for all patients.

Dental Implantation, Endosseous↗

Weathering the storm: Most maternal and environmental drivers of individual reproductive success do not scale up to population recruitment in a large herbivore.

Population growth depends upon individual survival and reproduction, but do drivers of individual reproductive success scale up to population recruitment? Factors affecting individuals may have little effect on population dynamics if individuals within a population experience different conditions. When seasonal resource availability is unpredictable and breeding season long, average conditions over a breeding cycle may poorly reflect the environment experienced by many individuals. We compared the drivers of individual reproductive success and population recruitment in an asynchronously breeding large herbivore, the eastern grey kangaroo (Macropus giganteus). We analysed 18&#x2009;years of individual-based data using multivariate hierarchical Bayesian models to first identify the causal mechanisms relating population density, environmental conditions and maternal traits to individual success. We then assessed whether the drivers of individual reproductive success scaled up to determine population recruitment. Most maternal and environmental covariates strongly influenced individual reproductive success, with distinct effects on juvenile survival before and after pouch exit. Maternal traits had a greater influence in the pouch, whereas environmental conditions became increasingly important once young exited the pouch. Most drivers of individual reproductive success did not affect population recruitment. Recruitment increased with population density and mean body condition of adult females. Weather harshness had a weak positive effect on recruitment, which appeared independent of female age structure, previous recruitment or forage. Most drivers of individual reproductive success did not scale up to population recruitment. Birth asynchrony could buffer population recruitment against environmental variation such that variables affecting individual reproduction have little impact at the population level. Large herbivores that reproduce asynchronously may therefore be more resilient to environmental variability than synchronous breeders.

Bayesian modelling↗

Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura.

HYPOTHESIS: Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS). DESIGN: Case series. SETTING: Private, tertiary care referral center. PATIENTS: Sixty-seven consecutive patients undergoing LS for ITP between 1995 and 2001. INTERVENTIONS: Laparoscopic splenectomy. MAIN OUTCOME MEASURES: A successful response to LS was defined as a postoperative platelet count greater than 100 x 10(3)/microL without medical therapy. Failures were classified as recurrent or refractory. Patients considered refractory to surgery did not achieve a platelet count greater than 100 x 10(3)/microL without medical therapy. Patients with recurrent ITP initially achieved a platelet count greater than 100 x 10(3)/microL, but thrombocytopenia subsequently recurred. RESULTS: Both univariate and multivariate analyses were performed for 13 preoperative variables to identify factors predictive of success following LS. At a mean follow up of 22 months, 43 patients (64%) had a successful response to LS, 14 (21%) were refractory, and 10 (15%) developed recurrent ITP. By univariate analysis, patients responding to laparoscopic splenectomy were younger (P =.005) and had a higher preoperative platelet count (P =.005). In multivariate analysis, younger age (P =.005) and a higher preoperative platelet count (P =.007) again predicted a successful response to LS. CONCLUSIONS: A successful response to LS for ITP is expected in patients younger than 50 years and in those with preoperative platelet counts greater than 70 x 10(3)/microL. These factors can be incorporated into an equation that yields a splenectomy prediction score, which predicts the success of LS for ITP.

Adult↗

Validity of an estimator of reproductive success.

Lifetime reproductive success is a major component of individual fitness and a central dependent variable for the study of natural selection. For long-lived animals, such as apes or baboons, assessment of lifetime reproductive success requires observations of identified individuals in continuous, long-term studies from which it is difficult and often impossible to obtain an adequate sample of necessary reproductive and survival data. This situation can be alleviated by the availability of a valid measure that uses incomplete reproductive histories to estimate the lifetime reproductive success of individuals. The validity of one such estimator was tested by determining if, after 10.5 years of studying free-ranging female baboons, it predicted lifetime reproductive success obtained from full reproductive histories after 21.5 years. Validity was evaluated for seven criteria of success, ranging from the number of a female's live births to the number of her offspring that reached the age of 72 months. Moderate to good prediction of lifetime reproductive success by the estimator was found for criteria of offspring living to 36 months or more. After 10.5 years, complete reproductive life spans were available for only eight females. Using the estimator, analytic potential, via sample representativeness and size, was improved at 10.5 years by an increase from a sample of eight to between 34 and 62, depending upon the criterion used, and at 21.5 years from 39 to 70. With a valid estimator, the opportunity to study lifetime reproductive success of a long-lived species is substantially improved without having to depend upon rarely available, uninterrupted data collection for 20-60 years.

Animals↗

Percutaneous transluminal coronary angioplasty of chronic total occlusions. Determinants of primary success and long-term clinical outcome.

This study was conducted to assess the determinants of the procedural success and long-term clinical benefits of percutaneous transluminal balloon angioplasty (PTCA) of chronic total occlusion (CTO) in recent years. Two hundred and twenty-six consecutive patients who underwent PTCA of CTO were divided into two groups according to the procedural success (n = 134) or failure (n = 92). Both groups were analyzed in terms of the initial success, predictors of procedural failure, and clinical outcome. The procedural success rate was noted to have improved to more than 70% since 1995. A multiple logistic regression analysis revealed that the presence of calcification, the length of the occlusion and the presence of multivessel disease were independent predictors of procedural failure. Cardiac death and the need for coronary surgery were significantly less frequent in patients with procedural success than in those with procedural failure. In properly selected cases, the success rate of PTCA of CTO is acceptable. Long-term clinical benefit is suggested by the high rate of freedom from coronary surgery and the low cardiac death rate in the patients who underwent successful revascularization.

Aged↗