The Houston Methodist CTO-PCI Registry: Contemporary risk profile, procedural characteristics, and outcomes of
Chloe Kharsa1, Gal Sella1, Mangesh Kritya1
1Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, United States of America.
Insights
Percutaneous coronary intervention for chronic total occlusion (CTO PCI) is safe and effective in complex patients, with high success rates and positive long-term outcomes. Lesion characteristics, not comorbidities, primarily predict procedural success.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) presents significant technical challenges.
- Predictors of procedural success and long-term outcomes in CTO PCI are subjects of ongoing research.
- Real-world data is crucial for understanding the safety and efficacy of CTO PCI.
Purpose of the Study:
- To report real-world data on procedural success, safety, and mid- to long-term outcomes of CTO PCI.
- To characterize the patient population undergoing CTO PCI.
- To identify predictors of procedural success in CTO PCI.
Main Methods:
- Retrospective analysis of 507 patients undergoing CTO PCI between 2018 and 2023.
- Evaluation of baseline clinical characteristics, procedural details, and outcomes (procedural success, complications, follow-up events).
- Multivariable logistic regression and Kaplan-Meier analysis to identify predictors and assess long-term outcomes.
Main Results:
- High procedural success rate (81.2%) with low in-hospital mortality (0.4%) and complication rates.
- Independent predictors of success included younger age, cumulative air kerma, and shorter lesion length.
- Favorable 2-year outcomes: 91.4% overall survival, 93.6% freedom from target lesion revascularization (TLR), and 85% event-free survival from target lesion failure (TLF).
Conclusions:
- CTO PCI is a safe procedure with high success rates and favorable outcomes in complex patient populations.
- Procedural success is mainly influenced by lesion-specific factors rather than patient comorbidities.
- Findings support the continued use and advancement of CTO PCI in selected patients.
Background:
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains technically challenging, with ongoing debate about procedural success predictors and long-term outcomes. We report real-world data from the Houston Methodist CTO PCI Registry to characterize procedural success, safety, and mid- to long-term outcomes.
Methods:
We retrospectively analyzed 507 patients undergoing CTO PCI between 2018 and 2023. Baseline clinical characteristics, procedural details, and outcomes including procedural success, in-hospital complications, and follow-up events were evaluated. Multivariable logistic regression identified predictors of procedural success.
Results:
The cohort had a mean age of 65.3 ± 10.0 years, 20.9 % women, and a high prevalence of comorbidities (hypertension 96.1 %, diabetes 49.7 %). The mean J-CTO score was 1.8 ± 1.1. Procedural success was achieved in 81.2 % of cases, with low in-hospital mortality (0.4 %) and complication rates. Annual success rates improved from 72.7 % in 2018 to a peak of 86.7 % in 2020, reflecting growing operator experience and evolving techniques. Multivariable analysis showed that age (OR 0.97, 95 % CI [0.95-1.00]; p = 0.03), cumulative air kerma (OR 1.00, 95 % CI [1.00-1.00]; p = 0.003) and lesion length (OR 1.05, 95 % CI [1.03-1.07], p < 0.001) were independent predictors of success. KM analysis revealed a 2-year overall survival of 91.4 %, freedom from clinically driven target lesion revascularization (TLR) of 93.6 % at 2 years, and event-free survival from target lesion failure (TLF) of approximately 85 % at 2 years. At a median follow-up of 745 days, all-cause mortality was 9.2 %, and TLR occurred in 2.4 % of patients.
Conclusion:
CTO PCI can be performed safely with high success rates and favorable mid- to long-term outcomes in a complex population. Procedural success is primarily driven by lesion-specific factors rather than clinical comorbidities. These findings support the continued evolution and application of CTO PCI in appropriately selected patients.
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