Contemporary Clinical Practices in Korean Patients With Coronary Chronic Total Occlusion: Results From the K-CTO...

Coronary chronic total occlusion (CTO) is among the most challenging forms of coronary artery disease, yet large-scale real-world data remain limited. We aimed to describe contemporary CTO clinical practice and outcomes in South Korea.

The Korean Chronic Total Occlusion (K-CTO) registry 2.0 is a nationwide retrospective registry including patients diagnosed with CTO between 2003 and 2023 at 34 centers performing percutaneous coronary intervention (PCI), irrespective of CTO-PCI performance. Demographic, clinical, procedural, and outcome data were analyzed.

Of 9,316 patients with CTO, 7,267 (78.0%) underwent PCI. The overall procedural success rate was 82.2%. The antegrade approach was used in 87.5% of cases and the retrograde in 12.5%, with procedural success rates of 82.8% and 78.5%, respectively. Intravascular ultrasonography was employed in 37.3%, and drug-eluting stents were implanted in 76.8%. Predictors of PCI attempts included younger age, prior PCI, and stable angina, whereas diabetes mellitus (DM), chronic kidney disease (CKD), prior CABG, and higher Japanese CTO scores were associated with less frequent PCI attempts. In-hospital all-cause mortality was 2.3% and periprocedural myocardial infarction (MI) 4.4%. At a median follow-up of 651 days, 5-year cumulative incidences of major adverse cardiac and cerebrovascular events, major adverse cardiac events, net adverse clinical events, and all-cause mortality were 30.4%, 28.5%, 30.9%, and 14.5%, respectively.

In routine practice across South Korea, most patients with CTO underwent PCI with high success. These descriptive findings should not be interpreted as evidence of improved long-term outcomes. Broader adoption of advanced techniques and device accessibility may further improve results in complex CTO lesions.