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

Zaid I Almarzooq1,2, Hector Tamez1, Yongfei Wang3,4

  • 1Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Journal of the Society for Cardiovascular Angiography & Interventions
|August 12, 2024
PubMed

Insights

Chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) carry higher in-hospital risks but lower long-term risks compared to high-risk non-CTO PCIs. These findings aid clinicians and patients in understanding PCI outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • Chronic total occlusion (CTO) percutaneous coronary interventions (PCIs) account for 4% of US PCIs for stable angina.
  • CTO PCIs are linked to lower success rates and higher in-hospital event rates than non-CTO PCIs.
  • Long-term outcomes of CTO PCI versus non-CTO PCI, including high-risk subgroups, require examination.

Purpose of the Study:

  • To compare long-term outcomes of CTO PCI with non-CTO PCI.
  • To evaluate CTO PCI outcomes against high-risk non-CTO PCI subgroups (atherectomy, SVG, unprotected left main).

Main Methods:

  • Analysis of 551,722 patients from the National Cardiovascular Data Registry CathPCI Registry linked to Medicare (July 2009-December 2016).
  • Comparison of in-hospital and long-term major adverse cardiovascular events (MACE) between CTO PCIs (N=29,407) and non-CTO PCIs (N=522,315).
  • Comparative analysis of CTO PCIs against high-risk non-CTO PCIs (N=53,662), excluding STEMI and NSTEMI patients.

Main Results:

  • CTO PCI patients were younger and more likely male.
  • CTO PCI had higher in-hospital event rates versus both non-CTO PCI (7.0% vs 4.2%) and high-risk non-CTO PCI (7.0% vs 6.5%).
  • CTO PCI showed a slightly higher risk of long-term repeat revascularization (aHR, 1.09) but a lower risk of long-term MACE (aHR, 0.87) and readmission (aHR, 0.87) compared to high-risk non-CTO PCIs.

Conclusions:

  • CTO PCI is associated with increased in-hospital and out-of-hospital event risks.
  • CTO PCI demonstrates a slightly lower risk of long-term events compared to high-risk non-CTO PCIs.
  • Findings highlight PCI procedure complexity, informing clinical decision-making and patient expectations.
Abstract

Keywords:
atherectomychronic total occlusionleft main coronary arteryoutcomespercutaneous coronary interventionsaphenous vein graft

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