Chronic Total Occlusion Percutaneous Coronary Intervention Research Articles

Distal Target Vessel Quality and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention

BackgroundDistal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm. ObjectivesThe study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention. MethodsWe examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as <2 mm diameter or with significant diffuse atherosclerotic disease. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. ResultsA total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01). ConclusionsA poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose.

Retrograde Approach via Ipsilateral Septal Collateral Channel in Percutaneous Coronary Intervention for Coronary Chronic Total Occlusion: A Single-Center Experience.

The septal collateral channel (CC) is the preferred channel in retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). However, reports on the utilization of the ipsilateral septal CC are limited. To evaluate the feasibility and safety of the ipsilateral septal CC in retrograde CTO PCI. Twenty-five patients with successful wire CC tracking via the ipsilateral septal CC in retrograde CTO PCI were retrospectively analyzed. All procedures were performed by experienced CTO operators. Procedures were divided into the left descending coronary artery (LAD)-septal-LAD group and the LAD-septal-left circumflex coronary artery (LCX) group. Procedural complications and in-hospital outcomes were ascertained. Both groups were similar with respect to risk factors and angiographic characteristics of the CTO, except for the collateral tortuosity (86.7% vs 20%, p=0.002). The success rate of microcatheter CC tracking was 96%. Both technical success and procedural success rates were 92%. Procedural complications were found in one case (septal perforation, 4%), which happened in the LAD-septal-LAD group (p=0.250). One postoperative adverse event (Q-wave myocardial infarction, 4%) was observed before discharge. The retrograde approach via the ipsilateral septal CC was feasible, with high success rates and acceptable complications, in the hands of experienced operators.

Periprocedural Mortality in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry.

Death is a rare but devastating complication of chronic total occlusion (CTO) percutaneous coronary intervention. We examined the clinical characteristics and procedural outcomes of patients who died periprocedurally in the Prospective Global Registry for the Study of CTO Interventions (PROGRESS-CTO). Of the 12 928 patients who underwent CTO percutaneous coronary intervention 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% versus 28%; P=0.023). The J-CTO ([Multicenter CTO Registry of Japan]; 2.8±1.1 versus 2.4±1.3; P=0.019), PROGRESS-CTO mortality (2.6±0.9 versus 1.6±1.1; P<0.001), and PROGRESS-CTO pericardiocentesis (2.9±1.1 versus 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 also higher (41% versus 3.5%; P<0.001), and retrograde crossing was more often the first crossing strategy (33% versus 13%; P<0.001). The cause of death was cardiac in 43 patients (83%) and noncardiac 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%). Noncardiac causes of death were: stroke in 3 (5.8%), renal failure in 2 (3.8%), respiratory distress in 2 (3.8%), and hemorrhagic shock in 2 (3.8%). Approximately 0.4% of patients who underwent CTO percutaneous coronary intervention died during the index hospitalization. The main cause of death was tamponade in 58%. PROGRESS-CTO complication scores might help in risk stratification and procedural planning in patients undergoing CTO percutaneous coronary intervention. URL: https://www. gov; Unique Identifier: NCT02061436.

Prognostic Value of Different Levels of Uric Acid in Patients with Coronary Chronic Total Occlusion Undergoing Percutaneous Coronary Intervention.

Recent data suggest that uric acid (UA) might be an independent predictor of clinical outcomes following percutaneous coronary intervention (PCI). The predictive value of uric acid in patients undergoing PCI for chronic total occlusions (CTO) is unknown. We included patients with CTO who underwent PCI at our center in 2005 and 2012, with available uric acid levels before angiography. Subjects were divided into groups according to uric acid tertiles (<5.5 mg/dL, 5.6-6.9 mg/dL, and >7.0 mg/dL), and outcomes were compared among the groups. Out of the 1963 patients (mean age 65.2 ± 11 years), 34.7% (n = 682) had uric acid concentrations in the first tertile, 34.3% (n = 673) in the second tertile, and 31% (n = 608) in the third tertile. Median follow-up was 3.0 years. Uric acid levels in the first tertile were associated with significantly lower all-cause mortality, as compared to the third tertile, with an adjusted hazard ratio (HR) of 0.67 (95% confidence interval (CI): 0.49 to 0.92; p = 0.012). No significant differences regarding all-cause mortality were found between patients in the first and second tertiles (HR: 0.96 [95% CI: 0.71 to 1.3; p = 0.78]). High levels of uric acid emerged as an independent predictor of all-cause mortality in patients with chronic total occlusion treated with PCI. Hence, uric acid levels should be incorporated into the risk assessment of patients with CTO.

OUTCOMES OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION WITH CHRONIC TOTAL OCCLUSIONS

This study aimed to assess the efficacy of percutaneous coronary intervention (PCI) with chronic total occlusions (CTO) in a cardiology department in Peshawar, Pakistan, between January 2021 and December 2022. The study included 190 to 200 patients, most of whom had a history of hypertension and diabetes and were predominantly male. The successful CTO-PCI group had significantly lower major adverse cardiac events (MACE) and target vessel revascularization (TVR) rates than the failed CTO-PCI group. Younger age, male gender, absence of previous myocardial infarction, and lower J-CTO score were significant risk factors for CTO PCI success. Long-term outcomes indicated that CTO PCI was linked to lower rates of MACE, TVR, and repeat revascularization compared to non-CTO PCI. These results indicate that CTO-PCI can be a safe and efficient treatment option for patients with chronic total occlusions. Identification of significant risk factors can aid in selecting patients who are likely to benefit from this procedure. Further research is required to confirm these findings and examine the long-term outcomes of CTO-PCI in larger patient cohorts.

Effectiveness, safety, and patient reported outcomes of a planned investment procedure in higher-risk chronic total occlusion percutaneous coronary intervention:Rationale and design of the invest-CTO study.

The anatomical complexity of a chronic total occlusion (CTO) correlates with procedural failure and complication rates. CTO modification after unsuccessful crossing has been associated with subsequent higher technical success rates, but complication rates remain high with this approach. While successful CTO percutaneous coronary intervention (PCI) has been associated with improved angina and quality of life (QOL) this has not been demonstrated in anatomically high-risk CTOs. Whether a planned CTO modification procedure, hereafter named Investment procedure, could improve patient outcomes has never been investigated. Invest-CTO is a prospective, single-arm, international, multicenter study, evaluating the effectiveness and safety of a planned investment procedure, with a subsequent completion CTO PCI (at 8-12 weeks), in anatomically high-risk CTOs. We will enroll 200 patients with CTOs defined as high-risk according to our Invest CTO criteria at centers in Norway and United Kingdom.Patients with aorto-ostial lesions, occlusion within a previous stent, or a prior attempt at target vessel CTO PCI within 6 months will be excluded. The co-primary endpoints are cumulative procedural success (%) after both procedures, and a composite safety endpoint at 30 days after completion CTO PCI. Patient reported outcomes (PROs), treatment satisfaction, and clinical endpoints will be reported. This study will prospectively evaluate the effectiveness and safety of a planned two staged PCI procedure in the treatment of high-risk CTOs and may have the potential to change current clinical practice.

Comparison of outcomes of percutaneous coronary intervention for chronic total occlusion in patients with and without prior bypass grafting: A systematic review and meta-analysis.

This review assessed evidence on the impact of prior coronary artery bypass grafting (CABG) on outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). PubMed, CENTRAL, Embase, ScienceDirect, and Google Scholar databases were searched from 1st January 1980 up to 10th January 2022 for studies assessing outcomes of CTO-PCI in patients with and without prior-CABG. Eight studies were included. The meta-analysis demonstrated significantly reduced odds of procedural success in patients with prior history of CABG (OR: 0.51 95% CI: 0.41, 0.64 I2=84% p<0.00001). There was a tendency of increased in-hospital mortality (OR: 1.72 95% CI: 0.97, 3.04 I2=26% p=0.06) and major adverse cardiac events (MACE) (OR: 1.30 95% CI: 0.99, 1.69 I2=0% p=0.05), along with a significantly increased risk of myocardial infarction (MI) (OR: 2.56 95% CI: 1.65, 3.97 I2=0% p<0.0001) and coronary perforation (OR: 1.52 95% CI: 1.03, 2.24 I2=70% p=0.04) in patients with history of CABG. There was no difference in the risk of stroke, pericardial tamponade, major bleeding, vascular access complications, and renal failure. Our results suggest that patients with prior history of CABG undergoing PCI for CTO have a 49% reduced chance of procedural success. Such patients are at an increased risk of in-hospital mortality, MACE, MI, and coronary perforation.

Procedural Time and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention

Chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) can be lengthy procedures. We sought to investigate the effect of procedural time on CTO PCI outcomes. We examined the procedural time required for the various steps of CTO PCI in 6,442 CTO PCIs at 40 US and non-US centers between 2012 and 2022. The mean and median procedure times were 129 ± 76 and 112minutes, respectively, with no significant change over time. The median times from access to wire insertion, guidewire manipulation time, and post crossing were 20, 32, and 53minutes, respectively. Lesions crossed in <30minutes were less complex, as reflected by lower Japanese CTO score (1.89 ± 1.19, p <0.001) than lesions that were not successfully crossed (2.88 ± 1.22) and lesions that were crossed in ≥30minutes (2.85 ± 1.13). The likelihood of successful crossing if crossing was not achieved after 30, 90, and 180minutes were a 76.7%, 60.7%, and 42.7%, respectively. The parameters independently associated with ≥30minutes guidewire manipulation time in patients with a primary antegrade approach included left anterior descending target vessel, proximal cap ambiguity, blunt/no stump, occlusion length, previous failed attempt, medium/severe calcification, and medium/severe tortuosity. The mean duration of CTO PCI is approximately 2hours (∼20% of time for access to wire insertion, ∼30% wire manipulation time, and ∼50% postwiring time). Guidewire crossing time was shorter in less complex lesions and in cases without complications.

A-23 | Gender Disparities in Cardiovascular Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusions

Several studies have demonstrated the utility of percutaneous coronary intervention (PCI) in improving cardiovascular outcomes in patients with chronic total occlusions (CTOs). However, the differences in clinical outcomes based on gender have not been well elucidated. This meta-analysis aims to evaluate the differences in cardiovascular outcomes of CTO PCI based on gender. A literature search was conducted for studies reporting on clinical endpoints after CTO PCI based on gender. The primary endpoint was all-cause mortality. Secondary endpoints included procedural success, recurrent acute myocardial infarction (AMI), and composite major adverse cardiovascular events (MACE). The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. A total of 14 studies with 15,129 patients with CTO PCIs (2804 females, 12325 males) met inclusion criteria. Mean follow-up was 48 months. Female gender was associated with a trend toward higher risk of all-cause mortality and MACE and lower procedural success; however, this was not statistically significant (OR 1.2, 95% CI 0.98-1.48; p=0.08; OR 1.26, 95% CI 0.99-1.59; p=0.06; OR 1.12, 95% CI 0.98-1.27; p=0.08). There was no significant difference in the risk of recurrent AMI on long-term follow-up post-PCI in females compared to males (OR 1.07, 95% CI 0.82-1.40; p=0.61). Female patients who undergo CTO PCI have similar procedural success without increased risk of long-term all-cause mortality, MACE, or recurrent AMI compared to male patients.

A-22 | Gender Disparities in Periprocedural Complications After Percutaneous Coronary Intervention for Chronic Total Occlusions

Several studies have reported on gender differences in the risk of periprocedural complications after percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs). The purpose of this meta-analysis is to evaluate differences in the risk of periprocedural complications of CTO-PCI based on gender. A literature search was conducted for studies reporting on periprocedural complications after CTO PCI based on gender. Clinical endpoints included embolic cerebral vascular accident (CVA), tamponade requiring pericardiocentesis, intra-operative coronary perforation, occurrence of major bleed, and vascular complications. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. A total of 8 studies with 7814 patients who underwent CTO PCI (1609 females, 6205 males) met inclusion criteria. Female patients had significantly higher risk for all secondary endpoints compared to male patients (CVA OR 3.67, 95% CI 1.55-8.70; p<0.01; Tamponade OR 2.70, 95% CI 1.40-5.24; p<0.01; Coronary Perforation OR 5.18, 95% CI 3.76-7.15; p<0.01; Major Bleed OR 2.43, 95% CI 1.50-3.93; p<0.01). There was no significant difference in the risk of perioperative vascular complications in females compared to males (OR 1.43, 95% CI 0.68-3.02; p=0.34). Female patients who undergo CTO PCI have similar rates of perioperative vascular complications, however significantly higher risk for CVA, tamponade requiring pericardiocentesis, coronary perforation, and major bleeding events.

B-11 | Donor Vessel Injury During Percutaneous Coronary Interventions for Chronic Total Occlusion: Insights from the PROGRESS-CTO registry

Donor vessel injury is a potentially life-threatening complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the incidence and outcomes of donor vessel injury among 12,349 CTO PCIs performed between 2012 and 2022 in a large multicenter CTO PCI registry. The incidence of donor vessel injury was 0.5% (n=59). The baseline clinical characteristics of patients with and without donor vessel injury were similar. Cases complicated with donor vessel injury were more complex with higher J-CTO score (3.0 ± 1.1 vs. 2.4 ± 1.3; p<0.001) and lower procedural success rate (71% vs. 85%; p=0.003). The retrograde approach was used more commonly among cases complicated with donor vessel injury (68% vs. 31%; p<0.001). The incidence of major adverse cardiovascular events (MACE) was significantly higher in cases with donor vessel injury (22% vs. 1.9%; p<0.001). Left ventricular assist device was used in 13 patients (22%) with donor vessel injury. Of the 59 patients with donor vessel injury, 8 patients (11%) experienced acute myocardial infarction (MI), and 4 patients died (6.8%). CTO PCIs complicated with donor vessel injury required longer procedure time and fluoroscopy time, higher air kerma radiation dose, and larger contrast volume. Donor vessel injury occurred in 0.5% of CTO PCIs performed by experienced operators, and was associated with lower procedural success and higher adverse clinical outcomes, such as death and acute MI.

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

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.

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

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.

Interventions in chronic total occlusions with bifurcation lesions: incidence, treatment, and in-hospital outcome

Introduction and objectivesCoronary chronic total occlusions (CTO) involving bifurcation lesions are a challenging lesion subset that is understudied in the literature. This study analyzed the incidence, procedural strategy, in-hospital outcomes and complications of percutaneous coronary interventions (PCI) for bifurcation-CTO (BIF-CTO). MethodsWe assessed data from 607 consecutive CTO patients treated at the Institut Cardiovasculaire Paris Sud (ICPS), Massy, France between January 2015 and February 2020. Procedural strategy, in-hospital outcomes and complication rates were compared between 2 patient subgroups: BIF-CTO (n=245=and non–BIF-CTO (n=362). ResultsThe mean patient age was 63.2±10.6 years; 79.6% were men. Bifurcation lesions were involved in 40.4% of the procedures. Overall lesion complexity was high (mean J-CTO score 2.30±1.16, mean PROGRESS-CTO score 1.37±0.94). The preferred bifurcation treatment strategy was a provisional approach (93.5%). BIF-CTO patients presented with higher lesion complexity, as assessed by J-CTO score (2.42±1.02 vs 2.21±1.23 in the non–BIF-CTO patients, P=.025) and PROGRESS-CTO score (1.60±0.95 vs 1.22±0.90 in the non–BIF-CTO patients, P<.001). Procedural success was 78.9% and was not affected by the presence of bifurcation lesions (80.4% in the BIF-CTO group, 77.8% in the non–BIF-CTO-CTO group, P=.447) or the bifurcation site (proximal BIF-CTO 76.9%, mid–BIF-CTO 83.8%, distal BIF-CTO 85%, P=.204). Complication rates were similar in BIF-CTO and non–BIF-CTO. ConclusionsThe incidence of bifurcation lesions is high in contemporary CTO PCI. Patients with BIF-CTO present with higher lesion complexity, with no impact on procedural success or complication rates when the predominant strategy is provisional stenting.

Acute coronary complications in chronic total occlusion interventions.

Chronic total occlusion (CTO) interventions are among the most complex procedures within the panorama of percutaneous coronary intervention (PCI). Awareness of potential complications, adequate procedural planning in order to avoid them, and prompt recognition and management should any occur are at the cornerstone of a successful CTO programme. Complications can be acute or late after the procedure and can be cardiac or non-cardiac. Acute cardiac complications can occur directly at the coronary artery level or can have other strictly non-coronary manifestations, such as hypotension, myocardial infarction, arrhythmias, or tamponade. In this review, we focus on acute coronary complications of CTO PCI, in particular their causes, prevention, and management strategies.

Effect of complete percutaneous revascularization on improving long-term outcomes of patients with chronic total occlusion and multi-vessel disease.

Limited data are available on the comparison of clinical outcomes of complete vs. incomplete percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) and multi-vessel disease (MVD). The study aimed to compare their clinical outcomes. A total of 558 patients with CTO and MVD were divided into the optimal medical treatment (OMT) group ( n = 86), incomplete PCI group ( n = 327), and complete PCI group ( n = 145). Propensity score matching (PSM) was performed between the complete and incomplete PCI groups as sensitivity analysis. The primary outcome was defined as the occurrence of major adverse cardiovascular events (MACEs), and unstable angina was defined as the secondary outcome. At a median follow-up of 21 months, there were statistical differences among the OMT, incomplete PCI, and complete PCI groups in the rates of MACEs (43.0% [37/86] vs. 30.6% [100/327] vs. 20.0% [29/145], respectively, P = 0.016) and unstable angina (24.4% [21/86] vs. 19.3% [63/327] vs. 10.3% [15/145], respectively, P = 0.010). Complete PCI was associated with lower MACE compared with OMT (adjusted hazard ratio [HR] = 2.00; 95% confidence interval [CI] = 1.23-3.27; P = 0.005) or incomplete PCI (adjusted HR = 1.58; 95% CI = 1.04-2.39; P = 0.031). Sensitivity analysis of PSM showed similar results to the above on the rates of MACEs between complete PCI and incomplete PCI groups (20.5% [25/122] vs. 32.6% [62/190], respectively; adjusted HR = 0.55; 95% CI = 0.32-0.96; P = 0.035) and unstable angina (10.7% [13/122] vs. 20.5% [39/190], respectively; adjusted HR = 0.48; 95% CI = 0.24-0.99; P = 0.046). For treatment of CTO and MVD, complete PCI reduced the long-term risk of MACEs and unstable angina, as compared with incomplete PCI and OMT. Complete PCI in both CTO and non-CTO lesions can potentially improve the prognosis of patients with CTO and MVD.

Meta-analysis Comparing Long-Term Clinical Outcomes of Percutaneous Coronary Intervention versus no Intervention in Patients with Chronic Total Occlusion.

We performed a meta-analysis to evaluate the efficacy of CTO PCI. The study outcomes were the occurrence of all-cause mortality, myocardial infarction, repeat revascularization, stroke, or freedom from angina at the longest documented follow-up period. In five trials including 1790 patients, the mean age was 63 ± 10 years, 17% were female, with a median follow-up of 2.9 years. The procedural success rate ranged from 73% to 97% and the right coronary artery was the most involved artery (52%). There was no significant difference between CTO PCI and no intervention regarding all-cause mortality (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 0.49-2.47, P = 0.82), myocardial infarction (OR: 1.20, 95% CI: 0.81-1.77, P = 0.36), repeat revascularization (OR: 0.67, 95% CI: 0.40-1.14, P = 0.14), or stroke (OR: 0.60, 95% CI: 0.26-1.36, P = 0.22). In two trials including 686 patients, significantly more patients were free of angina at 1 year, defined as the Canadian Cardiovascular Society grading of angina pectoris Grade 0, in the CTO PCI group compared to the no intervention group (OR: 0.52, 95% CI: 0.35-0.76, P < 0.001). Meta-regression analyses based on various trial-level covariates (gender, diabetes, previous myocardial infarction, PCI or coronary artery bypass graft, SYNTAX or J-CTO scores, and CTO-related artery percentages) did not suggest any statistically significant relationships. CTO PCI appears to have a similar efficacy profile compared to no intervention at long-term follow-up, but with a significant improvement of angina favoring PCI-treated patients. Further adequately powered and long-term trials are required to identify the best management strategy for patients with coronary CTO.

Same day discharge versus overnight observation following chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS‐CTO registry

Same day discharge (SDD) following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We evaluated the clinical, angiographic, and procedural characteristics of patients discharged the same day versus those kept for overnight observation in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO, NCT02061436). Of the 7181 patients who underwent CTO PCI, 943 (13%) had SDD. The SDD rate increased from 3% in 2015 to 21% in 2022. Patients with SDD were less likely to have a history of heart failure (21% vs. 26%, p = 0.005), chronic lung disease (10% vs. 15%, p = 0.001), or anemia (12% vs. 19%, p < 0.001). Technical success (87% vs. 88%, p = 0.289) was similar, but in-hospital major adverse cardiovascular events (0.0% vs. 0.4%, p = 0.041) were lower in SDD. In multivariable logistic regression analysis, prior myocardial infarction odds ratio (OR): 0.71 (95% confidence interval [CI]: 0.59-0.87, p = 0.001), chronic lung disease OR: 0.64 (95% CI: 0.47-0.88, p = 0.006), and increasing procedure time OR: 0.93 (95% CI: 0.91-0.95, p < 0.001, per 10-min increase) were associated with overnight observation, while radial-only access OR: 2.45 (95% CI: 2.03-2.96, p < 0.001) had the strongest association with SDD. In the SDD, 2 (0.4%) of 514 patients were readmitted, due to retroperitoneal bleeding (n = 1) and ischemic stroke (n = 1). The overall frequency of SDD after CTO PCI was 13% and has been increasing over time. SDD is feasible in select patients following CTO PCI, and radial-only access had the strongest association with SDD.

Long-Term Outcomes of Patients Undergoing Percutaneous Coronary Intervention (PCI) for Chronic Total Occlusions

Introduction: Percutaneous coronary intervention (PCI) is a minimally invasive procedure used to treat patients with coronary artery disease. Chronic total occlusions (CTO) occur when a coronary artery is completely blocked for more than 3 months. Objectives: The main objective of the study is to find the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions. Material and methods: The retrospective cohort study was conducted at the Hayatabad Medical Complex in Peshawar, Pakistan from June 2019 to June 2020. The study included 384 patients who underwent PCI for chronic total occlusions. Data were collected from patient records and follow-up visits. The primary outcome of the study was all-cause mortality, while the secondary outcomes included major adverse cardiovascular events (MACE), repeat revascularization, and quality of life. Data were analyzed using descriptive statistics and survival analysis. Result: The results of the retrospective cohort study investigating the long-term outcomes of patients who underwent PCI for chronic total occlusions showed that the study included 384 patients who underwent PCI for at least one chronic total occlusion. The mean age of the patients was 60.3 years, and 76.3% were male. Conclusion: In conclusion, this study suggests that percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) can provide good long-term outcomes with an overall success rate of 87.5%.

DES Strut Thickness and Clinical Outcomes After CTO Recanalization: Insights From LATAM CTO Registry

BackgroundUltra-thin strut drug-eluting stent (UTS-DES) may improve outcomes after percutaneous coronary intervention (PCI) but have received limited study in chronic total occlusion (CTO) PCI. AimsTo compare of 1-year incidence of major adverse cardiac events (MACE) between patients who underwent CTO PCI with ultrathin (≤ 75 μm) versus thin (>75 μm) strut DES in the LATAM CTO registry. MethodsPatients were considered for inclusion only if successful CTO PCI was performed and when only one type of stent strut thickness (ultrathin or thin) was used. A propensity score matching (PSM) was computed to produce similar groups in relation to clinical and procedural characteristics. ResultsBetween January 2015 and January 2020, 2092 patients underwent CTO PCI, of whom 1466 were included in the present analysis (475 in the ultra-thin and 991 in the thin strut DES). In unadjusted analysis the UTS-DES group had lower rate of MACE (HR: 0.63 95 % CI 0.42 to 0.94, p = 0.04) and repeat revascularizations (HR: 0.50 95 % CI 0.31 to 0.81, p = 0.02) at 1-year follow-up. After adjustment for confounding factors in a Cox regression model there was no difference in 1-year incidence of MACE between groups (HR: 1.15 95 % CI 0.41 to 2.97, p = 0.85). On PSM of 686 patients (343 in each group) the 1-year incidence of MACE (HR 0.68 95 % CI 0.37–1.23; P = 0.22) and individual components of MACE did not differ between groups. ConclusionsOne-year clinical outcomes after CTO PCI were similar with ultrathin and thin strut DES.