Abstract 12063: Ad Hoc Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry

Abstract

Introduction: Although discouraged, ad hoc chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is occasionally performed. Methods: We examined the clinical, angiographic characteristics and procedural outcomes of patients who underwent ad hoc CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436). Results: Of the 10,998 patients included in the registry, 899 (8.2%) underwent ad hoc CTO PCI. The incidence of ad hoc CTO PCI decreased from 18% in 2016 to 3% in 2022. Ad hoc CTO PCI patients had a lower prevalence of comorbidities and less complex angiographic characteristics demonstrated by lower J-CTO score (1.9 ± 1.2 vs 2.4 ± 1.3, p<0.001). In these patients, PROGRESS-CTO major adverse cardiovascular events (MACE) (1.9 ± 1.4 vs 2.5 ± 1.7), mortality (1.2 ± 1.0 vs 1.6 ± 1.1), and perforation (1.5 ± 1.2 ± 2.2 vs 1.5) scores were lower (p<0.001). Technical success was similar between the groups (86%). MACE were lower in the ad hoc CTO PCI group (0.8% vs 2.0%, p=0.009). Ad hoc CTO PCI was not associated with MACE after adjusting for potential confounders, odds ratio: 0.69 (95% confidence interval, 0.30-1.57). In patients with higher J-CTO scores, planned CTO PCI was associated with higher technical success (p<0.001) (Figure). Conclusions: Approximately 8% of CTO PCI procedures are performed ad hoc, usually in less complex lesions and patients with lower complication risk. While ad hoc CTO PCI might be appropriate for carefully selected cases, a staged approach is recommended for most CTO PCI.