Impact of CTO-related myocardial infarction and procedural success on long-term outcomes after CTO PCI
HunJoo Lee1,2, YouMi Hwang1,2, Sung Jung Kim1
1Department of Cardiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea.
Insights
Chronic total occlusion percutaneous coronary intervention (CTO PCI) outcomes are influenced by CTO-related myocardial infarction (MI) and procedural success. Chronic kidney disease is a key predictor of adverse events after CTO PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The long-term prognostic impact of CTO-related myocardial infarction (MI) and procedural success after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is not fully understood.
- This study aimed to identify clinical and procedural predictors of adverse outcomes following CTO PCI.
Purpose of the Study:
- To evaluate the prognostic significance of CTO-related MI and procedural success on long-term outcomes after CTO PCI.
- To identify independent predictors of major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing CTO PCI.
Main Methods:
- Retrospective analysis of 347 patients who underwent CTO PCI between 2004 and 2018.
- Primary composite endpoint included ventricular tachyarrhythmia and follow-up MACCE (cardiopulmonary resuscitation, coronary artery bypass grafting, device implantation, acute coronary syndrome, cardiovascular death, or all-cause death).
- Kaplan-Meier analysis and Cox proportional hazards models were used to assess long-term risk.
Main Results:
- CTO-related MI was linked to a higher incidence of adverse outcomes.
- Procedural success correlated with improved event-free survival.
- In multivariable analysis, chronic kidney disease was the strongest independent predictor of the composite endpoint; higher left ventricular ejection fraction was protective.
Conclusions:
- CTO-related MI and unsuccessful CTO PCI are associated with worse long-term outcomes.
- Chronic kidney disease is a dominant independent predictor of adverse events, while preserved ventricular function is protective.
- Integrating clinical risk factors and procedural success is crucial for refining long-term management strategies post-CTO PCI.
Background:
The prognostic impact of CTO-related myocardial infarction (MI) and procedural success on long-term outcomes after chronic total occlusion (CTO) PCI remains uncertain. This study evaluated clinical and procedural predictors of adverse outcomes following CTO PCI.
Methods:
In this retrospective registry, 347 patients who underwent CTO PCI were analyzed after screening 543 individuals between 2004 and 2018-CTO-related MI and procedural success stratified patients. The primary composite endpoint included ventricular tachyarrhythmia and follow-up MACCE, defined as cardiopulmonary resuscitation, coronary artery bypass grafting, pacemaker or implantable cardioverter-defibrillator implantation, acute coronary syndrome, cardiovascular death, or all-cause death. Kaplan-Meier analysis and bootstrap-derived Cox models were used to assess long-term risk.
Results:
CTO-related MI was associated with a higher cumulative incidence of adverse outcomes, whereas procedural success was associated with improved event-free survival. In multivariable analysis, chronic kidney disease was the strongest independent predictor of the composite endpoint, while higher left ventricular ejection fraction was protective. Procedural success showed a trend toward lower risk, whereas CTO-related MI showed a trend toward higher risk in multivariable analysis.
Conclusions:
CTO-related MI and unsuccessful CTO PCI were associated with worse long-term outcomes. Chronic kidney disease was the dominant independent predictor, whereas preserved ventricular function was protective. These findings highlight the prognostic value of integrating clinical risk factors and procedural success to refine long-term management strategies after CTO PCI.
