B-24 | Periprocedural Mortality in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the PROGRESS-CTO Registry

Abstract

Death is a rare but devastating complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical characteristics and procedural outcomes of patients who died periprocedurally in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436). Of the 12,928 patients who underwent CTO PCI between 2012 and 2022, 52 (0.4%) died during the index hospitalization. Patients who died were more likely to have a history of heart failure (43% vs. 28%, p=0.023). The J-CTO (2.8 ± 1.1 vs 2.4 ± 1.3, p=0.019), PROGRESS-CTO mortality (2.6 ± 0.9 vs. 1.6 ± 1.1, p<0.001), and PROGRESS-CTO pericardiocentesis (2.9 ± 1.1 vs. 1.9 ± 1.3, p<0.001) scores were higher in patients who died. In these patients, the use of left ventricular assist devices was higher (41% vs 3.5%, p<0.00), and retrograde crossing was more often the first crossing strategy (33% vs 13%, p<0.001). The cause of death was cardiac in 43 patients (83%) and non-cardiac in 9 patients (17%). Complications leading to cardiac death were: tamponade in 30 patients (58%), acute myocardial infarction in 9 (17.3%), and cardiac arrest/shock in 4 (7.7%). Non-cardiac causes of death were: stroke 3 (5.8%), renal failure 2 (3.8%), respiratory distress 2 (3.8%), and hemorrhagic shock 2 (3.8%) (Figure). Approximately 0.4% of patients who underwent CTO PCI died during the index hospitalization. The main cause of death was tamponade in 58%. The PROGRESS-CTO complication scores might help in risk stratification and procedural planning in patients undergoing CTO PCI.