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The Gulf Chronic Total Occlusion Registry: Short- and Long-Term Outcomes Across Management Strategies

Amin Daoulah1, Mokhtar Abdirahman Kahin2, Prashanth Panduranga3

  • 1Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.

JACC. Advances
|August 6, 2026
PubMed

Insights

For chronic total occlusion (CTO), neither percutaneous coronary intervention (PCI) nor coronary artery bypass grafting (CABG) showed superiority over medical therapy for hard cardiovascular outcomes. However, revascularization, especially CABG, significantly reduced angina burden.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Chronic total occlusion (CTO) significantly increases ischemic burden, heart failure, and mortality.
  • Comparative outcomes of medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) for CTO are not well-established.

Purpose of the Study:

  • To compare the clinical outcomes of medical therapy, PCI, and CABG in patients diagnosed with CTO.
  • To evaluate hard cardiovascular endpoints and angina burden across different treatment strategies.

Main Methods:

  • Analysis of 741 patients with angiographically confirmed CTO across 7 centers in 4 Gulf countries (2021-2023).
  • Patients were managed with medical therapy (n=151), PCI (n=441), or CABG (n=149).
  • Primary in-hospital endpoint: major adverse cardiovascular events (MACE). Long-term endpoint: major adverse cardiac and cerebrovascular events (MACCE)-free survival.

Main Results:

  • PCI and CABG did not significantly differ from medical therapy for in-hospital MACE after adjustment.
  • At a median 22-month follow-up, no significant difference in 36-month MACCE-free survival was observed between the three strategies.
  • CABG was associated with a significant reduction in angina burden (Canadian Cardiovascular Society class I), while PCI showed no significant difference compared to medical therapy.

Conclusions:

  • No revascularization strategy (PCI or CABG) demonstrated superiority over medical therapy for hard cardiovascular outcomes in CTO patients.
  • Revascularization, particularly CABG, was associated with a significant improvement in angina symptoms at follow-up.
  • Treatment decisions for CTO should consider both hard outcomes and symptom relief.
Abstract

Keywords:
CABGPCIRMSTchronic total occlusionmedical therapypropensity weighting

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