Long-Term Follow-up After Percutaneous Coronary Interventions for Chronic Total Occlusions

Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) remain challenging procedures with controversial long-term clinical benefits.

We conducted an observational monocentric study including consecutive patients who underwent PCI for CTO by experienced operators in a French University Hospital between January 2015 and December 2022. All patients had symptoms and/or proven myocardial ischemia. Patients were divided into two groups based on PCI success or failure. The primary endpoint was the occurrence of MACE, defined as the composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularization up to 8 years of follow-up.

Of the 448 patients who underwent a CTO-PCI, 401 (89.5%) had a successful procedure, while 47 (10.5%) experienced a failed intervention. During a mean follow-up of 3.7 years, MACE occurred in 71 patients (15.8%), including 12 patients (25.5%) in the failed group and 59 patients (14.7%) in the successful group (HR 2.68 [1.42; 5.06]; p < 0.01). While both groups had similar baseline clinical risk profiles, the failed CTO-PCI group had a lower overall survival rate (74.5% vs. 88.8%; HR 2.23 [1.17; 4.27]; p = 0.02). The successful CTO-PCI group showed significant improvements in left ventricular ejection fraction (LVEF) (p < 0.01) and NYHA class (p < 0.01). The J-CTO score was the only predictor of procedural failure (1.96 [1.44; 2.67]; p < 0.01).

Failed CTO-PCI was associated with increased incidence of MACE. LVEF and NYHA class was improved in successful CTO-PCI, supporting the pursuit of this procedure in selected cases.