non-CTO Percutaneous Coronary Intervention Research Articles

Long-term outcomes after revascularization in chronic total and non-total occluded coronary arteries: A regionwide cohort study.

Understanding the prognostic impact of percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) is crucial for patient management. Previous studies have primarily been studying prognostic impact of successful versus unsuccessful CTO PCI. This study investigated the prognostic impact of successful and unsuccessful percutaneous coronary intervention (PCI) of chronic total occluded coronary arteries (CTO) with non-CTO PCI as reference. Patients treated with PCI from 2009 to 2019 in the Central Region of Denmark were included in a population-based cohort study. We compared successful and unsuccessful CTO PCI with non-CTO PCI. Exclusion criteria was myocardial infarction within 30 days. Primary outcome was difference in a composite major adverse cardio- and cerebrovascular events (MACCE) encompassing all-cause death, any myocardial infarction, stroke, hospitalization for heart failure or revascularization tracked via nationwide registries. Of 21,141 screened patients, 10,638 were enrolled: 9,065 underwent non-CTO PCI, 1,300 had successful CTO PCI, and 273 had unsuccessful CTO PCI. Median follow-up time was 5.9 [3.5;9.0] years and 4,750 MACCEs were recorded. Compared to non-CTO PCI, the adjusted MACCE rate for successful CTO PCI was equivalent (Hazard Ratio (HR): 0.98, 95% Confidence Interval (CI): 0.90-1.07, p = 0.71). In contrast, unsuccessful CTO PCI was associated with a higher MACCE rate (HR: 1.22, 95% CI: 1.04-1.43, p<0.01). HR was adjusted for age, body-mass index, previous revascularization, smoking, kidney disease, two or three-vessel disease, left ventricular ejection fraction, diabetes and comorbidities. The pre-specified hypothesis was accepted. Successful CTO PCI was associated with equivalent long-term outcomes as non-CTO PCI, and unsuccessful CTO PCI was identified as a high-risk group associated to worse outcomes.

Mechanisms of Medial Wall Thinning in Chronic Total Occlusion

BackgroundThe success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is lower and the risk for complications higher compared with other non-CTO PCI. Although interventionalists focus on intimal plaque characteristics, the coronary media is an important (especially for techniques involving antegrade dissection and re-entry) but poorly understood structure in CTO PCI. ObjectivesThe aim of the present study was to investigate coronary medial wall thinning in CTO lesions and determine how this thinning might affect CTO PCI. MethodsA total of 2,586 sections were investigated, from arteries with evidence of CTO from 54 subjects (1,383 sections) and arteries without evidence of CTO from 54 subjects with non-coronary-related deaths (1,203 sections) after matching for age, gender, body weight, and body height. ResultsThe medial thickness in subjects with CTO was lower than that in those with non-coronary-related death (P < 0.001). In subjects with CTO, CTO lesions had thinner medial walls compared with those with lower luminal narrowing (P < 0.001). At the CTO distal segments, the 6- to 12-mm distal segment from the distal end of the CTO had significantly less luminal narrowing (P < 0.001), and similar medial thickness, compared with the distal end of the CTO. Immunohistochemical analysis revealed that short-duration CTO had more cleaved caspase-3–positive cells in media and had significantly more CD3+, CD4+, CD8+, and CD4+CD28null T cells compared with long-duration CTO. ConclusionsCTO lesions demonstrated coronary medial thinning compared with non-CTO lesions. Further investigation of the cause-and-effect relationship among inflammation, apoptosis, and coronary medial wall thinning is warranted in future mechanistic studies.

A non-interventional cardiologist's guide to coronary chronic total occlusions.

Coronary chronic total occlusions (CTO) are present in up to one-third of patients with coronary artery disease (CAD). It is thus essential for all clinical cardiologists to possess a basic awareness and understanding of CTOs, including optimal evaluation and management. While percutaneous coronary intervention (PCI) for CTO lesions has many similarities to non-CTO PCI, there are important considerations pertaining to pre-procedural evaluation, interventional techniques, procedural complications, and post-procedure management and follow-up unique to patients undergoing this highly specialized intervention. Distinct from other existing topical reviews, the current manuscript focuses on key knowledge relevant to non-interventional cardiologists.

Abstract 11687: Percutaneous Coronary Intervention for Chronic Total Occlusions is Associated With Higher Inpatient Mortality and Complications

Background: Percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is commonly performed despite unclear long-term benefits. Hypothesis: The goal of this study was to evaluate the post-procedural outcome of patients with CTO intervention. Methods: The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients with CTO intervention were compared to patients without CTO. We evaluated post-procedural mortality and complications. Results: PCI in patients with CTO was associated with higher mortality and all post-procedural complications. A total of 2,011,854 patients underwent PCI with 259,574 having CTO. The CTO group had a 3.17% mortality rate vs 2.57% of non-CTO PCI. (OR, 1.24; CI:1.18-1.31; p&lt;0.001). Using multivariate analysis adjusting for age, sex, race, diabetes mellitus, and chronic kidney disease, CTO PCI remained significantly associated with higher mortality (OR, 1.37; 95% CI, 1.3 - 1.45; p&lt;0.001). Patients with CTO compared to non-CTO PCI patients had higher rates of myocardial infarction (OR, 2.85; 95% CI, 2.54 - 3.21; p&lt;0.001), coronary perforation (OR, 6.01; 95% CI, 5.25-6.89; p&lt;0.001), tamponade (OR, 3.36; 95% CI, 2.91-3.88, p&lt;0.001), contrast-induced nephropathy (OR, 2.05; 95% CI, 1.45-2.90), p&lt;0.001), procedural bleeding (OR, 3.57; 95% CI, 3.27-3.89, p&lt;0.001), and acute post-procedural respiratory failure (OR, 2.07; 95% CI, 1.81-2.36, p&lt;0.001). All post-procedural complications were more than 3 times the non-CTO patients (OR, 3.45; 95% CI, 3.24-3.67; p&lt;0.001). Conclusion: Using a large national inpatient database, PCI performed in patients with CTO was associated with significantly much higher mortality and post-procedural complications compared to PCI in non-CTO patients.

TCT-274 Chronic Total Occlusion Specialist Outcomes in Non-CTO Percutaneous Coronary Intervention: Insights From BMC2

TCT-274 Chronic Total Occlusion Specialist Outcomes in Non-CTO Percutaneous Coronary Intervention: Insights From BMC2

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.

Long-Term Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention Among Medicare Beneficiaries

BackgroundChronic total occlusion (CTO) percutaneous coronary interventions (PCIs) represent 4% of all PCIs for stable angina in the United States and have been associated with lower success and higher in-hospital event rates compared with non-CTO PCIs. We aimed to examine long-term outcomes of CTO PCI compared with non-CTO PCI, including prespecified subgroups of high-risk non-CTO PCI (atherectomy/saphenous vein graft/unprotected left main).MethodsAmong 551,722 patients in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare (July 2009-December 2016), we evaluated in-hospital events and long-term major adverse cardiovascular events of CTO PCIs (N = 29,407) compared with non-CTO PCIs (N = 522,315). We then evaluated similar outcomes between CTO PCIs and high-risk non-CTO PCIs (N = 53,662). We excluded patients with ST-elevation myocardial infarction and non–ST-elevation myocardial infarction.ResultsPatients undergoing CTO PCI were more likely to be younger and male. CTO PCI was associated with a higher risk of in-hospital events compared with non-CTO PCI (7.0% vs 4.2%; P < .001) and high-risk non-CTO PCI (7.0% vs 6.5%; P = .008). In addition, CTO PCI was associated with a slightly higher risk of long-term repeat revascularization compared with non-CTO PCI (adjusted hazard ratio [aHR], 1.09; 95% CI, 1.05-1.13). However, compared with high-risk non-CTO PCIs, CTO PCIs were associated with a slightly lower risk of long-term major adverse cardiovascular events (aHR, 0.87; 95% CI, 0.84-0.90) and readmission (aHR, 0.87; 95% CI, 0.84-0.90).ConclusionsIn this study, CTO PCI was associated with higher risk of both in-hospital and out-of-hospital events but a slightly lower risk of long-term events compared with high-risk non-CTO PCIs. These findings shed light on the complexity of various PCI procedures that can inform clinicians and patients of expected outcomes.

B-18 | Comparison of the Incidence of Procedural Complications Associated with Elective Chronic Total Occlusion and Non Chronic Total Occlusion Percutaneous Coronary Intervention

Successful percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) leads to improvement in anginal symptoms and ventricular function. However, CTO are technically challenging and are associated with lower success rates and more complications. In this retrospective study we compare the incidence of procedural complications associated with elective single-vessel (SV) CTO and non-CTO PCI.

B-19 | Comparison of Cost of Hospitalization between Single-Vessel Chronic Total Occlusion and Non Chronic Total Occlusion Percutaneous Coronary Intervention

Successful percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) leads to improvement in anginal symptoms and ventricular function. As CTO PCI are technically challenging, associated with more complications and require additional equipment, we hypothesize that they are associated with a higher cost of hospitalization as compared to non-CTO PCI. In this retrospective study using the National Inpatient Sample (NIS) we compare the cost of hospitalization associated with elective single vessel (SV) CTO PCI to SV non-CTO PCI.

B-16 | Comparison of In-Hospital Mortality between Chronic Total Occlusion and Non Chronic Total Occlusion Percutaneous Coronary Intervention

Successful percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) leads to improvement in anginal symptoms and left ventricular function but does not lead to a decrease in mortality. CTO PCI are technically challenging and are associated with lower success rates and more complications. In this retrospective study, we identify the in-hospital mortality trend associated with elective single vessel (SV) CTO PCI and compare it to non-CTO PCI.

Efficacy of MAVIG X-Ray Protective Drapes in Reducing CTO Operator Radiation.

Background The MAVIG X-ray protective drape (MXPD) has been shown to reduce operator radiation dose during percutaneous coronary interventions (PCI). Whether MXPDs are also effective in reducing operator radiation during chronic total occlusion (CTO) PCI, often with dual access, is unknown. Methods We performed a prospective, randomized-controlled study comparing operator radiation dose during CTO PCI (n = 60) with or without pelvic MXPDs. The primary outcomes were the difference in first operator radiation dose (μSv) and relative dose of the first operator (radiation dose normalized for dose area product) at the level of the chest in the two groups. The effectiveness of MXPD in CTO PCI was compared with non-CTO PCI using a patient-level pooled analysis with a previously published non-CTO PCI randomized study. Results The use of the MXPD was associated with a 37% reduction in operator dose (weighted median dose 26.0 (IQR 10.00–29.47) μSv in the drape group versus 41.8 (IQR 30.82–60.59) μSv in the no drape group; P < 0.001) and a 60% reduction in relative operator dose (median dose 3.5 (IQR 2.5–5.4) E/DAPx10−3 in the drape group versus 8.6 (IQR 4.2–12.5) E/DAPx10−3 in the no drape group; P=0.001). MXPD was equally effective in reducing operator dose in CTO PCI compared with non-CTO PCI (P value for interaction 0.963). Conclusions The pelvic MAVIG X-ray protective drape significantly reduced CTO operator radiation dose. This trial is clinically registered with https://www.clinicaltrials.gov (unique identifier: NCT04285944).

Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion.

Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of technical failure, and adverse in-hospital events including all-cause death, myocardial infarction, stroke, and target vessel revascularization (MACCE), as well as pericardial tamponade. We stratified the procedures as PCI for chronic total occlusion (CTO, n = 2720) and PCI for non-CTO (n = 9818). Logistic regression demonstrated a significant association between fluoroscopy time and procedural failure with a significant interaction with PCI type (both p < 0.001). The odds ratios (OR) of procedural failure for a 10-min increment in FT were 1.15 (confidence interval (CI) 95% 1.12–1.18, p < 0.001) in non-CTO PCI and 1.05 (CI 95% 1.03–1.06, p < 0.001) in CTO PCI. The optimal cut-point for prediction of PF was 21.1 min in non-CTO PCI (procedural success in 98.4% versus 95.3%, adjusted OR for PF 2.79 (CI 95% 1.93–4.04), p < 0.001) and 41 min in CTO PCI (procedural success in 92.3% versus 83.8%, adjusted OR for PF 2.18 (CI 95% 1.64–2.94), p < 0.001). In CTO PCI, the increase in PF with FT was largely driven by technical failure (adjusted OR 2.25 (CI 95% 1.65–3.10), p < 0.001), whereas in non-CTO PCI, it was driven by major complications (adjusted OR 2.94 (CI 95% 1.93–4.53), p < 0.001). Conclusions: Prolonged FT is strongly associated with procedural failure in both non-CTO and CTO PCI. In CTO PCI, this relation is shifted towards longer FT. The mechanisms of procedural failure differ between CTO and non-CTO PCI.

Safety and efficacy of a low frame rate protocol for percutaneous coronary intervention for chronic total occlusions.

Safety and efficacy of a low frame rate protocol for percutaneous coronary intervention for chronic total occlusions.

Management of Chronic Total Occlusion of Coronary Artery.

Chronic total occlusion (CTO) of a coronary artery is typically defined as a completely occluded artery without any antegrade flow and a duration of at least 3 months. We reviewed the current literature describing the optimal management of CTO including the role of revascularization and choice of modality, i.e., percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery. Databases (PubMed, the Cochrane Library, Embase, EBSCO, Web of Science, and CINAHL) were searched and relevant studies of patients with CTO were selected for review. The prevalence of coronary artery CTOs is approximately 25% among patients undergoing coronary angiography for angina. Available data suggests that PCI of CTO can be a technically complex procedure with relatively lower success rates compared with non-CTO PCI and typically associated with a higher complication rate especially at nonspecialized centers. Furthermore, successful CTO-PCI is associated with symptomatic improvement but does not appear to improve mortality, myocardial infarction, stroke, and repeat revascularization rates. Based on contemporary data, PCI of CTO lesions may be considered in patients with incapacitating angina despite treatment with optimal guideline-directed medical therapy and in whom based on coronary anatomy there is a reasonable chance of technical success with an acceptable risk.

A contemporary definition of periprocedural myocardial injury after percutaneous coronary intervention of chronic total occlusions

Abstract Background Coronary chronic total occlusion (CTO) recanalization represents the most technically challenging percutaneous coronary interventions (PCI). The complexity harbours a significant increased risk risk for complications with CTO PCI as compared to non-CTO PCI. However there are evidenced biomarker cut-off levels that help to identify those patients at risk for an unfavorable clinical outcome. Objective This study aimed to assess the prognostic impact of postprocedural troponin T increase and mortality in patients undergoing CTO-PCI in order to define the threshold, where procedural related myocardial injury drives mortality. Methods We enrolled a total of 3712 consecutive patients undergoing PCI for at least one CTO lesion and performed comprehensive troponin Tmeasurements 6, 8, and 24 hours after the procedure. All-cause mortality was defined as the primary study endpoint. Results Using spline curve analysis, we observed that a more than 18-fold increase of troponin above the upper reference limit (URL) is significantly associated with mortality. In the Cox regression analysis we observed a crude hazard ratio (HR) of 2.32 (95% CI 1.83–2.93, P&amp;lt;0.001) for a ≥18fold increase compared to patients with post-procedural troponin increase &amp;lt;18-fold of the URL.Results remained virtually unchanged after bootstrap- or clinical confounder-based adjustment. Conclusion This large-scale outcome study demonstrates for the first time the prognostic value of post-procedural troponin T elevation after PCI in CTO patients. We could define a threshold for procedure related myocardial injury in CTO patients that differ non- CTO patients and may help guide the postprocedural clinical care in this high risk patient population. Figure 1 Funding Acknowledgement Type of funding source: None

Management and outcomes of coronary artery perforations treated with the block and deliver technique

Coronary artery perforation (CAP) is a potentially life-threatening complication during percutaneous coronary interventions (PCI) and the best strategy for its management is yet to be proved. We aimed to analyze the safety, efficacy, and long-term clinical outcomes of the block and deliver (BAD) technique, as only anecdotal cases are reported in literature. From January 2016 to January 2020, all consecutive patients treated with the BAD technique at five high-volume centers in Italy were retrospectively identified. 25 CAPs treated with the BAD technique were included. The most frequently perforated artery was the left anterior descending artery (32%) and spring-coil wires with a hydrophilic coating were the most common culprit wires (68%). Mean sealing time was 46.9 ± 60.1min, with no significant differences between CTO-PCIs and non-CTO PCIs (p=.921). Acute successful sealing of the CAP was achieved in 96% of the cases. Immediate cardiac tamponade occurred in 28% of patients, four during CTO PCI and three during non-CTO PCI (p=.55). Two patients required pericardiocentesis during hospitalization, one patient developed acute kidney injury, and one patient underwent cardiac surgery due to severe mitral regurgitation. At 1-year follow-up no significant differences were observed between groups in terms of POCE (25 vs 25%, p=.628) and its individual components. The BAD technique proved to be effective for the management of CAP, showing high successful sealing rates. Rates of in-hospital events and at 1-year follow-up did not significantly differ between patients suffering CAP during CTO revascularization or during non-CTO PCI.

Silent cerebral infarction after percutaneous coronary intervention of chronic total occlusions (CTO) and non-CTOs.

Silent cerebral infarctions (SCI) determined by neuron specific enolase (NSE) elevation may develop more during chronic total occlusion (CTO) percutaneous coronary interventions (PCI) than non-CTO interventions. Our aim was to examine CTO and non-CTO PCIs for SCI development. 100 consecutive CTO and 100 non-CTO PCI patients were enrolled. SCI was detected by serum NSE measurements performed at baseline and 12h after the interventions. New NSE elevations > 12ng/mL after the procedure were counted as SCI. Post-procedural NSE levels were found to be significantly higher in the CTO PCI group and NSE positivity was more prevalent in the CTO PCI group (56 (56%) vs. 31 (31%), p < 0.001), but PCI of CTOs did not independently increase risk of SCI (OR: 2.39 (0.85-6.73), p: 0.10). Patients who developed SCI after PCI had the characteristics of tough PCI interventions. In the multivariate analysis, two parameters were found to be independently associated with SCI development, namely more contrast volume (OR: 1.014 (1.005-1.023), p: 0.003) and longer procedural time (OR: 1.030 (1.010-1.051), p: 0.003). It has been firstly demonstrated in the literature that CTO PCIs, by its nature, have increased rates of SCI when compared to non-CTO PCIs but presence of a CTO was not an independent predictor of SCI. Mainly, procedural characteristics of the PCIs, especially longer procedural times and more contrast consumption, observed more in CTO PCIs, have been found to be independently associated with elevations of plasma NSE levels.

The success of opening concurrent chronic total occlusion lesion to improve cardiac function trial in patients with multi-vessel disease (SOS-moral): Study protocol of a prospective multicenter study.

Aims:The purpose of the present trial is to determine whether opening co-existing chronic total occlusions (CTOs) using percutaneous coronary interventions (PCIs) improves cardiac function in patients with multi-vessel disease (MVD). Patients with MVD are defined as having at least one additional major vessel exhibiting no less than 75% stenosis combined with the presence of a CTO artery.Methods and results:Patients will be prospectively recruited who meet the following criteria:(1)angiographically diagnosed with MVD concurrent with CTO;(2)previously diagnosed with myocardial infarction, or suffered myocardial necrosis of the CTO-territory determined using cardiovascular magnetic resonance (CMR).Patients presenting with no necrosis of myocardial tissue in the territory of the CTO will be excluded. Recruited patients will be randomized into 2 groups: those undergoing PCI of only the non-CTO artery (non-CTO PCI group), and those undergoing PCI of the non-CTO artery concurrently with the CTO artery (CTO-PCI group). The primary outcome will be the change in cardiac function evaluated via CMR at a 12-month of follow-up appointment, which will be compared to a baseline measurement. Secondary outcomes include occurrence of major cardiac events, CMR-assessed myocardial viability in the CTO-supplied territory, and quality of life assessed by Seattle angina questionnaire, Patient Health Questionnaire 9 and Generalized Anxiety Disorder Scale-7 after 12-month follow-up.Conclusion:The SOS-moral trial will provide data necessary to determine whether to open concurrent CTOs among MVD patients with CMR-detected necrotic myocardial tissue.

Five-year report from the Polish national registry on percutaneous coronary interventions with a focus on coronary artery perforations within chronic total occlusions.

IntroductionPatients treated within chronic total occlusions (CTO) using percutaneous coronary intervention (PCI) are at increased risk of periprocedural complications.AimTo assess the frequency of periprocedural complications with particular emphasis on coronary artery perforations (CAPs) among patients treated with PCIs stratified according to CTOs and their predictors.Material and methodsBased on a nationwide registry (ORPKI), we analysed 535,853 patients treated with PCI between 2014 and 2018. The study included 12,572 (2.34%) patients treated with CTO PCI. We compared CTO PCI to a non-CTO PCI group before and after propensity score matching (PSM). Multifactorial mixed regression models were used to assess predictors of periprocedural complications and CAPs which occurred within the catheterization laboratory.ResultsFrequencies of all periprocedural complications (2.75% vs. 1.93%, p < 0.001) and CAP (0.72% vs. 0.16%, p < 0.001) were significantly higher in the CTO PCI group. Multifactorial regression analysis performed in the all-comers group of patients treated with PCI showed that PCI within CTO was related to a higher CAP rate (odds ratio (OR) = 2.18; 95% confidence interval (CI): 1.68–2.82, p < 0.001). After PSM, we extracted 5,652 patients treated within CTO and 5,652 patients with non-CTO PCI. CTO PCI was also related to a higher frequency of CAPs (OR = 1.89; 95% CI: 1.11–3.31, p = 0.01).ConclusionsThe frequency of periprocedural complications and CAPs remained stable during the assessed period of time. CTO PCI was confirmed to be among the predictors of increased CAP rate in the overall group of patients treated within CTO.

Long-Term Outcomes of Chronic Total Occlusion Recanalization Versus Percutaneous Coronary Intervention for Complex Non-Occlusive Coronary Artery Disease

The durability of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is uncertain. We aimed to compare the long-term outcomes of CTO PCI with those of complex non-CTO PCI. We built a single-center registry including all patients who underwent CTO and complex non-CTO PCI between 2012 and 2017. Complex non-CTO PCI was defined as: 3 vessels treated, ≥3 stents implanted, total stent length >60 mm, saphenous vein graft intervention, 2-stent bifurcation intervention, left main PCI, protected PCI, or rotational/laser atherectomy. The primary endpoint was target-lesion failure, a composite of cardiac death, myocardial infarction, and target-lesion revascularization. A total of 2,396 patients were included (n=609 CTO PCI, n=1,787 complex non-CTO PCI). Patients who underwent CTO PCI were younger and had higher prevalence of cardiovascular comorbidities. CTO PCI patients exhibited worse procedural metrics and success rate (74% vs 98%, p <0.001). They also suffered a higher incidence of coronary perforation (3.5% vs 2.0%, p = 0.04) and cardiac tamponade (0.8% vs 0.1%, p = 0.001). However, there was no difference in the overall incidence of in-hospital major adverse cardiac and cerebrovascular events (4.1% vs 5.0%, p = 0.40). At 36 months, there were no differences in the incidence of target-lesion failure (10.1% vs 9.9%, p = 0.91) or its individual components, between the CTO and complex non-CTO group. This finding was confirmed on multivariable analysis. In conclusion, CTO PCI is associated with lower success rates and higher risk for coronary perforation and tamponade compared with complex non-CTO PCI. The incidence of other in-hospital and long-term adverse events is similar and reasonably low.