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Clinical and Angiographic Outcomes Following Percutaneous Treatment of Chronic Totally Occluded Versus Non-Totally

Alp Aytekin1, Felix Voll2, Fiorenzo Simonetti1

  • 1Department of Cardiovascular Diseases, German Heart Centre, School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.

The Canadian Journal of Cardiology
|February 4, 2026
PubMed

Insights

Successful chronic total occlusion percutaneous coronary intervention (CTO-PCI) showed similar major adverse cardiac events compared to non-CTO-PCI. However, CTO-PCI was linked to increased target lesion revascularization and reduced myocardial infarction, with worse angiographic outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Clinical and angiographic outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) require further investigation.
  • Direct comparisons between CTO-PCI and non-CTO-PCI are limited.
  • Mid-term outcomes of successful CTO-PCI versus non-CTO-PCI need evaluation.

Purpose of the Study:

  • To compare mid-term clinical and angiographic outcomes between successful CTO-PCI and non-CTO-PCI.
  • To assess the incidence of major adverse cardiac events (MACE) and binary restenosis.
  • To identify independent predictors of outcomes following PCI.

Main Methods:

  • Analysis of consecutive patients from the ISAR-CTO Registry and institutional database.
  • Inclusion of successful CTO recanalization and non-CTO-PCI procedures.
  • Propensity score matching (1:3 ratio) for patient comparison.
  • Primary endpoint: MACE at 12-month follow-up.
  • Secondary endpoint: In-segment binary restenosis at surveillance angiography.

Main Results:

  • No significant difference in 12-month MACE between CTO-PCI and non-CTO-PCI groups (HRadj=1.26).
  • CTO-PCI was independently associated with higher target lesion revascularization (TLR) (HRadj=1.66).
  • CTO-PCI showed a significantly lower risk of myocardial infarction (MI) (HRadj=0.231).
  • CTO-PCI correlated with a higher occurrence of binary restenosis (ORadj=1.86).

Conclusions:

  • CTO-PCI is independently associated with higher TLR rates and lower MI incidence at 12 months.
  • Non-CTO-PCI demonstrated superior angiographic outcomes based on surveillance angiography.
  • Further research is needed to optimize CTO-PCI strategies and outcomes.
Abstract

Keywords:
coronary chronic total occlusiondrug-eluting stentin-stent restenosispercutaneous coronary interventionsurveillance angiography

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