Long-term follow-up after percutaneous coronary interventions for chronic total occlusions

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Abstract Background Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) remain challenging procedures with controversial long-term clinical benefits. Purpose This study aimed to evaluate the impact of successful versus failed CTO-PCI on long-term patients’ outcomes. Methods We conducted an observational monocentric study including all 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 proved myocardial ischemia. The patients were divided into two groups based on the success or failure of the PCI procedure. 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 follow-up. Results 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 patients in both groups had a similar clinical risk profile at baseline, including SYNTAX score (17.58 ± 6.63 vs.18.46 ± 6.9; p=0.7) and medical therapy, the successful CTO-PCI group, as compared with the failed CTO-PCI group, had higher overall survival rate (88.8% vs. 74.5%; HR 2.23 [1.17 ; 4.27] ; p=0.02) and significant improvements in LVEF (p<0.01), NYHA class (p<0.01) and myocardial ischemia in SPECT imaging (p=<0.01). Moreover, the risk of rehospitalizations for cardiac causes was twice as high in the failed CTO-PCI group (HR 2,03 [1,07 ; 3,86] ; p=0,03). The J-CTO score was the only predictor of procedural failure (1.96 [1.44 ; 2.67] ; p<0.01). Conclusions Successful CTO-PCI, achieved in nearly 90% of patients in experienced hands, was associated with significant long-term benefits, including reduced rates of MACE, all-cause death and rehospitalizations, as well as improvements in LVEF, NYHA class and myocardial ischemia. These findings support the pursuit of this procedure in selected cases.Time to event curves

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