Clinical and Angiographic Outcomes Following Percutaneous Treatment of Chronic Totally Occluded Versus Non–Totally Occluded Coronary Vessels

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Background Clinical and angiographic outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remain incompletely investigated, whereas direct comparisons with non-CTO-PCI are missing. The present study aimed to compare the mid-term clinical and angiographic outcomes following successful CTO-PCI and non-CTO-PCI. Methods Consecutive patients from the Intracoronary Stenting and Angiographic Results – Chronic Total Occlusion (ISAR-CTO) Registry undergoing successful CTO recanalization as well as all successful non-CTO-PCI procedures from our institutional database were included. Propensity score matching (PSM) with a 1:3 matching ratio was performed. The primary endpoint was the incidence of major adverse cardiac events (MACE) at 12-month follow-up. The secondary angiographic endpoint was in-segment binary restenosis at surveillance angiography. Results Overall, 453 CTO-PCI patients (472 lesions) and 14733 non-CTO-PCI patients (23458 lesions) were analyzed. After PSM, a total of 1812 patients were included in the present study [CTO-PCI, n=453 patients (472 lesions); non-CTO-PCI, n=1359 patients (1424 lesions)]. There were no significant differences in terms of MACE (adjusted hazard ratio [HR adj ]=1.26, 95% confidence interval [CI] 0.95-1.66) between CTO-PCI and non-CTO-PCI at 12-month follow-up. CTO-PCI independently correlated with a higher risk of target lesion revascularization (TLR) (HR adj =1.66, 95%CI [1.21-2.27]) and a significantly lower risk of MI (HR adj =0.231; 95%CI [0.06-0.98]). CTO-PCI independently correlated with the occurrence of binary restenosis (adjusted odds ratio [OR adj ]=1.86, 95%CI [1.38-2.51]) at surveillance angiography. Conclusions CTO-PCI was independently associated with significantly higher rates of TLR as well as a significantly lower incidence of MI at 12-months follow-up. QCA analysis of surveillance angiography showed superior angiographic outcomes following non-CTO-PCI.

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