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Percutaneous Coronary Intervention or Medical Therapy for Chronic Total Occlusion in Older Adults

Yasser Jamil1, Matthew Dermksian2, Alaaeddine El Ghazawi3

  • 1Inova Center of Outcomes Research, Inova Schar Heart and Vascular, Falls Church, Virginia, USA.

JACC. Advances
|October 30, 2025
PubMed

Insights

Attempted or successful chronic total occlusion percutaneous coronary intervention (CTO-PCI) in older adults may improve quality of life and cardiovascular outcomes compared to optimal medical therapy (OMT). However, more randomized trials are needed to confirm these findings.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Managing coronary chronic total occlusion (CTO) in older adults is challenging due to limited evidence.
  • Older adults represent a growing population with complex cardiovascular needs.

Purpose of the Study:

  • To assess the association of attempted/successful CTO percutaneous coronary intervention (CTO-PCI) with quality of life (QoL), mortality, and cardiovascular outcomes in older adults.
  • To synthesize evidence from studies adequately representing this demographic.

Main Methods:

  • Systematic search of 6 databases for randomized trials and observational studies.
  • Inclusion of studies with significant representation of older individuals.
  • Meta-regression analyses to estimate relative risks (RRs) for key outcomes.

Main Results:

  • Attempted CTO-PCI was linked to reduced cardiac death (RR: 0.55), all-cause mortality (RR: 0.61), and major adverse cardiovascular events (RR: 0.68) compared to optimal medical therapy (OMT).
  • Successful CTO-PCI specifically reduced cardiac death and all-cause mortality.
  • CTO-PCI demonstrated greater improvements in quality of life compared to OMT or failed PCI.
  • Evidence primarily stems from observational studies, indicating lower certainty.

Conclusions:

  • Attempted or successful CTO-PCI may offer improved QoL and cardiovascular outcomes in older adults versus OMT.
  • Findings are hypothesis-generating due to reliance on observational data.
  • Randomized trials in representative older populations are essential for confirmation.
Abstract

Keywords:
chronic total occlusionscoronary artery diseasemedical therapyolder adultsrevascularization

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