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Prevalence and Prognostic Impact of Coronary Chronic Total Occlusions in Patients With Cardiogenic Shock

Michael Behnes1, Moritz Schmidberger1, Giuseppe Vadalà2

  • 1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Baden-Württemberg, Germany.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 26, 2025
PubMed

Insights

Coronary chronic total occlusions (CTO) are common in cardiogenic shock (CS) patients and independently predict higher 30-day mortality. Identifying CTO is crucial for improving outcomes in CS.

Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Interventional Cardiology

Background:

  • Mortality in cardiogenic shock (CS) remains high despite advanced treatments.
  • Identifying prognostic predictors in CS patients is essential for improving survival.
  • The prognostic impact of coronary chronic total occlusions (CTO) in CS patients requires investigation.

Purpose of the Study:

  • To investigate the prognostic impact of coronary chronic total occlusions (CTO) in patients experiencing cardiogenic shock (CS).
  • To determine if CTO presence is associated with increased all-cause mortality in CS patients.

Main Methods:

  • Included consecutive patients admitted with CS undergoing invasive coronary angiography (ICA) from 2019-2021.
  • Compared 30-day all-cause mortality risk between patients with and without CTO.
  • Performed risk stratification based on the extent of coronary artery disease (CAD).

Main Results:

  • 24% of CS patients had at least one CTO.
  • CTO presence was associated with significantly higher 30-day all-cause mortality (70.2% vs. 47.6%; HR=1.783).
  • CTO remained an independent predictor of mortality after multivariable adjustment (aHR=1.898) and in multi-vessel CAD patients (aHR=1.723).

Conclusions:

  • Coronary CTO are prevalent in patients with CS.
  • CTO is an independent predictor of 30-day all-cause mortality in CS patients.
  • These findings highlight the importance of assessing CTO in CS management.
Abstract

Keywords:
cardiogenic shockchronic total occlusioncoronary artery diseasecritical careinternal medicine

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