Revascularization of Chronic Total Occlusions vs. Planned Complex Percutaneous Coronary Intervention: Long-Term
Marcel Almendarez1,2, Alberto Alperi1,2, Isaac Pascual1,2,3
1Heart Area, Hospital Universitario Central de Asturias, Avenida de Roma S/N, 33011 Oviedo, Spain.
Insights
Long-term outcomes for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) were compared to planned complex non-CTO PCI. CTO PCI demonstrated a significantly lower risk of death, myocardial infarction, and revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) rates are increasing with improved outcomes.
- Limited long-term data exists comparing CTO PCI to planned complex non-CTO PCI.
- Need for comparative long-term outcome data in complex PCI procedures.
Purpose of the Study:
- To compare the long-term composite endpoint of all-cause death, myocardial infarction, and target vessel revascularization.
- To evaluate outcomes of CTO PCI versus planned complex non-CTO PCI.
- To assess the safety and efficacy of CTO PCI in a complex PCI setting.
Main Methods:
- Retrospective analysis of 1394 complex PCI cases from January 2018 to June 2023.
- Inclusion of 201 CTO PCI and 800 planned complex non-CTO PCI patients.
- Multivariable Cox regression and propensity score matching to compare outcomes.
Main Results:
- Mean follow-up of 2.5 years.
- Lower incidence of the composite endpoint in CTO PCI (11.6%) versus non-CTO PCI (28.2%) before matching.
- Propensity score matching (195 pairs) confirmed significantly lower risk in CTO PCI (HR: 0.46; p=0.003).
Conclusions:
- Planned complex CTO PCI is associated with a reduced long-term risk of adverse cardiovascular events.
- CTO PCI demonstrates favorable outcomes compared to planned complex non-CTO PCI.
- CTO PCI is a safe and effective strategy for selected complex coronary interventions.
Abstract:
Introduction: The number of chronic total occlusion (CTO) revascularization procedures has continuously increased, obtaining better results in recent years. However, there are few data regarding long-term outcomes and no comparisons to planned complex non-CTO percutaneous coronary intervention (PCI). Methods: We included all patients undergoing planned complex PCI. Our main objective was to compare a combined endpoint of all-cause death, myocardial infarction, and target vessel revascularization at the long-term follow-up of CTO PCI versus planned complex non-CTO PCI. We compared the groups using multivariable Cox regression and performed a propensity score matching analysis to control the baseline characteristics. We repeated the analysis for the separate components of the primary endpoint. Results: From January 2018 to June 2023, 1394 complex coronary PCIs were performed at our center. After excluding 393 non-planned cases, 201 CTO PCIs and 800 non-CTO PCIs were included. The mean follow-up was 2.5 ± 1.5 years. The composite endpoint occurred in 23 (11.6%) CTO PCIs and 219 (28.2%) planned non-CTO PCIs. The multivariable Cox regression using the CTO group as the reference showed a lower risk for the primary outcome (HR: 0.59; 95% CI 0.37-0.95; p = 0.031). After matching, a total of 195 adequately balanced pairs were obtained. The CTO group presented a lower risk for the primary combined outcome (HR: 0.46; 95% CI 0.27-0.76; p = 0.003). Conclusions: In patients undergoing planned complex PCI, those in the CTO group presented a reduced risk of all-cause death, myocardial infarction, and target vessel revascularization at the end of the follow-up.
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