Coronary CTO PCI is Associated With Higher In-Hospital Mortality and Complications Despite Adjusting for Baseline and...

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) has shown a higher procedural risk. The goal of this study was to compare complications and mortality of patients undergoing CTO-PCI with patients without CTO (non-CTO-PCI) by using propensity score matching. The national Inpatient Sample database (NIS), years 2016-2020, was studied using International Classification of Diseases, Tenth Revision Codes. Among 501,680 PCI hospitalizations, 250,840 had CTO-PCI and none-CTO-PCI. After matching, CTO-PCI had higher mortality (3.12% vs 2.62%, OR: 1.20, CI: 1.1 to 1.29, p <0.001) and higher odds of procedure-related myocardial infarction (0.65% vs 0.28%, (OR: 2.39, CI: 1.95-2.92, p <0.001), perforation (0.62% vs 0.19%, OR: 3.33, CI: 2.63 to 4.22, p <0.001), tamponade (0.40% vs 0.18%, OR: 2.18, CI: 1.7 to 2.8, p <0.001), procedural bleeding (1.13% vs 0.63%, OR: 1.8, CI: 1.57 to 2.07, p <0.001), post procedural cerebral infarction (0.03 vs 0.01, OR: 2.43, CI: 0.99 to 5.94, p = 0.05), acute post procedural respiratory failure (0.45% vs. 0.23%, OR: 1.96, CI: 1.56-2.47, p <0.001) and contrast induced nephropathy (0.07% vs 0.04%, OR: 1.95, CI: 1.10 to 3.44, p = 0.02). Overall risk for all complications was more than double (2.56% vs 1.21%, OR: 2.14; 1.93-2.37, p <0.001). When perforation, tamponade, or bleeding occurred, mortality was significantly higher in CTO-PCI compared to non-CTO-PCI (perforations: 2.43% vs. 0.69 %, p <0.001, tamponade: 2.88% vs 1.68%, p = 0.03 and bleeding 2.30% vs 1.14%, p = 0.02). In conclusion, propensity-matched national cohort confirmed that CTO-PCI was associated with higher in-hospital complications and mortality compared to non-CTO-PCI, mostly driven by perforation, bleeding, and tamponade. These findings support the previous report that CTO-PCI is associated with worse in-hospital outcomes.