Multiple Versus Single Vessel CTO PCI in the Same Hospitalization: Data From the PROGRESS-CTO Registry

Percutaneous coronary intervention (PCI) of multiple chronic total occlusions (CTOs) during a single procedure is infrequently performed and remains understudied. We compared the characteristics and outcomes of patients who underwent multiple versus single CTO PCIs during the same procedure. We analyzed data from 16,550 patients (16,876 CTO PCIs) from a large, multicenter registry. PCI of multiple CTOs was attempted in 626 lesions (3.7%) in 304 patients: 289 patients (95.1%) underwent PCI of 2 CTOs, 15 patients underwent PCI of 3 CTOs (4.9%) and 1 of 4 CTOs. Single CTO PCI was attempted in 16,246 patients. These patients had more comorbidities and more complex lesions, with higher prevalence of moderate or severe calcification and tortuosity, higher PROGRESS-CTO scores (1.56 vs 1.22, p <0.001), but similar J-CTO scores (2.46 vs 2.38, p = 0.110). Technical (84.7% vs 87.3%, p = 0.215) and procedural (83.0% vs 86.0%, p = 0.163) success were similar. Patients who underwent PCI of multiple CTOs required longer procedure and fluoroscopy times and higher contrast volume and use of percutaneous ventricular assistance devices (pVAD) (9.2% vs 1.8%, p <0.001). The incidence of major adverse cardiovascular events (MACE) was similar (2.6% vs 1.9%, p = 0.372). In patients who underwent PCI of multiple CTOs during the same procedure, subsequently treated CTOs had higher complexity compared with the initially treated CTO. Despite higher complexity, attempting PCI of multiple CTOs during the same procedure was associated with similar outcomes, but higher use of radiation, contrast and pVAD compared with PCI of single CTOs.