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Long-Term Follow-up After Percutaneous Coronary Interventions for Chronic Total Occlusions
Rémi Arnold1, Richard Gervasoni1, Bertrand Ledermann2
1Cardiology Department, University Hospital of Montpellier, Montpellier, France.
Clinical Cardiology
|July 16, 2026
Summary
Percutaneous coronary interventions for chronic total occlusions (CTO-PCI) can improve outcomes, but procedural failure increases major adverse cardiac events (MACE). Successful CTO-PCI enhances left ventricular ejection fraction and NYHA class, supporting its use in select patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) are complex procedures.
- Long-term clinical benefits of CTO-PCI remain debated.
- High success rates are crucial for positive patient outcomes.
Purpose of the Study:
- To evaluate the clinical outcomes of CTO-PCI.
- To compare MACE rates between successful and failed CTO-PCI procedures.
- To identify predictors of procedural failure and assess long-term benefits.
Main Methods:
- An observational monocentric study of 448 patients undergoing PCI for CTO between 2015-2022.
- Patients were grouped based on PCI success (401) or failure (47).
- Primary endpoint: Major Adverse Cardiac Events (MACE) up to 8 years, including cardiac death, MI, and TVR.
Main Results:
- CTO-PCI success rate was 89.5%.
- Failed CTO-PCI was associated with a significantly higher MACE incidence (25.5% vs. 14.7%) and lower overall survival.
- Successful CTO-PCI improved LVEF and NYHA class; J-CTO score predicted procedural failure.
Conclusions:
- Failed CTO-PCI significantly increases MACE risk.
- Successful CTO-PCI improves cardiac function and functional status.
- CTO-PCI should be pursued in carefully selected patients to optimize long-term outcomes.
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