B-19 | Follow-Up Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the PROGRESS-CTO Registry

Abstract

There is limited information on follow-up major adverse cardiac events (MACE) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic characteristics, as well as procedural and follow-up outcomes of patients who underwent CTO PCI at 38 US and non-US centers between 2012 and 2022 and had follow-up. Of the 3,488 patients with follow-up, 246 (7.1%) experienced MACE, including 73 deaths, 102 acute myocardial infarctions, and 122 target vessel revascularizations (with PCI or coronary artery bypass graft surgery [CABG]). The mean and median follow-up periods were 268±335 and 98 days, respectively. The incidence of MACE at 1, 2, and 3 years was 12%, 23%, and 27%, respectively. Patients with follow-up MACE were more likely to have comorbidities and had more complex lesions as indicated by higher Japanese CTO (J-CTO) scores (2.52 vs 2.33; p=0.026), and longer procedure (135 vs 110 min; p<0.001) and fluoroscopy (48.9 vs 40.0 min; p=0.006) times, higher contrast volume (250 vs 200 mL; p<0.001) and air kerma radiation dose (2.86 vs 2.20; p<0.001). The antegrade crossing strategy was less commonly the successful crossing strategy in patients with follow-up MACE (40.4%) compared with patients without follow-up MACE (58.3%; p<0.001). Cox regression analysis identified parameters associated with follow-up death, acute coronary syndrome, repeat target vessel PCI and target vessel coronary artery bypass graft surgery. Several parameters are associated with follow-up MACE after CTO PCI.