Clinical outcomes of percutaneous coronary intervention of chronic total occlusion vs. non-chronic total occlusion: a multicentre registry

Abstract

Abstract Background Revascularization of Chronic Total Occlusions (CTO) has gained popularity in recent decades. However, there is still debate about the benefits of treating a chronic total occlusion, resulting in a class IIa indication in the ESC Guidelines. Especially data regarding bleedings is scarce which could be expected due to the use of multiple and large-bore access and the use of prolonged and strong dual antiplatelet therapy after percutaneous coronary intervention (PCI). Providing more insight in the benefits and risks of CTO treatment in the context of PCI revascularization could be performed on a more evidence-based assessment. Purpose This study aims to provide additional data about outcomes and complications of patients undergoing revascularization of a CTO. Methods Patients from an ongoing, multicentre registry (‘Zuid-Oost Nederland Hart Registratie’ (ZON-HR)), which has started in November 2020, are included, in which patient- and angiography characteristics and 30-day and 1-year outcomes are collected. MACCE was defined as a composite endpoint of cardiovascular death, myocardial infarction, ischemic cerebrovascular accidents and stent thrombosis. Results A total of 3996 patients with complete 30-day follow-up were included in the registry, of which 185 patients underwent a PCI of a CTO and 3811 patients underwent a PCI of a non-CTO lesion between November 2020 and June 2022. Baseline characteristics are described in Table 1. The mean age of the entire population was 67.9 (± 12.1) years and predominantly male (72.7%). Analysis showed a significantly higher incidence of bleedings in patients treated with CTO (7.6% vs. 3.4%, p < 0.01) and especially access bleedings (5.9% vs. 1.9%, p < 0.01). In patients with access bleedings double access-site punction was more frequently applied for CTO PCI (80% vs. 25%, p < 0.01). Patients with CTO PCI showed more coronary dissection/perforation with the need for covered stent treatment (2.7% vs. 0.6%, p < 0.01) as well. No significant difference for MACCE within 30 days was present. Additionally, multivariate analysis were performed for baseline variables showing no association with the occurrence of access bleedings and peripheral artery vessel disease and the indication of PCI. Ancillary analyses were performed with patients with 1-year follow-up (n = 1356; CTO = 64 vs. non-CTO = 1292), showing no significant differences in MACCE and bleedings. Conclusion(s) This registry shows that CTO PCI results in higher incidence of complications and access bleedings. Access bleedings are possibly related to the frequent use of double access-site punction in patients with CTO PCI which should be investigated further, as well as the role of DAPT after PCI.