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Percutaneous Coronary Intervention of Chronic Total Occlusion Associated with Higher Inpatient Mortality and
Allistair Nathan1, Mehrtash Hashemzadeh1, Mohammad Reza Movahed2
1University of Arizona College of Medicine-Phoenix.
Insights
Percutaneous coronary intervention (PCI) for chronic total occlusion increases in-hospital mortality and complications. This large study highlights significant risks associated with CTO PCI compared to non-CTO PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Percutaneous coronary intervention (PCI) is frequently performed for chronic total occlusion (CTO), but long-term outcomes remain debated.
- The clinical significance of CTO intervention requires further evaluation regarding associated risks.
Purpose of the Study:
- To assess the postprocedural outcomes, including mortality and complications, of patients undergoing PCI for CTO.
Main Methods:
- Analysis of the National Inpatient Sample database (2016-2020) using International Classification of Diseases, Tenth Revision codes.
- Comparison of in-hospital mortality and postprocedural complications between patients with CTO undergoing PCI and those without CTO.
Main Results:
- PCI for CTO was linked to higher in-hospital mortality (3.17% vs 2.57%) and significantly increased rates of myocardial infarction, coronary perforation, tamponade, contrast-induced nephropathy, bleeding, and respiratory failure.
- Multivariate analysis, adjusting for numerous baseline characteristics and high-risk features, confirmed CTO PCI's association with higher total mortality (OR 1.07).
- Overall postprocedural complications were more than three times higher in the CTO PCI group (OR 3.45).
Conclusions:
- PCI in patients with CTO is associated with substantially higher mortality and a greater incidence of postprocedural complications compared to PCI in non-CTO patients.
- These findings underscore the increased risks associated with CTO interventions and the need for careful patient selection and procedural planning.
Background:
Percutaneous coronary intervention (PCI) in patients with chronic total occlusion is commonly performed despite unclear long-term benefits. The goal of this study was to evaluate the postprocedural outcome of patients with chronic total occlusion intervention.
Methods:
The National Inpatient Sample database, years 2016-2020, was studied using International Classification of Diseases, Tenth Revision codes. Patients with chronic total occlusion interventions were compared with patients without chronic total occlusion. We evaluated postprocedural mortality and complications.
Results:
PCI in patients with chronic total occlusion was associated with higher total inhospital mortality and all postprocedural complications. A weighted total of 10,059,269 patients underwent PCI, with 259,574 having chronic total occlusion. The chronic total occlusion group had a 3.17% mortality rate vs 2.57% of nonchronic total occlusion PCIs (odds ratio [OR] 1.24; 95% confidence interval [CI], 1.18-1.31; P < .001). Using multivariate analysis adjusting for basline charcteristics and high risk features such as age, sex, race, diabetes mellitus, chronic kidney disease, systolic heart failure, 3-vessel PCI, hypertension, chronic obstructive pulmonary disease, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, prior PCI, history of coronary artery bypass graft, history of anemia, smoking status, atrial fibrillation/flutter, valvular heart disease, and , history of stroke, chronic total occlusion PCI remained significantly associated with higher total mortality (OR 1.07; 95% CI, 1.02-1.13; P = .02). Patients with chronic total occlusion compared with nonchronic total occlusion PCI had also higher rates of myocardial infarction (OR 2.85; 95% CI, 2.54-3.21; P < .001), coronary perforation (OR 6.01; 95% CI, 5.25-6.89; P < .001), tamponade (OR 3.36; 95% CI, 2.91-3.88; P < .001), contrast-induced nephropathy (OR 2.05; 95% CI, 1.45-2.90; P < .001), procedural bleeding (OR 3.57; 95% CI, 3.27-3.89; P < .001), and acute postprocedural respiratory failure (OR 2.07; 95% CI, 1.81-2.36; P < .001). All postprocedural complications were more than 3 times the nonchronic total occlusion patients (OR 3.45; 95% CI, 3.24-3.67; P < .001).
Conclusion:
Using a large national inpatient database, PCI performed in patients with chronic total occlusion was associated with significantly much higher mortality and postprocedural complications compared with PCI in nonchronic total occlusion patients.
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