Chronic Total Occlusion PCI in Cancer Patients: National Trends and Periprocedural Risk Stratification

Area of Science:

• Cardiology
• Oncology
• Health Services Research

Background:

• Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with active malignancy are not well understood.
• This study investigates trends in cancer prevalence and in-hospital outcomes for patients undergoing CTO PCI.

Purpose of the Study:

• To evaluate the association between active malignancy and in-hospital mortality after CTO PCI.
• To examine trends in CTO PCI utilization among cancer patients.
• To identify high-risk subgroups within the cancer patient population undergoing CTO PCI.

Main Methods:

• Analysis of the National Inpatient Sample (2016-2022) to identify CTO PCI admissions.
• Utilized ICD-10-CM/PCS codes for patient identification.
• Employed survey-weighted multivariable logistic regression and inverse probability of treatment weighting (IPTW) for outcome comparison.
• Examined myelosuppression as a specific high-risk subgroup.

Main Results:

• Active cancer was present in 1.9% of 214,365 CTO PCI admissions.
• The proportion of CTO PCI recipients with active cancer increased from 2016-2022.
• Active cancer was not independently associated with increased in-hospital mortality (aOR 0.91, p=0.62) or after IPTW (aOR 1.14, p=0.54).
• Myelosuppression was associated with over twofold higher mortality (aOR 2.59, p=0.037) in an exploratory analysis.

Conclusions:

• Active malignancy was not an independent predictor of in-hospital mortality in selected patients undergoing CTO PCI.
• Findings suggest that while selected cancer patients may tolerate CTO PCI, procedural safety cannot be broadly established due to cohort selection.
• Myelosuppression and transfusion risks are important periprocedural considerations requiring further prospective study.